Related Experiment Video
Updated: Aug 23, 2025
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Every treasured drop! Blood transfusion requirements in very preterm neonates after implementation of blood
Vishnu Anand1, Femitha Pournami1, Ajai Kumar Prithvi1
1Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, India.
Insights
Blood conservation strategies significantly reduced red blood cell transfusions in preterm infants. Micro-sampling with point-of-care testing was key to minimizing blood loss and transfusion needs.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Critical Care Pediatrics
Background:
- Anemia of prematurity is a common complication in preterm infants.
- Current therapy relies on red blood cell transfusions (RBCT), which carry risks.
- Reducing RBCT is crucial for minimizing morbidities in vulnerable neonates.
Purpose of the Study:
- To compare the need for RBCT before and after implementing blood conservation strategies (BCS) in preterm infants.
- To evaluate the impact of BCS on blood loss and transfusion requirements.
- To identify key components of BCS that contribute to reduced RBCT.
Main Methods:
- Observational analytical study comparing two time epochs (before and after BCS).
- Included infants born at or before 30 weeks gestation.
- BCS included delayed cord clamping (DCC), strict sampling indications, micro-sampling with point-of-care testing (MS-POCT), and adherence to RBCT thresholds.
Main Results:
- The proportion of infants requiring at least one RBCT significantly decreased after BCS (51.1% vs. 26.7%).
- Cumulative blood volume losses were significantly lower post-BCS (35.3 ml vs. 21.9 ml).
- Reduced need for >1 RBCT, lower hemoglobin drops, and fewer arterial lines were observed.
Conclusions:
- Blood conservation strategies effectively reduce the need for RBCT in very preterm infants.
- Micro-sampling with point-of-care testing (MS-POCT) appears to be a pivotal factor in reducing blood loss.
- Neonatal units should consider procuring MS-POCT equipment to improve care for preterm infants.
Background:
Certain morbidities are inevitable in preterm infants; the challenge lies in minimizing them. Anemia of prematurity is multifactorial. Therapy largely depends on adult red blood cell transfusions (RBCT); which inherently, are not without problems. Most literature in this respect are retrospective or evaluate individual stratagems to reduce RBCT.
Methods:
This observational analytical study was planned to compare need for RBCT, before and after institution of blood conservation strategies (BCS). All those ≤30 weeks gestation at birth during two-time epochs were included (Before BCS: retrospective; After BCS: prospective). BCS constituted of delayed cord clamping (DCC), strict sampling indications, micro-sampling with point-of-care testing (MS-POCT) and adherence to RBCT thresholds.
Results:
Of 45 enrolled neonates in each group, proportion of those requiring even 1 RBCT was significantly reduced after BCS [51.1% vs. 26.7%, p = 0.02, OR 0.35, 95%CI (0.14, 0.84)]. Calculated cumulative blood volume losses (35.3 ml vs. 21.9 ml) and loss per kilogram birth weight (35.3 ml/kg vs. 20.12 ml/kg) were significantly lower after BCS (p = 0.0036). Need for >1 RBCT, mean lowest Hb, mean maximum-hemoglobin drop, need for arterial lines were reduced. Adherence to RBCT thresholds were acceptably good in both time epochs. However, the compliance to DCC was low in both groups, identifying one area of focus with scope for massive improvement.
Conclusions:
Need for RBCT transfusions largely attributable to reduced blood losses for lab analysis were reduced after BCS. Installation of in-house MS-POCT seemed to be the pivotal factor. Units that care for very preterm infants must make attempts to procure MS-POCT equipment.
Related Concept Videos
02:45Blood Transfusion and Agglutination
History
The history of blood transfusion dates back to the 17th century, when early attempts were made in animals. In 1818 James Blundell, a British doctor, performed the first successful human blood transfusion. Later in 1900, Karl...
01:15Blood Transfusion
Blood Transfusion Overview
A blood transfusion is a medical procedure used to replace blood lost due to injury, surgery, or to treat conditions such as anemia or cancer. During a transfusion, donor blood is...
01:19Rh Blood Group
01:22Bone Marrow Sampling and Transplants
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy...