Parent's Guide to Blood Transfusions

Infants in the Neonatal Intensive Care Unit (NICU) at St. John's Mercy Medical Center may require a transfusion of blood or blood products during their stay.

Why are blood transfusions necessary? Blood can be used to help infants with an acute loss of blood, anemia, lung disease, gastrointestinal diseases, blood clotting abnormalities, infections and several other health problems.

If your baby requires the replacement of blood or would benefit from receiving a particular blood product, you will be asked to sign a consent form regarding blood transfusions. We hope this guide answers some of your questions about blood transfusions. Please ask the NICU staff if you have any other questions or concerns.

Types of Blood Products & Uses

Red blood cells are obtained by removing plasma, platelets and white cells from blood. They are obtained from a single donor. Red blood cells transport oxygen throughout the body. They are the most frequently used blood product in the NICU.

Red blood cells are used to replace blood lost if a fetus or an infant:

• Loses blood during the pregnancy, labor or delivery
• Loses blood due to bleeding into the lungs, brain or gastrointestinal tract
• Requires a surgical procedure where blood is lost
• Temporarily stops producing red blood cells (this occurs in all newborns for 6 to 12 weeks though most will not need a transfusion)

Though the amount of blood used in laboratory tests is quite small, a sick baby may require numerous tests, all of which remove blood. This can cause anemia of prematurity (a low red blood cell count). Symptoms of anemia in preterm infants include rapid heart rates, increased episodes of apnea, decreased activity, or tiring during feedings. If the red blood cell count (measured as the hematocrit) falls too low, we give the infants a red blood cell transfusion.

Fresh frozen plasma (FFP) contains the proteins, antibodies, clotting factors and water obtained from a unit of blood after the red and white blood cells have been removed. A unit of FFP is obtained from a single donor. It is frequently used to provide factors to help blood clot in infants whose own clotting factors are low or who are having bleeding problems.

Platelets are substances made in the bone marrow that help blood clot. Platelets are obtained from a single donor and are obtained from a unit of blood after the red blood cells, white blood cells and much of the plasma have been removed. Infants are given platelets if their platelet counts are very low because the bone marrow is not producing platelets, or if the infant's own platelets are being rapidly destroyed.

White blood cells are the cells that fight infections. They are obtained from a unit of blood after removing red blood cells, platelets and most of the plasma. These cells are given to an infant who has an overwhelming infection and whose bone marrow has used up its supply of white blood cells.

Albumin is a large protein that acts to keep the water content of the blood at an appropriate level. If levels are low, fluid shifts from the blood in the tissue causing swelling or edema. Albumin is obtained by pooling blood from many donors. However, it is among the safest blood products because it is processed to destroy any infectious agents.

Immunoglobulins (IgG) are small proteins that are more commonly called antibodies. These substances are important in fighting infections. An infant with an overwhelming infection may receive IgG. Some preparations of IgG are directed against a specific infection such as Respiratory Syncytial Virus (RSV) and are given to prevent infections. Like Albumin, immunoglobulins are obtained by pooling blood from many donors, processed to destroy infectious agents, and therefore, among the safest blood products.

Where Does the Blood Come From?

• Only healthy volunteers are allowed to donate blood.
• Donors are required to answer an extensive questionnaire to screen for potential exposures to infections.
• Every unit of blood collected is tested for infectious diseases, such as HIV (AIDS), hepatitis B, hepatitis C, Human 1 Lymphocyte Leukemia and syphilis. Though the risks of transmitting these illnesses are extremely low, the screening and testing cannot completely eliminate the risk.
• Before a unit of blood is used for your baby the blood type and Rh factors are checked for compatibility. A filter is used to remove most remaining white blood cells to minimize reactions such as fever, chills and rash.

Can Family Members Donate Blood for Children?
Yes, blood may be donated for a specific patient. This is referred to as directed donor blood. Precautions are taken to determine the exact blood group so that it matches the patient's blood group. Parents should contact Blood Donor Services at 314-569-6328 to provide a list of potential donors. Donors should call Blood Donor Services to schedule a time to donate the blood. It usually takes two to three days following a donation for the blood to be ready for use.

Studies have not shown that using directed donor blood is safer. If you wish your child to receive blood from a relative or friend, they need to understand that it is much more important for the blood to be safe than it is for it to be their blood that is transfused.

Limiting Exposure to Multiple Donors
Blood used in the NICU for red blood cell transfusions is collected from a small group of donors who are regularly scheduled to donate blood just for use in the NICU. These are donors who have given blood for many years. Infants are assigned to a unit of blood when they receive their first transfusion. Since most of the red blood cell transfusions are small (10 to 20 ml or 2 to 4 teaspoons), a number of transfusions can be given from the same unit of blood. This is done to limit the exposure to multiple donors and decrease the risk of transmitting an infection.

What are the Risks from a Blood Transfusion?
As with any medical procedure, there are risks. The risks from a blood transfusion may include hemolytic reactions (the red blood cells fall apart causing fever, low blood pressure and kidney failure) allergic reactions, the transmission of infection, and risks associated with the placement of the intravenous needle. Our NICU staff, working closely with St. John's Mercy Blood Donor Services, strives to ensure the risks to your baby will be as low as possible.

Questions?
Please ask the NICU staff if you have any questions or concerns.
Blood Donor Services: Call 314-569-6328 for an appointment.

© 2009 St. John's Mercy Health Care
615 S. New Ballas Rd., St. Louis, Missouri, 63141