This document provides guidelines for red blood cell (RBC), fresh frozen plasma (FFP), platelet, intravenous immunoglobulin (IVIG), and albumin transfusions in infants. For RBC transfusions, the guidelines specify hemoglobin level thresholds for transfusion based on factors like oxygen needs, respiratory support, and medical conditions. The document also presents a case study example. Guidelines for FFP, platelet, IVIG and albumin transfusions provide indications based on coagulation abnormalities, bleeding risks, and bilirubin/albumin levels.

3. RBCs

4. Guidelines for transfusion of RBCs
1. Hemoglobin <7g/dl.
2. Hemoglobin <10 g/dl in an infant:
– on O2 by nasal Cannula or by head box
– on CPAP <6 cm H2O
– on mechanical ventilation with MAP<6 cm H2O
– with significant apnea
– with significant tachycardia or tachypnea
– with low weight gain
– Having Surgery

5. Significant apnea = More than 6 episodes in 12 hours or 2
episodes in 24 hours requiring bag and mask ventilation
while receiving therapeutic doses of methylxanthine.
Significant tachycardia or tachypnea = Heart rate >180
beats per minute for 24 hours; respiratory rate >80
breaths per minute for 24 hours.
Low weight gain = Gain of <10 g per day observed over 4
days while receiving >100 kcal per kg per day.

6. Guidelines for transfusion of RBCs
3. Hemoglobin <12 g/dl in an infant:
–on CPAP >6cm H2O or >35% O2
–on mechanical ventilation with MAP >6cm H2O
or >35% O2
4. Hemoglobin <13 g/dl in an infant:
–with critical congenital heart disease

7. Quiz ??
• PT 30 week GA ( Birth Weight 1,150 KG )
was admitted in NICU for prematurity and
RD for 35 day, before discharge he was
clinically stable with acceptable weight
gain ( 1,750 KG ) but CBC was done and
Hgb was 7.5 g/dl.
Should we give him RBCs ?

9. Fresh Frozen Plasma

10. Guidelines for FFP transfusion
• Coagulopathy : Acquired (e.g., DIC , liver
failure and Vit K deficiency ) or congenital.
• Volume expansion in the presence of
abnormal coagulation.
• protein C or S deficiency and purpura
fulminans.

11. Platelets

12. Guidelines for platelet transfusion
1. Stable infant with platelet count < 20 x 103/μL
2. Ill neonates with platelet count 20-50 x 103/μL
3. Infants receiving indomethacin or thrombolytics
/anticoagulants with platelet count of more than
<75 x 103/μL
4. Active bleeding or in need for elective invasive
procedures with platelet count < 100 x 103/μ
5. Hemorrhage with acquired (e.g., uremia) or
congenital qualitative platelet abnormalities
even if the platelet count is in the normal range.

13. Intravenous Immunoglobulin (IVIG)
1.IVIG (500-1,000 mg/kg IV over 2-4 hrs) is
recommended if the TSB is rising despite
intensive phototherapy or is within 2-3 mg/dl
of the threshold for exchange transfusion in
infants with isoimmune hemolytic disease.
The dose may be repeated in 12 hrs if
necessary.
2. Neonatal alloimmune & autoimmune
thrombocytopenia: The aim is to maintain the
platelet count above 30 x 103/μL.

14. Albumin
• Hypovolemia, hypoproteinemia ( but
Contraindicated in severe anemia or congestive
heart failure)
• Albumin (1 gm, 1 hr before exchange
transfusion): if bilirubin levels are >20
mg/dl and serum albumin levels are <3
gm/dl.

15. THANK YOU