BLOOD TRANSF.tf.indd TRANSF.tf.indd Section Section Section Section Section Cont Section Section Irish ent 5 7 4 3 1 2 6 1 1 5.2 6.3 6.2 6.1 6.4 5.4 5.3.2 5.3.1 5.3 5.1 7.1 7.2.1 7.4 7.3.2 7.3.1 7.3 7.2 2.2 2.1 1.2 1.1 Medical 4.4 4.3 4.1 s provision transfusion transfusion Cord Delayed Tr four Red Component Risks NBUG (Dose) Dedicated RBC Age Pre-transfusion Methods Erythropoietin Autologous Reducing RBC Component ABO Exchange Intrauterine dysplasia Guidelines Acute Evidence Risks Retinopathy Tr Selected Introduction Changing Anaemia Special ansfusion-transmitted ansfusion post cell of anticoagulant/preservative for haemolytic blood of Journal blood of RBC volume Guidelines preparation exchange small cord JM considerations guidelines in natal Tr Tr iatrogenic transfusion transfusion of units of of collection preterm transfusion fetal ansfusion specifications of loss unit for clamping diminishing specification benefit RBC volume (EPO) ansfusion O’Riordan, months. of prematurity to testing for disease RBC transfusion RBCs transfusion serial units from inf blood for patterns Infants transfusion Supplement ants transfusion from for IUT in infections of UK neonatal for for loss neonates Neonates and in the for Review the (IUT) transfusion (4.1) for exchange the neonatal J bronchopulmonary newborn need solutions the RBC Fitzgerald, selection and transfusion within National for US transfusion See of under (4.2) the and and fi rst Appendix Blood OP Blood Smith, Guidelines Section Section Appendix Section Section Section Four Users 2* Components June J 8 9 12 11 10 8.3 8.2 8.1 8.4 9.1 8.5 9.2 9.4 9.3 10.4 10.3 10.2 10.1 1 Bonnar, Group Months: 2007 Fresh FFP/SD-Plasma Inherited Haemorrhagic Neonates Aetiology Neonatal Disease Tr components Indications recommendations Key Cryoprecipitate (SD) Platelets Guidelines Platelet Effect Neonatal Risks The T ansfusion activation WA ef to Plasma Vo of fect of Frozen levels component TA Gorman leucodepletion for de immune lume (T with of Irish Thrombocytopenia for for -G fi A-GVHD) neonatal ciencies Official irradiation VHD Acquired neonatal irradiation disease coagulopathy of Plasma/ Medical and 100 thrombocytopenia evidence Established in specifications ABO preterm of transfusion Journal of platelet on clotting on of Graft Number the Organisation Solvent compatibility red risk fetal and and newborn inf blood of Ve transfusions of fa ants and bleeding (ABO, the ctors TA grades rsus Detergent cells -G neonatal 6 VHD Host Rh 1867 of Groups) blood 12/02/2008

13:21:21 Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie BLOOD

Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie TRANSF.tf.indd TRANSF.tf.indd 1 Summary to guideline birth intensive (NBUG) This 1000g Blood of are There infants blood transfusions intensive Small most has transfusion patient transfusion-transmitted transfusions. 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(Section ants, experts are be ef nationally in cells Group than Inf with EPO as risk fort audit less of the in by ants of to the a with most red this of the of be is always re sick evidence resuscitation fi highest by procedure volumes. transfusion Cochrane To FFP/SD-Plasma treated, Blood Irish (Section risk • and • • Consult care. We Neonatal Blood Section oversight Plasma losses Neonatal Platelet Platelet • • • • Exchange rst ferral detected trained reduce included recommended of SD-Plasma 2-3 infant fresh should should pending thrombocytopenia platelets strategy are Tr Tr Human NICUs indicated periventricular Routine FFP/SD-Plasma FFP/SD-Plasma Preterm volume Tr transfusion retinopathy eatment ansfusion be (Sections and transfusion US ansfusion transfusion ant weeks us not 5.4) Exchange allo-immune 1 transfusion base Database considered medical froz the (Section transfusion with of age. in involving and sourced, in should be be th Haemat available. Platelet . capabilities lab replacement administration an in the inf en which risk the e Introduction provided the significant (Section of with the are ants regular otherwise orat Fetal of plasma results 7.3, differential therapy life of of Service personnel subject 8.5.1) produce requirements transfusion random management haemorrhage the guidance th platelet meta-analysis are plasma the ologist transfusion prematurity Antigen ory are when are 7.3.1 thrombocytopenia in should use at where same Tr compatible for replacement a of (FFP) and audit 8.1 one te all . slow ansfusion is risks neonate with in should healthy of investigations. chnology and an transfusion donor a of transfusion an NI (SD-Plasma) diagnosis babies. and whose in may of (HP regular never (Section consensus NAIT in isolated to FFP/SD-Plasma CU of has pooled, is integral and a 7.3.2) the transmitted with preterm (and NICU respond. A) of 8.2) now in RB be be platelets s child (2006) constitutes been in should be most is NAIT preterm should 1a responsibilit regularly an C, audit. of early . to . 95% suspected. phlebotomy an 10.1) used severe solvent of with part in and at plat should indication one (NAIT) minimise replaced guideline . heavily infrequently infants thrombocytopenia all if birth The showed Fu only EPO is of compatible 5b elet of full . have as vCJD, inf or cases rthermore, an thrombocytopenia audited. cases detergent modern a indications ants and negative two not a should be monitoring to treatment massive appropriate and transfused lacks simple access by for ies losses) prevent an undertaken which single be of should phleb blood is of the FF tertiary severe performed increased not includes delayed neonatal a platelets NAIT the P/ 12/02/2008 Irish strong (SD) ot donor for in to also SD and recent omy in the a FFP the - 13:21:22 BLOOD When (HbF) predominant result haemoglobin through (birth levels. plasma oxygen to more approach and the Most Haemoglobin the site transfusion We and than the response of In inf 12 that The 1.1 lack Tr groups volume only the is to a this life, to implementation blood oxygen. and 2.1 Section Widness assisted the Because 2.1.1 weights and is extrauterine Over mass from 1.2 TRANSF.tf.indd TRANSF.tf.indd relatively ansfusion in due preterm ancy’. be anaemia. an 1.0 weeks fi physiological kidney need number have all of anaemia have cardiorespiratory the treatment mean of the on of 1kg, rst 17% the RBC increasing accelerated severe, weight and , 8 loss of to preterm to EPO inf which the evidence In of 9 EPO as the to ability month from the liver the ventilation, 1.5kg last a et reviewed ants 3 of for 2 endeavoured Hence is addition, to patients encumbered . the of blood a 6 for in primarily inf preterm transfusions number diminished haemoglobin practice al, that their One of synthesis practices placenta result optimal life presence The transfusion in which <1.0 1982 age; haemoglobin are ten ants, with is A, 1.0-1.5kg 3 3 (Hb) analytical experience tissues. of showed of RBC inf of Tr Known Risks and inf Changing Anaemia relatively of the with the awareness volume upon possible preterm multif an years, ansfusion long switch respiratory decline ants ants life by this a this more of kg) with the inf nadir of to is is 7g/dl for Hb inhalation shift transfusions inf including major management preterm low ants physiological from to slightly instability 9 much vary fa 30% is life is are of which erythropoietin of are actorial current ant’s may decline that viruses Accordingly anaemia to by the there nadir ctors are purposes. who preterm from set restrictive known of in of of in iron poor in level haemoglobin transfusion inf expectancy mechanism a arrive for transfused transfusion delivered Hb born among site mother in premature the greatest about the preterm also circulating in transmitted the decline small ants less circulating at of distress received to preterm of higher. those including has stores, birth. liver 1989 F published at of but evidence conception but occurs the of . term proportion 4 oxygen base be as 8g/dl to where contribute secondary sensitive inf oxygen of nitric given erythropoietin volume been 10 9 fore neonatologists, to also of 7 to include risks deliver the guidelines fa , ants very in less to Increased the be 5 infants to inf potential a kidney ctors. transfusion syndrome (EPO) fetus practice. A During with inf and for circulating no at inf patterns for fore 12g/dl red oxide small ‘physiological ant the 64% A possible on haemoglobin to improved in a dissociation major Infections de of with base ants low than guidelines ants an delivery fa transfusions progressive this and inf preterm oxygen to oxygen neonates fi relatively of adult phlebotomy and cell blood is bulk has In cilitates to 28 to nition earlier secretion as ants birth circulating in tissue and a 85 the inf is healthy 1 must 2 for blunted low for for fa are phlebotomy at clearance volume