Neonatal Anemia in Preterm Infants: Are We Overtransfusing?

Area of Science:

• Neonatal Medicine
• Hematology
• Pediatric Transfusion Practices

Background:

• Preterm infants often require packed red blood cell transfusions (PRBCTs).
• Adherence to international transfusion guidelines is crucial for optimizing care.
• Variations in PRBCT practices may exist, particularly in resource-limited settings.

Purpose of the Study:

• To evaluate the appropriateness of PRBCT practices in preterm infants.
• To assess adherence to international transfusion guidelines (BCSH, CBS, ANBA).
• To identify areas for quality improvement in neonatal transfusion protocols.

Main Methods:

• Retrospective analysis of PRBCTs in preterm neonates (<32 weeks gestation) at a tertiary care center in India.
• Evaluation of hemoglobin levels against BCSH, CBS, and ANBA transfusion thresholds.
• Consideration of postnatal age and respiratory support status.

Main Results:

• 78 PRBCTs were administered to 43 preterm neonates.
• Most transfusions (70.5%) occurred at three or more weeks of age.
• Adherence to guidelines varied: ANBA (100%), BCSH (80.7%), CBS (74.3%).
• Liberal PRBCT use for late anemia in stable infants was observed, exceeding BCSH and CBS thresholds but aligning with ANBA.

Conclusions:

• A liberal approach to PRBCT for late anemia in stable preterm infants was noted.
• Practices were generally consistent with ANBA guidelines, but showed variation with BCSH and CBS.
• Quality improvement interventions are recommended to refine PRBCT policies and prevent potential over-transfusion.