Rebecca Cardigan, BSc, PhD; Sheila Maclennan , MBBS, FRCP, FrCPath

Disclosures

Transfusion Alter Transfusion Med. 2008;10(3):92-101. 

In This Article

Compoents for Intrauterine Transfusion and for Neonatal Transfusion

Intrauterine Transfusion and Exchange or Large-volume Transfusions to Neonates

Red cells are transfused in utero to treat severe fetal anemia. In order to keep the volume transfused to a minimum, they are prepared by removing some of the plasma from whole blood to achieve a high hematocrit of 0.70-0.90. Platelets may also need to be transfused in utero in cases of severe thrombocytopenia because of fetomaternal alloimmunization to platelet antigens (e.g. HPA-1a). A hyperconcentrated platelet for this purpose can be produced using apheresis technology from genotyped donors.

Exchange transfusions are performed on neonates to treat hyperbilrubinemia. As for red cells for IUT, those for exchange transfusion are prepared by removing some of the plasma from whole blood, but to achieve a lower hematocrit of 0.50-0.55. Red cells for IUT/exchange transfusion are limited to a 5-day shelf life and should be used within 24 hours of irradiation.

Because of concerns over the potential toxicity of adenine and mannitol in red cell additive solutions, red cells for IUT and exchange transfusion are prepared and stored in plasma. The same concerns apply to other clinical situations where large volumes of red cells are transfused to neonates, such as cardiac surgery or extracorporeal membrane oxygenation. However, some countries use red cells in additive for exchange and large volume transfusion without apparent problem. In the UK, there is a move toward the use of red cells in additive for large volume transfusion where possible to reduce the unnecessary exposure of neonates to plasma and therefore risk of TRALI and vCJD.

Top-up Red-cell Transfusions to Neonates

These are usually given to replace blood taken repeatedly for laboratory analysis in premature babies. They are prepared by splitting red cells in additive solution into multiple smaller packs which can be stored up to the normal shelf life of red cells in additive (35 days in the UK) and reserved for individual recipients. This reduces the exposure of the recipient to different donors considerably. These need not be irradiated unless there has been a previous IUT, or the blood donation is from a family member.

Platelets and FFP

These are generally given to extremely sick babies with multiple defects in hemostasis. They can be prepared bysplitting a full size unit into multiple aliquots or in the case of platelets by preparing them from a single donor by the PRP or buffy-coat method. They have the same shelf life as standard platelet and plasma components. In the UK, plasma for FFP and cryoprecipitate productionfor those under the age of 16 is imported from the USA as a precautionary measure to reduce the risk of vCJD transmission.


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