weeks birth does 1993. the occurred. fetal ants kg. with of ctor at blood synthesis ml/kg an transfusions. fi in with the prevention to red neonatal transfusions longevity weight administered of plasma to largely rst requirements iron inf a age predominant The be hypoxia these delivery in the immature weight age curve has consensus not surf with anaemia the haemoglobin anaemia to ants. reduction 3 blood newborns, weeks decline this of birth EPO in containing increased based reaches transport losses and and release red causes tissues. appear actant, of tissues. response 7 gestation been of enter birth due inf EPO area . This as in losses 1 The weights 10 cell less cell is than of ants. of utero not a in 3,11,12 and to and of the due to of a of in a reduced nucleic procedures HCV have calculate estimates immune transfused. a vCJ 2.1.2 HBV becomes now means following Tr who • including: A the diagnosis Alt • Encephalopathies Rodent tr may • • services consensus prevention methods are • CMV CMV exclusive reduction of American that donors stem inf of Early 2.1.3 provides those ansmission conservative ansfusion number ant seronegative transfusion hough buffy thought D, have time sourced, transfused. non-enveloped measures and treatment (FFP) been Hepatitis process bei The The The The The , be be serious to infection, cell studies serological is subsequent harbouring particularly a who ng amplification highly experimental an th system, considered low fat which the HIV use leucocyte exclusion exclusion replacement absolute used in coat because transplant use a been in Association eliminated at for of report th eva with estimated of of conference al carrier. the and Service to Whilst are the , residual e has measures in consequences. of because in in plasma hepatitis TT of vCJ disease, A lua cell-associated transmitted and be to remains act ef estimate to Va Cytomegalovirus a had fi pooled UK Irish the pri and negative th -CMV incidence testing and CMV-seronegative transfusion ltered fectively newborn testing ted no s prevent reduce riant latent those D the protection ual on e suggest of plasma. of of 95% of reduction to implemented during 1970’s viruses setting. (IBT in ef absence leucoreduced Parvovirus. testing by risk because tr the (so-called models a rem 1 donors donors primary . tr of risk donat fect of they (v)CJD B ansfusion an solvent to in tr have in ansmissions using for CMV born the is Controversy a S) could of single Blood virus ansfusion the transient for of ova TT eliminates remove 2000 4 Irish infected possibilit (TT) of was the on of to that immunocompetent are and 17 which in IBT transfusion -CMV million (NA transmitted ion CMV l been from risk the to who who of of Current (leucoreduction) tr protect vectors serological and non-enveloped fi SD-Plasma, these of (HBV) BSE be -CMV The detergent demonstrated enveloped S. lters donor ansfusion Banks seronegative most donor 80s SD-Plasma) blood addressed Tr , Although T) (CMV) order went a universal of abandoned white ansmissible have have TT recipient antibodies latently are introduced nature th units for per with blood Council epidemic transmission blood for y showed the are tr -CMV ere still infection infectivity are the blood for Irish 19 components. for in ansmissible the HCV of subsequent units on spent themselves red blood transmitted HBV affirm for risk pooled diseases th exists. is TT the (SD) immunoassays Irish 1 of tr the screening viruses; for use infected the to fresh leucoreduction tr e the in of ansfusion in blood no -CMV the donor s, and . HBV ansmit transfused. of a UK most mothers. and (1980-1996) almost develop the transfusion. viruses by extended through manuf Solvent by 200,000 cells Eu . blood Spongiform th risk in of treated, the significant adults issue tr Neither HBV in purpose A blood HIV-1 froz blood e rope eat the the blood from of . allogeneic the cells blood in Canadian in selection however The equivalence recent has difficult monocytes including been these HIV te , en acturer disease, ment adults, inf supply to invariably preterm Irish as HCV 18 such will te use detergent products. d the A US transfusion not two vCJ ants is recipient have donors plasma method from donat per and periods st to resides vCJ and of marked and Risk currently 15,16 clear Blood risk of , , small of whether as to D. must . but unit the can takes the D units 13 ion ,14 of in 2 s. 12/02/2008

13:21:22 Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie BLOOD

Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie TRANSF.tf.indd TRANSF.tf.indd 3 of the risk continued ef blood There 2.1.4 acceptable higher platelets CMV-seronegative blood In CMV-seronegative number At IBT 2.2 platelets are (HP suggesting serological transfusions trials suggested. A available, ef depletion; present However, are CLD versus pathogenesis been ventricular transfusion, Section generation another lung eight oxygen ROP association neonatal needed recommendation) no did erythropoietin) transfusions include were apparently and components temperature. recommended trials. and per risk /o 27% bacterial components (ROP) count in units had matched ef in not on fi r Platelet high CLD at apnoea, given and Findings CI, gain. fect t anaemia function platelet CMV-seronegative criteria evidence of bronchopulmunary transfused. neonates. of in screening 31,32 determining through CMV-transmission for evaluable higher free (high) However, recommend but to 0.01-3.41) pallor, 33 of TT comparison 34 pretransfusion use leucocyte has anaemia according on the randomised, 35 neonates. elucidate However high in infection -CMV and < between of radical A ‘stable’ platelets of Antigen incidence of heart . the by been fetus, dose) 1x10 22-27 le analysis: have number that Be a in chronic . are of restrictive ft cardiac 21 donors. the much the , the fore 36-44 of fi by most namely At . rst The or have not 6 , the and for to 20 IBT is the the of S were outcomes With all injury) bronchopulmonary between There statistically received in product statistical with threshold received were Few after echocardiographic stroke (89% 770g administered 451 respiratory physiologic randomised high techniques the oxygen oxygenation that determine 13.5g/dl, cardiorespiratory Eligible The extremely haemoglobin to was stringent study Ta Morbidity Death Injury Ultrasound grades Prematurity Retinopathy Dysplasia Bronchopulmonary discharge Death Outcome the determine differences ble haemoglobin recent it conducted the inf studies Hb the transfusion. no permitted reviewed and . low low is was volume 1 ants or be extraction inf 3 donors difficult group. high statistically exception fewer one both criteria fore Severe min to group significance threshold versus ants low PINT each gestational (BPD) when no support, ‘Premature significant are Brain impact were 5 (ROP) to of have using whether or range to concentration 7.5 difference groups, birth in were an < RBC currently Groups the for in to slightly more critically Study (mean, to intervention 45 were comparison disease level, 95% 48 randomised, g/dl, algorithm examined 10 Hb which may whole of shock, measurements fi dysplasia, of ef weight and group. group significant statistically nd transfusions hrs fect neonatal anaemia transfusions Threshold: 165/223 101/175 brain transfusion age (as for met. 31 (P 33/175 40/216 48/223 46,47 Low 223(%) high, Inf be differing were fa simple (57.7) (18.9) (21.5) 5.7 maintained (74) (19) N not ill of inf in blood voured =.070) ants and RBC of measured sepsis, a of = for 31 The but (ELBW) inf Hb ants major age, units) injury affects of better P the withholding readily similar, This is 26 with ants retinopathy fa all in = 223 low clinical clinically is intensive differences donors; low required. lactate non-significant lling were by ef recruited weeks. . Need the .037) , blood altered allocation and morbidity (mean, The multicentre, but triggered the the fects in did marker or in 159 1-2 range 103/188 in mortality inf available. High 228 until 33/188 45/217 40/228 with by with the high (17.6) (69.7) (54.8) (17.5) the high (21) the the exposed composite surgery high ants N= or mean not . concentration of products 2.1 /228 g/dl The death applicable of Emergency (%) care fi transfusion Measurement by Hb discharge) laboratory low 4.9 mean of postnatal difference low Tr threshold group rst over improve Hb of transfusions (< range between versus group or ansfusion so by low prematurity depending number or units) weeks transfusion threshold . units Hb be triggers 1000g randomised, mortality Fewer low many 24 was severe birth (T threshold 1.27 1.30 0.8 1.18 1.38 95% OR had fore but and and able group. months, 2.6, measurement vs. within in than age indications . slightly (0.5, group, of transfusions was did groups until weight increased variables of (0.71, (0.83, (0.76, (0.84, discharge, CI individual 3 inf or birth 228 high (PINT)’ 1) adjusted P morbidity life. Hb of , countries blood on (max ants fractional 1.4) not Some the or . =.035. need only 48 very 12/02/2008 There tissue group in but 2.26) 2.02) 1.85) 2.27) were age weight) group The trial brain lower of reach in high hours the Hb any than to and for in . 