Review of neonatal red cell transfusion practices

In the United States in 1991, 290,000 or 7.1% of the 4,110,907 live births were premature infants; 53,299 or 1.3% were infants with birth weights of less than 1500 grams. Many if not all of these very low birth weight infants will require red blood cell transfusions for one of several reasons. These include exchange transfusions for hyperbilirubinemia, but most often transfusions are simple small volume transfusion also called 'topper' transfusions. Most of these small volume transfusions are given for iatrogenic blood loss or 'bleeding into the laboratory.' Studies have demonstrated that the sicker the infant, the more blood sampling is needed and the greater the exposure to red blood cell (RBC), platelet and plasma products. Simple RBC transfusions may also be given for specific clinical indications or to maintain a predetermined hemoglobin concentration. This manuscript will review the criteria for RBC transfusion in neonates and selection of product as regards anticoagulant and specialized processing. In addition, the results of recombinant erythropoietin (r-EPO) clinical trials in neonates will be discussed.