| OVERVIEW - In term and preterm infants, transfusion should be considered if increased oxygen delivery to tissues is needed based upon the clinical status of the patient.
- Volume of transfusion should be 20 mL/kg PRBC unless the hematocrit is >29%. 20 mL/kg volume may be used if significant phlebotomy losses are anticipated in small infants with hematocrit >29%.
- For infants receiving erythropoietin, additional considerations should be made regarding the rate of decrease in hemoglobin or hematocrit, the infant's reticulocyte count, the postnatal day of age, the need for supplemental oxygen, and the overall stability of the infant*.
- Central measurements of hemoglobin or hematocrit are preferred when using hemoglobin or hematocrit target levels as indications for transfusion; alternatively, heelstick measurements may be obtained after warming the heel adequately.
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| CHRONIC BLOOD LOSS Indications for transfusion for infants with chronic blood loss is based on target hematocrit/hemoglobin levels that are dependent on the infant's need for respiratory support and age*. The following are guidelines used at the University of New Mexico that reflect a restrictive blood transfusion approach for infants. - For infants requiring moderate or significant mechanical ventilation, defined as mean air pressure (MAP) >8 cm H2O and FiO2 >0.4 on a conventional ventilator, or MAP >14 and FiO2 >0.4 on high frequency ventilator, and with a hematocrit ≤30% (hemoglobin ≤10 g/dL).
- For infants requiring minimal mechanical ventilation, defined as MAP ≤8 cm H2O and/or FiO2 ≤0.4 on a conventional ventilator, or MAP <14 and/or FiO2 <0.4 on high frequency, and with a hematocrit ≤25% (hemoglobin ≤8 g/dL).
- For infants on supplemental oxygen who are not requiring mechanical ventilation, transfusions can be considered if the hematocrit is ≤20% (hemoglobin ≤7 g/dL) and one or more of the following conditions is present:
- ≥24 hours of tachycardia (heart rate >180 beats per minute) or tachypnea (RR >60 breaths per minute)
- Doubling of the oxygen requirement from the previous 48 hours
- Serum lactate ≥2.5 mEq/L or an acute metabolic acidosis (pH <7.2)
- Weight gain <10 g/kg/day over the previous four days while receiving ≥120 kcal/kg/day
- If the infant will undergo major surgery within 72 hours
- For infants without any symptoms, transfusions can be considered if the hematocrit is ≤21% (hemoglobin ≤7 g/dL) associated with an absolute reticulocyte count <100,000 cells/microL (<2%).
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