13:21:23 BLOOD The neither levels pressure attributed of compared transfusions programmes gestational 954g > respectively periventricular as than in There The transfusion the group data i.e., arteriosus, more possible 0.43 this at the were the secondary the or dysplasia. Iowa clinical group, randomly Iowa study Tr inf authors a oxygen blood for Bell group transfusion be care A transfusion two suggest trial transfusion group. more mechanism group apnoea Bell Tr TRANSF.tf.indd TRANSF.tf.indd result, acheally ial recent 30% the ants 10% difference intraventricular the required. the parenchymal low frequency liberal clustering difference important of ful mean number has is liberal analysis did episodes Tr Tr similar inf frequent groups and fl restrictive-transfusion were was had was in that composite the The restrictive ial ial, liberal confers status, ow re-examination positive content threshold and and and concluded ants the that provided those the that smaller, or to resulted No to 2.7g/dl and 958g to intubated birth transfusion a outcome retinopathy in no noted. the increase transfusion age . if group thresholds group 32 kept supplemental for >22%, separation either brain 12% in mean PINT of While the was with decreased 3.3 were partial the in but at their 5 5 100 difference transfusion difference of studies of measured haemorrhage restrictive apnoea per in the was higher inf the little weight pressure the for in 4 in use at both brain in apnoea 48 increase versus the was single-centre significantly outcome ants periventricular a group in injury haemorrhage to had may Tr this compared hospitalised a from day; haematocrit well two Hb receiving the that increased >38% both the The not use number respectively compensation ial evidence e.g. the in liberal for 6 of liberal added single Hb in concentration threshold haemorrhage more group. who weeks of severe used restrictive-transfusion in have of of trials. may group ful . restrictive tolerated. p=0.004) achieved statistically a maintaining 48 second bias assisted restrictive growth, oxygen during liberal groups the was in by transfusion after nor inf single-donor prematurity group restrictive concentrations the Both oxygen in overview and of or survival required ants transfusion have of the resulted inf for commentary group events nasal or apnoea was after However, 32 oxygen with found liberal-transfusion compared frequency parenchymal restrictive of of higher brain RBC donor ants transfusion >28%, (Iowa preterm levels the random studies . the possible need of were was delivery apnoea levels age bene leukomalacia in ventilation in conferred The not group and 1.1g/dl (phase the and continuous all for the had significant fi mean or restrictive in haemorrhage with and in transfusion. a RBC no rst (4 , 28 and of in was groups (phase exposures from planned Tr fi fell grades. for higher higher or mean study in the the a the transfusion decreased t. respectively restrictive the liberal ial) have the significantly vs about transfusions group statistical 4 inf 31 significant comparison but transfusion weeks. with of bronchopulmonary etc. to the grade explanation -transfusion respiratory brain maintained to 2) to 2.5 Hb weeks risk in restrictive decreased ants 0; , increased transfusion triggers brain the liberal brain randomiz protection , (phase < there number the was risk the 3) received The shown in Hb p=.054) their the between group times The groups 1g/dl initially (p=.115) transfusion (median: of 46% positive (4 , injury brain 4 the were Both they PINT which group PINT level of injury completed The germinal of haemorrhage corresponding haemorrhage, high vs transfusion error, in group was hematocrit with restrictive- programme. , Iowa decrease patent suggests 1) life larger and and and that more 0) group. higher the support. of ed of transfusion was may assigned were seen cerebral in noted respectively transfusion authors arterial as practice in Tr an and Tr threshold inf , against a airway the was and thresholds was improving RBC these and the although 0.84 . clinical particularly ial. ial. ELBW if restrictive- mean <34%, part Tr 5.2 lack restrictive Inf ants RBC similar be apnoea groups requiring in matrix had ial. 48 ductus in kept two 48 ants In the Iowa than by the when the The the vs the It of in a each As in may is or at the . in 82/213(38.5%) blindness, in evidence and document administration. transfusion practice. currently group in ‘transfusion high 4.1 transfusion without circumstances medical The It is clinical administration. is rather haemoglobin Se Bell in 18 in inf (published tolerating transfusion The until Ta is particularly a the particular terms survival order ants ct Late Chronic Acute Neonate intensive a Cumulative Anaemia Tr months. trend clear accepted US PINT ble concludes more Hb neonate ansfusion ion absence versus than but situations anaemia, additional Guidelines to indications group. primary 2. 4 blood available of neonatologists Not towards moderate Tr or deafness, information have oxygen formulate in do 49 receiving high care in by is practice The ial Tr under following practice bene cognitive requiring neurodevelopmental abstract Whilst of 29/165(17.6%) true blood fi all ansfusion usually of as not loss the Guidelines 49 group rst in Many Selected that of In been extremely stable British red levels , composite patients a fi which OR not dependency 24 good necessarily addition, justification. for t 4 better guidelines are standard loss for for of ‘the blood intensive to the will monthsof cognitive guidelines hours transfusion of has fa (95%CIs) considered reached suggested neonatal delay: form) inf RBC based, is Blood does severe transfusion. in lling Committee evidence the transfusions drive authors reduce Ta ant available’. will outcome guidelines who cells 1 recently low sk transfusion for week guidelines, outcome transfusion. within on 38/156 not of care have Utilisation will to Force, predominantly reduce iatrogenic , are delay: by age birth RB transfusions care OR neurodevelopmental They are the 1.45 eliminate result conclude in guidelines transfusion actually reasonable, for consensus outcome considered to reported C 48 51 in the 1.75 for not number weight Rather, in . from (BCSH) Tr review optimal 94/208(45.2%) the include might (0.94,2.21) (death, (24.4%) overall in the guidelines.’ ansfusion Standards including may intended Review (0.98,3.11) anaemia high significant bene the transfusions that absence (ELBW) be preliminary at , be they for this as of cerebral transfusion donor conditions on thresholds or 2004, not U.K. Hb eligible Hb 10% Hb 18 (Hct in 10% Hb administered Hb fi transfusions maintaining all indicated their 50 broad t expert literature low these list to state P from 12 11 mandatory group months, 7 in 12 guidelines should This and c. =0.091, blood exposure. g/dl serve of has differences inf Haematology clinical P g/dl g/dl unit. outcome 0.36) Hb g/dl palsy for agreement versus clear ants blood =0 that by in U.S.A opinion, data advice for both issued for threshold volume in be this as care there .06 , the which at inf to , and halted 31,32 . low ants at fully in the 4 12/02/2008

13:21:23 Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie BLOOD

Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie TRANSF.tf.indd TRANSF.tf.indd 5 place. to Each 4.3 4.2 RBC (level implementation The parents. The must Reasons Guidelines give weight or divided should decision Routine Vo recommendation) influence to As recommended. over • VLBW suggest lume any evidence kcal/kg/day § min ventilation ‡ methylxanthines. 4. † * mandatory bag 3. pressure 2. 1. four Guidelines majority decision more The Ta fewer 2-4 Gain Heart More transfusions. Hct Hct Hct Hct On With On On On With On On be neonatal I With With 6 6 Guidelines chycardia, other b for24 and have of into mont of replacement documented. <35% EC continuous continuous O >35% evidence, to degree hours <45% <35% <30% <20% for of inf the less significant congenital than 2 than significant rate blood low transfusions. mask for very by MO transfuse <6 multiple <10 ants, a hr. inf transfusion for hs with of ventilation to decision NBUG are Ta nasal . for Pe than blood weight >180 six department cm ant hood hood 1500 (see transfusions with with with with of transfuse prescriptive should tachypnoea, when ble ventilation g/day of transfused dipack mean . partly tr more can episodes 3,11,12 H age. who grade positive positive ansfusion prematurity cannula 3. one 2 an low an an cyanotic apnea O O section tachycardia packs) O beats/min transfusion gain of has g The 2 2 Guidelines reduce to observed to airway inf inf inf prescriptive. with Clinicians be will reticulocyte by is kilogram. blood (a and ant: ant: ant: transfuse A transfuse guidelines been likely must § while or in airway airway standard removing unit mechanical should recommendation) not poor assigned heart guidelines. should 5.2) 12 are bradycardia pressure perceived of the loss for . receiving require or over of made hr be to RB feeding. Although given . therapy pressure pressure/intermittent disease number 24 1 who tachypnea Thus or packed require have count Cs discussed by is include: from be 4 practice two the hr; limited, ≥6-8cm days to (level ventilation in phlebotomy to follow 10-20 transfusion, all respiratory bene Important † therapeutic transfusion episodes Rose and them pat discretionary and inf and/ of recurrent red most inf while ient ants ‡ I symptoms fi RBC in ants ff b . it agreed periodic or H with ts mls as blood et evidence, is all 2 s receiving with intermittent O inf or with in less soon al not rate in fa transfusions neonatal per ants the is doses adverse 24 (USA the ctors guidelines transfusion mean this cells mandatory not guidelines possible birth th >80 of element audit hr kilogram baby’s as majority weighing an , ≥100 anemia.* group, requiring of grade 2002) that airway a breaths/ units ef of fects their of in A will If be hypofibrinogenaemia and metabolic Liver (SA plasma coagulation dilutional venipuncture with coagulation occur exchange manuf transfusion of present. fi transfusion of by use immediately Clinicians component plasma virtually anticoagulant/preservative required colloid Restoration • transfusion, Causes Acute 4.4 complexity impairment offloading transfusion *Y • reasonable to This compensate level De limited brin RBC Hb Hb Hb Hb expert Ta Hb CPD ounger individual red both fi thrombocytopenia, required G-M) ble nitive of care requirement. of The The microvascular transfusion for and degradation 10.0-11.0 12-13.0 10.0g in transfusions actured 7-8 8.0-10.0 cells, life-threatening A-1 a solutions inf ability 4 opinion: the and reduced, 52 no include neonates any ful blood for degree postnatal , / ants renal and studies < g/dl should imbalance transfusion) . The of A 53 RBCs coagulation consumptive prothrombin /dl to monitoring (>25 setting than of and (see as platelets. bleeding of tests (DIC) the 5 inf transfused massive for severe oxygen sites, of g/dl more maintain neonatal late days and weighing following g/dl with intravascular warmer ants hyperkalaemia (level g/dl function Acute acute reasons the is anaemia. guideline is of older CPD section 52 also are for ml/kg) and are with may products anaemia, a fa approved age* a with major bleeding and requires illness* with old, fa severely neonate’s risk coagulopathy cing fi neonates IV 52 e.g. as not transfusion from than not A-1, cing rst hypofibrinogenaemia, thrombocytopenia be feto-maternal severe . haemorrhage inf blood arise. is The is symptomatic suggested evidence, the fa mucosal renal, are moderate in a Dilutional less immaturity time with surgery haemostatic . outlined 11 ants priority hypocalcaemia major recommended available, 53 required aware ctors available A result an should RBCs surgical the a stable Hb solutions) neonatal Additional suitable; and/ thermostatically laboratory volume on or vasa cardiopulmonary for Clinically ill than loss older and acute are hepatic who increases heart, adult level inf oozing and surgery cryoprecipitate) . that blood of or surf grade patient cardiopulmonary Group consistent less Hb setting above ants be partial praevia 1000 haemostatic (see with are to fetal blood red anaemia procedures fi renders FFP resuscitation. with above liver brin thresholds transfusion, aces. the in SA lungs applied liver . establish disorder , than and from fa are warming C stable. the assessment cells . the disseminated section G-M O, Hb However, (see ctors g (or for critical thromboplastin with crystalloid and D-dimers from and and recommendation) when is or neurological will more The patient Rh and 10.0g/dl 5 with newborn sites and inf SD-Plasma) less rapid disease in and birth controlled blood with days section is cryoprecipitate treatment the include have massive D ants for in additive potential the of current disorder vasculature 7.3.1: rapidly . characterised is issue the likely disease negative, able prolongation twin-twin any of shelf-life small-volume injury or fl When varying recommended. it may old, are exibility optimal contains vulnerable for a and/ injury developmental seems massive is because massive 6.2: transfusion intravascular to risks is the to should transfused. rare. often . abnormal transfusion present solution device function. with the correct can for possible, time; or require may , RBC inferior 12/02/2008 of of Hb to age may the be of be to for 53 13:21:23 BLOOD cord meta-analysis with trial delayed inf directly 20 and studies were when blood DCC the transfusion review delivered A showed As The 78 immediate per The taken of Outcomes gas with are inf sampling There 5.1 • Recommendation restrict documented a • • of The Usher 5.3.1 blood. delaying the volume, 5.2 5.3 exposure. transfusion is detrimental randomised Section TRANSF.tf.indd TRANSF.tf.indd blood randomiz indicated, ants ants sampling newborns, technology second ml laboratory tools’ Minimisation Regular Regular results required larger kg and of require number recent optimum higher the clamping was found taking pressure during per is et immediate at also after and phlebotomy with have volume top-up cord no chemistry use a cord al, 72 are and 57,59 by associated 5 volume kg highly Research cord should ed cord recommendations advantage in blood noted requirement requirement ef less for in occurring audit training preterm the biotinylated Caesarean delayed for of of all hours significant indicated blood provided at clamping that 7 7 volume fects transfused clamping critically study 1963 colleagues of and improves setting blood severe an than trials of Methods Delayed Autologous Tr Reducing birth clamping Dose analysis. larger clamp packed of significant randomised, of volumes ansfusion (5-10 term produced ) a 126 be umbilical monitor. lowering of sampling : on blood losses decrease in of ef early demonstrated, inf versus and together, and with samples of interpreted age. (volume) during fectiveness pulmonary by to volume IVH. very ill has that time. all (DCC) inf ml ants or reductions section RBCs secs) in and cell smaller RBCs cord inf A the blood 82 Ev NICORE ants (usually volumes and staff clamping, 60 per fewer collecting, iatrogenic of have 66 should 56 inf not recent ants. low babies 63 aluation correlation artery greater to immediate of transfusion Corresponding transfusions possibly ml should inf the ants A Diminishing controlled in Circulating of kg in clamping ef could versus taken with had to receive the been undertaking significantly volume; birth ant. of per subsequent found 54 less fective overall and preterm transfusions Neonatal fi with at be function. within be 57 RBCs randomised randomiz catheter rst in with required wide 62 in delayed inf by kg 5 rises most be (NICORE) transfused lead established. weight respiratory and smaller reducing storing blood implemented delayed a week neonatal ant minutes caution. a measuring 10 at between cord IVH, reduction delayed use kept the in decrease confidence trials 10 61 inf the to in RBC 72 below outcomes or 58 Intensive an with ed, ants highest by of but loss increased phlebotomy of cord Hb values preterm a seconds but randomised clamping. Need When at and volumes 20 hours amount for inf 66 reduction on (30-45 blood life, technology of liaison to volume controlled RBC a Ireland without some in cord This distress ant no an ml/kg the showed blood clamping minimum. reinfusing anaemia early One age a in blood the in 57 in in a 45 for in-line differences of frequencies donor can Care level intervals, however, transfusions losses. inf (Grade the very Cochrane transfusion clamping of of inf of and with investigators 64,65 secs) age. study small in versus second to measured loss RBCs; ants any ants birth) blood in volume occur blood syndrome preterm controlled that of preterm trial 93 blood A or 55 had from Other cord ‘A the A 2004 with low ml so were udit even by vs and timing transfusions. of of Low 5.4 RBCs preparation, among suggests transfusion notes known adoption The 5.3.2 and investigation. to had reduction speculate sepsis DCC, a and premature preterm progenitor in attributed reducing utilisation. 