A Survey of Canadian Neonatal Blood Transfusion Practices
Université de Montréal, Division of Hematology/Oncology, Hôpital Ste-Justine, Montréal, Quebec, Canada.Transfusion Science 04/1997; 18(1):71-80. DOI: 10.1016/S0955-3886(96)00079-3
In 1990, the Pediatric Hemotherapy Committee of the American Association of Blood Banks developed and distributed a questionnaire addressing neonatal blood transfusion practices. The same questionnaire was subsequently sent to Canadian university-affiliated hospitals (n = 92). This report describes the results of the Canadian survey. Seventy-two percent (n = 66) of institutions contacted responded. Of these 42% (n = 28) had sufficient experience with neonatal transfusions and provided sufficient data for analysis. Although the majority of stated practices did follow published guidelines, several areas of variability and/or suboptimal practices were identified. With respect to component selection and preparation, suboptimal practices included excessive pretransfusion testing, unnecessary routine washing of RBC concentrates for small-volume transfusions, routine volume reduction of platelet concentrates and the use of suboptimal granulocyte preparations. With respect to transfusion practices, a disturbingly high percentage of respondents indicated that frozen plasma would be given in situations generally considered inappropriate. There was a great deal of variability in the provision of blood components at low risk for CMV, in the use of gamma irradiation and in the platelet count used for prophylactic platelet transfusions. The data collected in this survey provide information concerning practices that require improvement, identify areas where further research is desirable and provide a basis for comparison with current and future neonatal blood transfusion practices.
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ABSTRACT: Modern transfusion support of pediatric patients requires attention to the necessity to provide specialized or modified blood components to these patients who are often immunocompromised and/or affected by very complex medical and surgical illnesses. In this review we will address three potential complications of transfusion that may require specialized components for their prevention in selected patients namely transfusion-associated graft-versus-host disease, transfusion-transmitted cytomegalovirus infection and HLA alloimmunization, with particular reference to the indications for prevention of these transfusion complications in neonatal and pediatric patients.Transfusion Science 09/1999; 21(1):73-95. DOI:10.1016/S0955-3886(99)00067-3
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ABSTRACT: The presence of WBCs in RBCs is thought to be associated with a number of significant adverse effects in recipients. In adults, WBC reduction has been shown to reduce the frequency of HLA alloimmunization, CMV and HTLV infections, and febrile nonhemolytic transfusion reactions. However, neonates are unique, given that they have an immature immune system and are frequently transfused with RBCs. Thus, the aims of this systematic review were to determine whether WBC reduction of RBCs transfused to neonates decreases the transmission of CMV, reduces the ability to develop HLA antibodies, or reduces the risk of immunomodulation. In addition, nosocomial infection, mortality, and duration of stay were identified and analyzed. All studies of WBC reduction were identified by a systematic review of the literature. Studies meeting the inclusion criteria were grouped based on study outcome. Where appropriate, studies were pooled to obtain an overall measure of effect. Nine eligible studies were identified from the systematic literature search, and six were deemed evaluable. Two studies evaluated WBC reduction and the development of CMV, with different results. The pooled OR was 0.19 (95% Cl, 0.01-3.41), suggesting a clinical but nonsignificant effect. Two studies evaluated WBC reduction and HLA antibody development. As with CMV, the two studies were not congruent in their results. The pooled OR was 0.17 (95% Cl, 0.01-2.43). As for immunomodulation, two small studies presented evidence of a statistically significant change in lymphocyte subsets. No studies were identified with a primary objective of evaluating the impact of WBC reduction on nosocomial infection, mortality, or duration of stay. Current evidence suggests that WBC reduction may be effective in neonates; however, further studies are needed. The lack of convincing data and the significant cost of WBC reduction mandate evaluations to determine the clinical and economic impact.Transfusion 03/2002; 42(2):159-65. DOI:10.1046/j.1537-2995.2002.00022.x · 3.23 Impact Factor
- Indian pediatrics 08/2002; 39(7):619-24. · 1.04 Impact Factor
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