Risks of neonatal blood transfusion

When the human body loses too much blood or does not have enough blood, doctors will provide blood to the body through blood transfusion. The blood type for blood transfusion must be the same, because if the blood types are different, it will cause the body to reject them. Some newborns may have anemia, which has a great impact on the body of the newborn and requires blood transfusion. So what are the hazards of blood transfusion for newborns?

What are the diagnostic criteria for anemia in newborns?

Neonatal examination

Anemia in newborns can be caused by blood loss, hemolysis, and low red blood cell (RBC) production. Blood loss can occur before birth (fetoplacental, fetofetal, and fetomaternal transfusions), during birth (umbilical cord rupture, placenta previa), and after birth (intracranial hemorrhage, visceral rupture). The most common cause of hemolysis is incompatibility of maternal and fetal blood types. It can also be caused by maternal autoimmune diseases, drugs, intrauterine infection, and neonatal RBC membrane or enzyme defects. Low RBC production is extremely rare in the neonatal period.

Clinical manifestations of anemia

Acute anemia is usually caused by blood loss and is often accompanied by pallor, shortness of breath, increased heart rate, and hypotension. The hematocrit (HCT) may be normal initially but may fall within 6 hours due to hemodilution. Chronic anemia may cause pallor, but there are no clinical symptoms of distress due to compensation. The liver and spleen may be enlarged, and some children may develop congestive heart failure.

Laboratory tests

(1) Find the cause of anemia immediately

① Check the placenta; ② observe the RBC morphology and reticulum RBC count on blood smear; ③ direct Coombs test; ④ calculate the ratio of fetal RBC to maternal RBC on maternal blood smear (acid elution method) to exclude fetal-maternal transfusion.

(2) Other optional examinations

① Specific IgM antibody test (rubella, CMV, toxoplasmosis, parvovirus B19); ② Hemostasis and coagulation test; ③ RBC enzyme test and Hb electrophoresis; ④ Imaging examination to find the site of bleeding.

Physiological anemia of premature infants

The umbilical cord blood Hb level of premature infants at birth is similar to that of full-term infants, but physiological anemia occurs early (4 to 6 weeks) and is severe (Hb 70 to 100 g/L). The younger the gestational age, the more severe the anemia and the longer it lasts. This is primarily due to low erythropoietin (EPO) levels in premature infants, but is also related to the short lifespan of RBCs and the frequent diagnostic blood draws required in premature infants.

2What are the harms of blood transfusion in newborns?

1. Prone to cause circulatory overload

The heart function of newborns is not yet fully developed, and improper calculation of blood transfusion volume or too fast a rate can easily cause heart failure.

Particularly sensitive to blood loss

When a newborn loses 10% of its blood volume (30-50 ml of blood), obvious symptoms may appear and a blood transfusion may be required. ㈢Cannot tolerate low blood temperature.

Newborns have poor temperature regulation function and their heart and lungs are not yet fully developed. Therefore, it is best to warm the blood to 32°C during blood transfusion. ㈣Cannot tolerate high blood potassium and low blood calcium.

The kidneys of newborns have poor functions in excreting potassium, retaining sodium, and maintaining acid-base balance. Transfusion of banked blood that has been stored for too long is prone to hyperkalemia, hypocalcemia, and acidosis.

㈤Hb needs to be maintained at a relatively high level. Newborns have high HbF content and low 2,3-DPG content. Red blood cells have a high affinity for oxygen, so Hb needs to be maintained at a relatively high level to meet physiological needs.

To avoid transmission of CMV through blood transfusion, it is best to transfuse blood components that have been depleted of leukocytes.

㈦The blood type antigen on the red blood cells is weak and the antibody titer in the serum is low, so a high titer standard serum is needed to determine the blood type. Babies under 3 months old do not need to be reversed.

The above is a detailed introduction to the characteristics of neonatal blood transfusion. Therefore, for many parents, in order to ensure the health of their children's blood transfusion, they must fully understand the characteristics of neonatal blood transfusion. Through the above understanding, and then through neonatal blood transfusion, they can ensure the health of their children. The above introduction, as a parent, must be understood.