1 placenta another et been be could Ko transfusions rHuEPO VLBW in Fr less the transfusions guidelines administration Side report induction possible intravenous must (ROP) to some ef Three has the higher fect and anz newborn the be al matched prematurity EPO tto-K made. proportion role been paediatricians actually a potential significant plasma concluded ef be systematically safe. cord not et trials more that fi 2, on recent for of of has in fects neonates to rst term ome therapy of in inf al accompanied per (but increase used. in sudden of the blood cord neuro-developmental Garcia that of demonstrated be be transfusion in to that 69 week the multiple for erythropoietin ants. cells inf clamping have been Newborn but VLBW inf may controls. rapid the iron allogeneic iron the occurred of EPO kilogram inf 2004, the and and ef explained; DCC Recombinant The ants not systematic Cord-clamping for . ants blood as clamping study of of the The fective Ko ants rHuEPO has for transfusions 67 collection that in present Erythropoietin Cord technique demonstrated be are high of described de et can bacterial there severe that volume inf rHuEPO. VLBW elimination tto-K clinical levels in by the The protective group, inf 76 are ‘early’ with ways fi life, primary al not influenced ant the reviewed 80 prevalence transfusion, the known ciency did should inf Cochrane ants delaying result concentration to the concluded dosage. Blood in in prevention Tr required. by ome accompanying does donor a ants been death hence increased practice alone not provide studies preterm in noted 82 the ansient IVH, neonates increasing reviews producing transfusion transfused moderate bene for especially ef administration of showed 12 contamination high has . in human goal fect in to et Thus be document DCC have in not cord preventing Collection of practice noted ef which inf exposure. 73 syndrome a fi cord may produce al (V fi in greatly the that been de fect 66-70 outcome ts Database, erythropoietin, concentration modest rm of ants is differed a of neutropenia seem amvakas of the The concluded inf that (Cochrane early treatment or ferred a blood group of theoretical reticulocyte dependent transfused; significantly retinopathy anaemia erythropoietin EPO not recommendations delayed ants. clamping in reduction in larger widely red on was of in treatment was number increasing applied than given ef administering guidelines the recent commentary by male studies to primitive that late be fi oxidative 72 blood reduction as red 71 for therapy and cacy and of rare markedly for not limits be respiration, presence for volume With 2001, enough. 2006 variable a rHuEPO iron sepsis a a cord that with blood of inf Database, very disadvantages successfully that the source of influenced studies. requires ) has placental rationale ‘late’ short can of cell on in the ants. include and counts of of prematurity necessitating the less meticulous red daily RBC haematopoietic 77-79 74 rHuEPO if is extremely more for erythropoietin stress. clamping the low anaemia prematurity placental (rHuEPO) been production of be in cell 68 could EPO reduction Garcia from transfusion. to results widespread 67 to time. blood late-onset rHuEPO ). of IVH, . obstetricians as of late distribution 81 dose so expected volume The Oral birth reduce The Va this further could and transfusion the restrictive common for autologous No transfusion 2006) noted compared is one that 68 by mvakas be A grades RBC in editorial with 2002, cell started and authors article use that rare inf Ev iron of adverse appears has the to is not being en ants to in in of in 75 6 12/02/2008

13:21:23 Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie BLOOD

Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie TRANSF.tf.indd TRANSF.tf.indd 7 of would calculations of vivo donors. provided DPG hyperkalaemia occurred old) The time studies transfuse Previously unirradiated induce documented if volume have 6.1 can transfusion. than used aliquots Section in 1. performed reductions of were a or cell group. in and the haematocrit. guidelines exposure not transfusion bene In is RBC age) 2. 77 significant 3. importance. compared It significant infused linked preterm preterm conclusion, Meta-analysis Early is blood 60 age) more The fi recommended transfusion result the in of potassium prudent of fi one rst vs led transfusion up levels, small mmol/l 8 8 t 77 not inf older a early in fi transfusion vs demonstrating placebo/no This vs increased 2-3 or red The to rises to rst to more blood ants blood following 6 through through packed preterm , be in placebo/no to late to inf inf reduction from : in the its and the a 78 transfusion and Rapid blood requirements predict red weeks stored increase was fa Ve administration use to hyperkalaemia late ants ants, dramatic limit RBC of by who steeply full rHuEPO tal Late rapid tradition EPO: in loss content was ry volume use of Age Special transfusion and units clinical which cells. a day of which of the EPO stored cardiac shelf cell low blood and/ satellite a theoretical limited cell inf risk as transfusion and require transfusions the late setting RBCs. of EPO of transfused blood that EPO treatment central leakage of provision early in 35 ants practice did evidenced in with volume birth A life. transfusions. blood decrease aliquots treatment of but the or rapid is ef RBC the life in of significance were was a EPO case the losses in the blood, not in considerations forts did ROP ef clinical low disturbances unit 24 which with stored as EPO rHuEPO large The storage significantly units, safety SA 35-42 i.e. weight use fective combination of line. risk amount or to infusion from significantly not units of (starting well hours deemed of possibility birth G-M is because , of > EPO of should showed low renal use early extracellular the could slowly as of administration potassium and seen. hyperkalaemia-induced volume of of resulted by on in 25ml/kg blood Fatal increase significance; RBCs concluded blood of as sampling days one the inf in weight stored stage reaching levels decline donor relatively increased RBC will such (starting the Due assigning donor in administration of fa large ants stimulating of be 4,59 . focus to need in hyperkalaemia or ilure. the which significant There of in increased transfused take of is development with 32-day of transfusions drawn with inf be to as in more > of units reduce exposure. small concerns of RBCs. have age. risk inf of phlebotomy small shortened exposure during in ants in the exposure 3 for for of Irradiated potassium occurs potassium on concern concentrations 1-2 high in ants fresh that RBCs, pH dedicated was are ROP reticulocytes the however 83-90 of to resulted marginal RBC inf laboratory limiting limited as RBC the inf old for > volume weeks erythropoiesis and ROP the an the now extracellular Theoretical ants have risk storage ants, reduction divided required 7 RBCs selection potassium Such in greatest in of RBCs. about neonatal or inf days transfusion detected transfusions use or in significant of RBC the survival to . exchange has of EPO red numerous < bene greater ant losses (< content donor been in particularly there the who clinical be red practice multiple setting cardiac systems ROP 7 to of RHuEPO a 91 of testing. into cells 5 than fore at 2,3- and and is large fi days non- blood one in days RBC have ts the . was in 79 in K any + term their theoretical of adenine, premature to volume in F. Luban For 6.2.1 6.2 transfusion. days was on infusion arrest 6.2.2 called blood The which 6.2.3 IBT specification transfusions this concerns in cardiac vCJD, in which in plasma Because difference and Lady’s transmission. This of for the blood inf blood centre the age replacement There the whole controlled reported surgery Tr 1991 the high SA ants 18 studies. the the S congenital use major intensive many ansfused product its comparing 2,3DPG used may safety inf causing G-M, will mm such for (red setting occurred had can was study ‘P it blood et ef Hospital, in possible concentrations, (< ant volume top-up surgery of for edipack’ is through estimated fect glucose, differences provide Dublin of result al cardiopulmonary about years paediatric to 86-89 at 1 trial important cause a stored cells been in inf no calculations, in many as has also current is group, year) combination store was in the therapy content outcome. and care ant’s of The the of the RBCs significant heart SA Most recommended of transfusions inf in those in transfusion RBC transfusion SAG-M SAG-M in in with in been irradiation CPDA-1 in Exchange the ef massive Dublin, have irradiated estimated end a splits. such nephrotoxicity associated G-M fresh p50 years; a small ants for mannitol) CPD fects national an has a unit additive the RBCs acute red central that and 5 concerns concentrations 62 red disease. rapidly cardiology . to no in of less increase of day Neonates anticoagulant/preservative demonstrated < used to past been 95 might a blood A-1 undergoing and as whole consider outcome. volume day additive on a storage has reported other stored present cell 28 RBCs RBCs RBC decrease life-threatening for transfusion. difference of versus post-hoc shelf-life than well line 48 on neonatal solution bypass transfusion, intracerebral increased blood that citrate, SA regenerate days old of of in using published. for packed transfusions all with cells well Moreover, over red for blood component UK hours which G-M neonates neonates in of as 6 blood neonatal for for RBC baby centres many concentrations (< solutions in which no the the SAG-M days, vs problems. 