Intrauterine, neonatal and pediatric transfusion therapy

Abstract

Transfusion practices for fetuses, neonates and children differ substantially from adults. These populations may be susceptible to adverse events due to their immature immune systems, decreased reserves to respond to stress and sensitivity to metabolic disturbances. Indications for intrauterine transfusions include hemolytic disease of the fetus and newborn, neonatal alloimmune thrombocytopenia and occasionally other immune or hematologic disorders. Neonates and children may require transfusions for diverse reasons including trauma, surgery, and severe medical conditions. Leukoreduction, donor selection criteria, and improved infectious disease screening have all contributed to a very safe blood supply. More recently, pathogen reduction has been implemented in many countries as a proactive protective approach for plasma and platelets, and has shown a good safety profile. Nevertheless, transfusions still carry infectious and non-infectious risks, and should therefore be administered carefully and judiciously. Excessive transfusions also consume blood products which may aid other patients. Fetuses, neonates and children are usually under-represented in trials because they constitute vulnerable populations. Thus, the transfusion literature is more limited than for older patients. Current neonatal and pediatric transfusion practices are guided by the age and clinical status of the patient but remain highly variable across institutions due to lack of evidence-based studies for many blood components. Recent clinical trials have contributed toward understanding of neonatal and pediatric transfusion triggers and clinical outcomes, but ongoing and future studies are needed for further clarification of these parameters as well as identification of viable alternatives to blood products.