Potential harms of blood transfusion in preterm infants

Hello friends .In this webinar we will learn about the potential harms resulting from the unnecessary and excessive use of blood products.
Blood transfusion is an important component of treatment in the SNCU and Preterm infants are the ones most frequently transfused . Blood transfusions we all know have potential harms, especially so in the Preterm infants. Very importantly these blood transfusions can be avoided or decreased by adopting Standard transfusion guidelines.
The harms associated with blood transfusions include : 1) Mismatched transfusions that can result from human errors. 2) Transfusion transmitted infections like HIV, HBV and HCV. A small but definite risk of acquiring these exists despite the screening that is done . And there are others , as worrisome but for which no screening is done routinely like CMV. 3) Risk of acquiring infection due to the procedure per se 4) Hyperkalaemia and 5) Volume overload which tends to happen due to not accounting for the additional volume transfused
Severe side effects that are peculiar to the preterm infant include Increased mortality, Oxygen free radical injury as the preterm has compromised anti oxidant defense and is therefore more vulnerable, Intraventricular Haemorrhage, Neonatal Necrotising Enterocolitis and Chronic Lung disease
Why is it important to reduce Blood transfusions? It is important because reduction of transfusion rates has been shown to reduce the incidence of Retinopathy of Prematurity, Neonatal Necrotising Enterocolitis, Intra ventricular haemorrhage, chronic Lung disease and improve outcomes in the preterm infant. It is therefore very very important to balance the benefits of blood transfusion against the possible harms.
  • Introduction...
  • 1. Blood and blood...
  • 2. Potential harms...
  • 3. Severe side eff...
  • 4. Why reduce unne...
 

Introduction

DR. GEETA GATHWALA
MD, DM (Neonatology)

Professor and Head
Department of Pediatrics
PGI, Rohtak

1. Blood and blood component transfusions in SNCU

► Blood transfusion is an important component of SNCU care


► Preterm infants in the SNCU receive frequent transfusions
    due to diverse reasons


► Blood transfusions have potential harms especially, in
    preterm infants


► Often, these blood transfusions can be avoided by adopting
    standard guidelines

2. Potential harms of blood and blood component transfusion

► Mismatched transfusion

► Transfusion transmitted infections e.g. HIV, HBV, HCV, CMV

► Procedure related infection risk

► Hyperkalemia (increased potassium)

► Volume overload

► Transfusion related acute lung injury

3. Severe side effects that are unique to preterm neonates

► Increased mortality


► Oxygen free radical injury


► Intraventricular haemorrhage (IVH)


► Neonatal necrotizing enterocolitis (NEC)


► Chronic lung disease (CLD)

4. Why reduce unnecessary transfusions?

► Reduction of transfusion rates has been shown to lower
    the incidence of


      ♦ Retinopathy of prematurity (ROP)
      ♦ Intraventricular haemorrhage (IVH)
      ♦ Necrotizing enterocolitis (NEC)
      ♦ Chronic lung disease (CLD)