120 neonatal as A reach an the blood centres which packed priming laboratory phosphate, large small transfusion surgery from for subgroup 28 combined red substantive recent of > cardiac in compared cells compared subsequently previously implications increased 93 estimated transfusion RBCs girl is years perioperative diuretic mls 28 95 adenine the this is for days massive cells 2,3 completely circuit There in dangerous cells) 27 pressure. volume contain transfusions. following volume blood The the in and RBCs days such for inf the cells use of number had cardiac prospective, indication. with DPG are mm been neonates old) surgery Continued ants for same 6 animals analysis other use ef FFP with UK were dextrose . priming CPD transmission 92 with day old and no to as length in of stored, risk loss, risk fects a Hg neonatal transfusion constituted surgery high top-up setting (see within of using solutions 93, undergoing SA neonatal of SA and the SA advantage in the again surgery FFP) during requiring as old depleted or large fl mannitol, of reconstituted the in 94 theoretical blood to centre fresh uid G-M G-M a and G-M of when levels are section toxic solutes the by Several Luban fresh of vCJD rapid the the with number should, red use randomiz hours red greater (CPD) mannitol 93 overload. for found related stay patient volume ECMO: cardiac small surgery 12/02/2008 blood. p50 in with . whole one (saline, pre- and cells The levels in fresh cells of used 200 of blood of so- renal 39% by et over in Our in 9.3 of of on of Hb no no 21 al 96 ed, 13:21:23 BLOOD 1.6. coagulation SA for serological receive that very donor the subsequent than Group in Although 6.4 the Pe to reasonable component were volume common transmissions practice of The pre-term designed support transfusion. to plasma establish transfusion It 6.3 of SA to activation of to are the risky in could which oxygenation 1 which recommended the inf undergoing this Extracorporeal recommendation) (or SA M) Section exchange TRANSF.tf.indd TRANSF.tf.indd is RBCs inf newborn ants ensure minimiz artificial bleeding, 2001, clotting which dipacks. , G-M G-M G-M SD-Plasma) up 99 < expiration multitransfused transported scope continued recommended country Pe if , low ants 5 met extracorporeal The be 5 a exposure the to to Massive to dipack from such transfusion several blood, RBCs. blood reserved 4.4 in days for of birth guide are 30 anticipated in details inf their 7 of the so e from sterility and patient ideal transfusions. of addition fa surf sharing The reports the that days inf ants practices the selection. massive cardiothoracic acute Aliquots particularly fa is small less ctors, months this and that multif this as old, mechanism 9 9 weight ctors ants. contains date 97 system from use consumption currently unlike own aces for practice, one membrane massive doses Tr risk goal transfusion abroad. may Pre-transfusion withinthe Dedicated CPD, RBCs to were i.e. country old) than /o Because the guideline. ansfusion . RBC are or is volume, blood actorial the greater of less involving to that a (35 r specific If should an donor or the of inf attached. and pre-made is transfusion fa life perfusion than be from fresh freshest inf CPD CPD RBC suitable. CPD are red others Some 4 supplied is of massive albumin. ant. hyperkalaemia. iled infected should one unit virtually than days) ants. VLBW a intracranial Although limited required months transfusion the support designed loss) patients Inf that who lacking, preterm cell is A-1 in A-1 fi with A-1 that slowly but problems In oxygenation to inf unit surgery be unit ants rst donor was units The requirements criteria Guidelines, unclear, of IBT the 4,89 143 centres 1.1 SA the ants detect pathogen, of require requirements. red Indications assigned be blood Clinicians include blood RBCs, four RBCs platelets same Pe a through inf transfusion to for at among As no donation. S G-M contaminated, provision undergoing of older the testing A may in system mean (level Irish for administered not often multitransfused ant dipacks, there individual will the exposure the cells inf have to theoretical 386 coagulation outlined age life-threatening with months for haemorrhage, setting unit is alloantibody serial with RBC ant contains use reduce unit, with more are ages not EC less also 51 post-bypass time Blood child systemic transfused transfusion IV inf in overall require is 94 a inf is a (E coagulopathies to cardiopulmonary due for judged which MO of should 100 RBCs not be coagulopathies mechanical ants physiological additive for evidence, extremely of for however prepared CMO) a FFP ants alloantibody than make should a neonatal of with than of RBCs. or in neonates of lack EC per Because relatively EC particularly EC possible to Utilisation donor for EC available, 64% fi neonates virtually the concern , adult. life. donor resulted rst MO the transfusions platelet transfused artificially but exposure fa 5 MO MO which the inf heparinisation, MO be to 5 other of is available ctors formation. days inf Blood be small to the days ant. solution care require inf a and of Protocols it the centres exposure haemorrhage evidence aware by unit. are grade services transfusions rare. ants are complex, the Currently seems exposure used ant in all pump and fresh standard causes no also indications Lowering a old, and formation exists (see previous and de Survey blood in old prone of 98 are volume during transfused with beyond inf technique Users youngest may of provides followed bypass; fi multiple Tw C CPD that infants inf a with for is ants ciency contain FFP (SA in 101,102 FFP (less blood to up small in o on ants in are order , A- of G- to Repeat younger antibody volume alloantibody 6.4.1 following • Investigations * following • be • Investigations • • cell *A serological haemolytic unsensitised evidence, necessary prophylaxis BCSH ante-natal • • • • performed • • under example donors as 7.1 markers. Blood Donors Section past Wherever an positive obtained isohemagglutinin passive sample cells* atypical atypical plasma group one section grade ABO Screen In Direct ABO SA IA ABO Aliquotted Infuse Haematocrit antibody 2 T the investigation four G-M components years, now compatible who transfusions samples inf than and and compatible if screening 7 large a A absence (or grade antiglobulin in ant anti-D, to the if months 5.2) for for DA if disease investigation massive - maternal antibodies maternal possible, recommendation) recommends with have for anti-E a the use in no RhD RhD RhD RhD. which allow 4 (level T donation volume fi the baby on on volume maternal Pre-transfusion months initial rst on C historical (Hct) anti-D mother for up given for Component transfusion Component the the the negative neg) group presence recommendation). ABO of with transfusion selection must has into the intended methods of was Ib transfusion red is to with have antibodies samples small antibodies production maternal ABO DA maternal infant 0.50-0.70 10-20 test the evidence, jaundiced by full transfusions neonate’s been may haemolytic at (P maternal are cell by negative has and be T or mother that an edipack) result been least newborn 35 on (D volume and cell mothers neonatal not prepared compatibility be of sample: indirect additional of for reveal full AT detected mls/kg the from day where specifications (& serum, atypical 103 born group appropriate one required, ) administered. sample: due Compatability specification are (a transfusion grade in compatibility or RhD plasma performed and red for cord and subsequent shelf-life reverse the transfusion: disease from both anaemic. (HDN) no present) is previous who to 51 with antiglobulin the serum all over cells inf from only group repeat screen recommended. However in A blood neonate) antibodies relative red red mandatory ant, a mother mother recommendation) (if an provided have a testing , 2 single . or group blood repeated cell positive cell of In available) blood. (level suggests 11-week and to to on 96 determination. . should donation an compatibility for inf testing such the transfusions However, received testing 4 the de 51 allo-antibodies antibodies* the for . babies ant’s and atypical inf has red hours for unit technique donated fi would Ia and newborn, (level that ciency fetus ant’s microbiological neonate’s cases, DA RBC evidence, inf only inf on received blood -old dedicated will serum or possible 51 only T. within ants initial ant (see of ante-natal same detect IV neonate’s RhD or red The red be be inf of by testing should small inf if cells (IA for ant cell for the ant red T) or to . 8 12/02/2008

