Blood products in the NICU

( Version 1.0 08/13/01 - 09/01/02)

Blood product transfusion is a frequently necessary aspect of neonatal care. Blood products include: reconstituted whole blood, packed RBCs, fresh frozen plasma (FFP), platelets, cryopreciptitate, and IVIG and albumin. As of 9/15/1998, all cellular blood products given in Children’s Hospital have been made CMV-safe and WBC-reduced by leukofiltration. All blood products administered in the NICU are also irradiated to reduce the incidence of GVHD in immunologically-incompetent recipients.

Although written consent from parents is not currently required to give blood products to an infant, the parents should be informed of the possible need for transfusion as soon as possible after NICU admission. Document that this was discussed with parents in the infant’s History and Physical. Furthermore, the parents should also be notified before transfusions, especially the first transfusion, are given.

Parents should be informed that direct blood donation may be option. Forms are available in the NICU nursing station. However, processing of direct donor blood takes a minimum of 3 days, and random donor blood may need to be given in the interim if the infant is in extremis. Direct donor blood has not been shown to be "safer" than random donor blood given current careful screening of blood products. Infectious risks of blood transfusion include: hepatitis B (1 in 100,000), hepatitis C (1 in 500,000) and HIV (1 in 1,000,000.) Viral transmission has not been documented by albumin products or currently-available immunoglobulin products.

All blood products are good for only 4 hours after they leave the blood bank.

Blood products should be infused via peripheral venous access. They can also be administered via surgically-placed central venous access or via UVC if peripheral access is problematic. PICC lines and UACs should not be used for blood transfusions due to the risks of line thrombosis and the consequences of embolism.

Prior to blood transfusion, a Type & Screen (0.5mL in a purple top) and a newborn state screen should be obtained.