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Iowa Neonatology Handbook: Hematology
UI NICU Guidelines for Administering 15mL/kg Erythrocyte
Transfusions to Neonates**
John A. Widness, MD
Peer Review Status: Internally Peer Reviewed
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"WELL" <------------------SEVERITY OF
ILLNESS------------------> "SICK"
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CATEGORY I
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CATEGYOR II (mild resp dis)
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CATEGORY III (mod respir dis)
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CATEGORY IV (severe resp dis)
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Subgroup A
(asymptomatic)
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Subgroup B (symptomatic)
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Subgroup C (pre-surgical)
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A. REQUISITE HEMATOCRIT:
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<20% (& Retics <100K/uL or <
2%)
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< 25%
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< 30%
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< 30%
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< 35%
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<40%
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B. RESPIRATORY DISEASE:
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<--------None to mimimal---->
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Mild
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Moderate
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Severe
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Conventional ventilation
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None
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None
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None
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MAP < 6 cm. water
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MAP 6-10 cm. water
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Yes
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High frequency ventilation
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None
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None
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None
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MAP < 8 cm. water
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MAP 9-12 cm. water
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Yes
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CPAP
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None
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None
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None
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MAP < 6 cm. water
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MAP 6-10 cm. water
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Does not apply
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FI02
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< 0.25
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< 0.25
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< 0.25
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>0.25 but <0.35
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>0.35
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>0.35
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Nasal Cannula with 100% o2
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<1/16 L/min.
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<1/16 L/min.
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<1/16 L/min.
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1/8 - 1/4 L/min.
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>1/4 L/min.
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Does not apply
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C. CLINICAL SIGNS:
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Absent
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Any 1 of 4 signs listed below*
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Major surgical procedure
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Often present
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Often present
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Sepsis, NEC, blood loss, etc.
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*
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1) sustained tachycardia averaging > 180/min. for
>24 hours based on the nursing record;
2) sustained tachypnea > 80/min. for >24 hours
based on the nursing record;
3) >10 apnea or bradycardia/8 hours, or > 2 apneic
or bradycardic episodes reuiring bag & mask ventilation
in 24th; or
4) weight gain < 10 g/day x 4 days while receiving
> 100 kcal/kg;
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Rule of Thumb: For each 1 mL or PRBC's transfused
(hct of almost 85%) kg, anticipate a 1 % increase in the
hematocrit. Hence for the recommneded Tx volume of 15 mL
PRBC/kg, a pre-transfuion hct of 32% should rise to
approximately 47% when checked several hours after
transfusion.
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References:
Oski FA, Naiman JL, Stockman III JA., & Pearson HA (1982).
Polycythemia and Hyperviscosity in the Neonatal Period. In: M.
Markowitz, ed. Hematologic Problems in the Newborn: Volume IV. Major
Problems in Clinical Pediatrics (3rd ed.). Philadelphia: PA:
Saunders, 1982:56-83.
Stockman JA III. Anemia of prematurity: Current concepts in the
issue of when to transfuse. Pediatric Clinics of North America
1986;33:111-128.
Section Top | Title Page
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