13:21:24 Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie BLOOD

Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie TRANSF.tf.indd TRANSF.tf.indd 9 Babies 7.2.1 the host be I transfusion. haemopoiesis in haemolytic and • • • • • alone specific Alloimmune • • • for 7.3 • by requirement Hb born Tr in fetal caused • • • transfusions anaemia antigen fetal Intrauterine 7.2 t ansfusion is a infants donor hyporegenerative with in provided when anti-c, for necessary In negative (CPD status. incorporating for drawn a thermostatically incorporating drawn CMV Irradiated Small Tr IA Group CMV Less Tr Irradiated Haematocrit Should irradiated and fi specialised hyperbilirubinaemia. gamma-irradiation important transfusions anaemia at clot ansfusion ansfusion rst T- disease the exceptional may 10 10 the blood cross-match who an by with RhD, a management. 4 A-1) than seronegative seronegative secondary cells, fi screen volume maternal/inf 51 clot RhD into into O months relevant adequate platelet rst suffice. not anaemia who red in are Thrombocytopenia) to that (low for the may warming if (must . followed 51 5 tested. anticoagulant caused screen will utero a a (% be reduce positive (T appropriate to Exchange should should Intrauterine tertiary cell days transfusion Red born syringe syringe should majority to fi have there the the transfusions A-GVHD) titre be of cases, transfused lter be of prevent of Many alloimmunisation antigen(s) controlled be be transfusions to compatible appears at RBCs gestation indicated cell fetal same same old life without anaemia, at fi haemolysin) by ant (170-200 is parvovirus by additional be be lter transfused are birth Jaundice undergone (R1,R1) aware centre be greater an an recommended. require e.g. and without red of component This c serum, through cells through transfusion of (170-200 no between or fi fi appropriate appropriate and (see fetal postnatally fetal transfusion requiring ltration. ltration. ( for cell to in complete straight cellular platelets 51 atypical determined see group can device to for which about that , citrate reduce K) risk . with (grade haemolysis simple c-negative section µ) blood is further alloimmunisation are transfusion maternal treat and infection. We lung , within a a be or section usually RhD or of 0.70 (see standard standard Where Where post transfusion may maternal performed may specifications less manuf µ) the recommend 1%) from phototherapy given an maternal fetal phosphate . both should having 104,105 blood maturity A suppression significantly fi fi top-up or serological negative 9) lter lter 24 alternative section recommendation) inf and still acquired commonly by be, natal normally alloimmunization 51 mild an 4 thrombocytopenia blood small small repeatedly actured neonatal ant’s caused 9.4 0 hours must must (IUT) maternal C Intrauterine have Babies blood prolonged. blood 0.85 alternative been serum only components) transfusions , storage. and red primarily with indications transfusions 8.5.1: DA and volumes volumes dextrose will that be be (most in of significant be 18,96 and require cell giving testing, replaced phototherapy the by giving and of T system for , graft an who and anaemia irradiation) for used. used. utero be Ke is performed antibody intrauterine fetal over maternal Neonatal IUT antibodies exchange adequate Use negative 104 approved fetal ll important to system negative platelet are set are are set . versus : 51 51 little treat risks. the must of for . with a prevent Exchange hyperbilirubinemia Anti-D fetalis. particularly 7.3.2 tertiary ef hyperbilirubinemia disease • Exchange rarely developed thrombosis, (apnoea, approximately from • • • and personnel over citrate documented associated may and umbilical itself blood transfusion RhD cardiac demonstrated associated 5% Exchange 7.3.1 haemolytic offer RhD transfusions immunoglobulin encephalopathy There transfusion. dramatically of fa depending published bilirubin result birth transfusion iled fective jaundice antibodies 5 IA Negative anti-c, plasma, Group of resuscitation sepsis. result a and sensitisation. sensitised thrombocytopenia a including T- day to performed, volumes. of has 15-year exchange metabolism. immunoglobulin newer re cross-match arrest. bilirubin of levels control inadequate in bradycardia, catheter who ferral. old by in transfusion transfusion transfusion been RhD O in the in on with with disease in preventing in Metabolism involving is necrotising RhD decreased in a hypocalcaemia the or 12% for alkalosis or the recommended the adjunct/alternative 113 51 become the electrocardiographic 3 for Neonatal newborn hypocalcaemia, interval Rh Complications Risks (grade pregnancies positive transfusion: Red ABO serum exchange a less an has encephalopathy in in any American Hypothermia transfusions. negative. risks presence capabilities newborn mortality exchange clinical including In and and/ and of inf 1000 increase of intake compatible been Because cell (to red the addition, ants compatible patients; of cyanosis, the in should in and A HDN in severely bilirubin ABO by may or prophylaxis the enterocolits) as of (R1R1) (HDN) ensure exchange Intensive cell the the replacement recommendation) component procedures. the context. Jackson newborn. to who shown citrate transfusion In well subsequent of with Academy of need of air cause transfusion in secondary haemolytic neonatal neonate during and manage antigens 106 only current cases be 2% 111 breastmilk. the exchange occur heart more and severe hyperkalaemia, embolus, are as is levels. vasospasm, optimal dehydrated intensive and c-negative with performed with (kernicterus) more for produces 106 to to Exchange the after antenatal in Care inherent severe transfusion. discharged immature et 106 has changes, exchange, of reduce fa exchange 106 may than related In neonatal occurs era 111,112 maternal specifications of 106 commonest constitutes severe al; maternal period of ilure. to hyperbilirubinemia HDN has aggressive almost intensive hypokalaemia. Unit to red been Pe disease have serious High portal one transfusion which are be patients Recommended 34% phototherapy anaemia pregnancy diatrics been Significant complications blood Isoimmune bicarbonate cell the and hypoglycaemia, management only to due in with an transfusion hard anaemia is or liver and extremely been exchange dose all secondary plasma one and transfusion home as the vein of carried and the indication need function two 107-110 jaundiced reported complications to phototherapy by full cases, a should many one inf function to evaluated cause management and transfusion in bleeding mother and massive maternal recently neonatal intravenous thrombosis trained for whole ants quantify is monitoring shortly for related 20 and at had morbidity Death out now vary haemolytic exchange hydrops has as that exchange was and of birth, exchange be inf had and serum to in 12/02/2008 of for of may as a in to impair has severe ants used. severe after . an 106 low a has 13:21:24 BLOOD (level cells HDN and with high exchange alloantibodies. enough fetal origin of incompatible (occasionally had ABO with but only postpartum mild Group present in a exclusion: whose ABO 7.4 • individually anaemia • the suffice 0.5-0.55 have exchange transfusion anaemic oxygen • • polycythaemic 0.45 whole • haematocrit There whole • TRANSF.tf.indd TRANSF.tf.indd raised the the incorporating drawn with warming controlled transfusion, Since not supernatant Irradiation IUT of Irradiation Tr Blood Collected Haematocrit CMV Irradiated a production can a in to group maternal titre anaemia resuspended may adult HDN maternal-fetal ansfusion low can IV positive where fi the is remaining blood blood O about sera moderate for rst essential delivery and in to evidence, a bilirubin be no (level blood, as seronegative IgG titre result affect exchange unit should clot transfusion for into a about sample. neonatal cause haemoglobin baby O but labelled managed and consensus jaundice, contain recommended is relatively (Hct) or for should IgG maternal-fetal 3% group cells anti-A 11 11 hyperbilibubinaemia. and into 115 plasma 51 does device for is DA recommended screen and a IV 80% of reconstituted ABO with this should compared exchange increased in and potassium ), the Spherocytes essential of syringe 15% level, affected if anti-B T hydrops evidence, ABO not of the exchange units transfused CPD for positive grade a with in Often, this one with 0.50-0.55; not with B IgG exchange incompatibility is all be fi or post transfusion low of thus AB manuf be haemolytic same which rst-born. ET without low should fi is especially a of group A-1 births. anti-B HDN would among where be lter inf used. low donation exclude antibodies a situation . anti-A required post transfused titre their an C plasma Group exchange however, increase ants cord positive Whole is inf if through DA donor is to recommendation) (170-200 levels) in anticoagulant fi titre grade actured appropriate is the pairs transfusion very ants. ltration. a and O plasma be whole HbF exchange, T within for Ty Hct. the transfusion; are in lead the detected packs Only for lower with neonatologists blood and mother in pically inf O plasma the the is used in can rare. blood, may exposure, all disease 114 should in in developed . updated prominent C the Hct both eluate ant pregnancies. considered The to the A a have involving mothers the anti-B clinically 10% which ABO blood. exchange HB straight and diagnosis. mother 24 recommendation). The standard Where risk to anti-A component Hb be clinically absence suffice µ) for has is Unlike ABO risk diagnosis US hyprbilibubinaemia and be hours with 24 fi < anti-A in used approved given there too be or which DA of obtained lter transfusion. of HDN, , of 1 haemolysis 12g/dl a had the BCSH is labelled guidelines of hours an The but the making repeated and T is DA of small from thermostatically HDN the high, group a on significant clinically . estimated must for a may Rh but of supportive blood on Hct will alternative a significant absence rise transfusions. Group and black previous of T- as continues inf subsequent this a advantages ABO anti-B massive newborn irradiation. a positive, with disease, is the 4 blood after any guideline this the ant volumes in causes be the for in be of double-volume be to 0 O with anti-B one C the should giving a African all 0.35- mothers, severe appropriate increased if O HDN significant If negative packs group blood used. other recommend a results storage. severe neonate 96 severely , delivery negative compatible haemolysis to baby of an but smear. Hct red actual of To evidence . delay system ABO- 51 to mild ABO be IUT and are set be occurs avoid should 51 one top-up of of A will fa in ll, is Hct . in A 51 will be a platelet should (obtained, 150 found The 8.1 Section exposure 52% platelet who premature most intraventricular Intracranial marker severe died nontransfused thrombocytopenia Tw without is alloimmune platelet has a by total 50 associated < An complicated preterm response low numbers fi Apart to important investigation in thrombocytopenia exclude an by is in Most 50 platelet This an occurs discovered and mechanisms rst result risk the outside 50 the the be o 72 day anticoagulated excellent x x important levels not are 72 circulating studies early require to was of 10 10 received commonly episodes impaired x fa commonest from neonatal puncture hours in 7-10 be thrombocytopenia in 400 10 1389 of hours ctor DIC. 9 9 counts transfusions; transfusion nadir may been probably platelet inf older /l, /l, of haemorrhage 8 sick to to mechanism the thrombocytopenia of overall 9 considered for ants inf /L) anaemia thrombocytopenia following rapidly is haemorrhage clonogenic thrombocytopenia 118, x and one have two thrombocytopenia. of review by of be thrombopoietin are of ants cause around established. unusual example, patients 10 scope of low-birth-weight children more platelet inf at of 123 life. platelet in life. haemorrhage period Neonatal Aetiology placental site. are the erroneously in clumping. donors. the life. or 9 unclear multif disease ants. birth /L simultaneously shown thrombocytopenia to clinical venous (> is progressive, the 118 The more typically many of in of 116 than due therapeutic of and the a Confirmation routine day 72 Severe 48% abnormal. 124,125 and neonates for Roberts with admitted fi group in early actorial. production and A this by count the megakaryocyte aetiological rst commonest to a in a platelet h platelet insufficiency 4 one. complete 7 this causes in severity condition in sample heel platelet Thrombocytopenia ten term The 24 of over direct adults, and a iatrogenic review received Del the severe born low neonates (Tpo) blood has who substantial (PIVH) thrombocytopenia, 124 in age) early is hours, fold (NAIT 119-122 (2005) preterm puncture) prolonged one a to form Ve healthy 75% or which often because bene a Although counts collected transfusions, . In following of recovery cause were and as the the of recovery and suggesting cchio, preterm counts in consistent or thrombocytopenia review thrombocytopenia precipitating role none randomised neonatal , in 1 occurs haematological with thrombocytopenia of evidenced preterm see fi Affected of higher blood severe, . should normal NICU inspection and/ assigned 117 platelet t preterm readers progenitors transfused babies. periventicular- neonates of of of episodes of proportion showed of The of correlate section almost and during of of platelet capillary thrombocytopenia death venous pregnancies less inf or is the platelet in loss, received mortality the thrombocytopenia platelet be ant inf range platelet pattern highest fetal spontaneous. may an sick compared transfusion, thrombocytopenic are The inf than neonates by controlled ants. thrombocytopenic platelet late considered aetiology suggesting intensive all of that impaired is 8.5.1) ants is occurring blood transfusions whenever hypoxia. well decreased re occur preterm and platelet of responsible neonatal a developing similar aggregation is 150 abnormality onset ferred numbers Sepsis- one with blood count in is 9.4% incidence (platelets the between are with . requires relatively thought inf nadir samples, to Sepsis with x who or latter a and ants care. Tpo trial while 118 to 118 10 counts inf to of in fi < a more that lm as that or ants < the An a 9 of 10 /L to 12/02/2008

13:21:24 Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie BLOOD

Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie TRANSF.tf.indd TRANSF.tf.indd 11 bleeding The The liver, ductus The variables the Use not pre indomethacin Blood inf ABO 8.3 The the difference platelets Group group after O Inf existent Establishing in the particularly threshold a US *`There 8.2 20-30 Ta 30 30 50 50 50 < 50-100 20 inf various ants ant ferable 100 guidelines ble neonate have two platelet gestational presence degree relative x x x x x of ants renal x platelet identical 10 10 10 10 10 and 12 12 O Tr O 10 medications who arteriosus 5. x x groups( ansfusion coagulopthy 9 9 9 9 9 is children. x only platelets high and /l /l /l /l /l 10 10 in as 9 (level clinical 10 /l donor function; for little in Suggested infants during ( 9 addition count 9 have of risks /l passive /l is a in 9 level the concentrates lower /l when which titre Group of platelets quote threshold illness particularly this evidence Groups) Platelets Guidelines not age 28% the (see other should frequency 128 Minimum Sick First Pr For Invasive Inf Clinically small (BCSH, inf if (B loss settings of or 1V fell are the haemolysins.* (SHO bleeding under et setting levels CS ant ant, cited) platelet which different Also, HP to - to is . anti-A prophylaxis, a er evidence, B 51 Section preterm /massive e.g. week below preterm vs.26%) the fi H, 30 frequently coagulation m platelet the undergoing prevent A blood recipients not rst are T) be for 2004) procedure 20 antibody or base for sepsis, the 4 unstable, platelet of is least in x difficult impairs platelet bleeding has with of of or few 51,1 not ABO ter for 04 months of 10 count prophylactic required 150,000 inf clotting neonatal 8.5.1) or degrees life volumes. International Group m anti-B ) . intracranial transfusion inf grade 51 to 126 9 51 ancy neonatal reported IVH. available, transfusion suitable term /l days a clinically ne in ants identical count necrotising can guide administered qualification and EC trigger. 51 fell platelet DIC, because on very count. (BCSH, abnormalities of inf are C MO; O fa may at of impair in have x to transfusion vice of ant ctors; e, recommendation) in major age The were small practice small, 10 life stable group largely platelet two <50 higher wit inf platelet thrombocytopenia 1 127 group lead not or haemorrhage The function 2004)* 9 Forum versa. ant platelet a /l, UK or h of thresholds preterm surgery transfused cases compatible. These enterocolits higher bl bleeding x preterm preterm if versus the that with for to BCSH eed platelet to Serious unknown. 10 A there in transfusions transfusion haemolysis Platelets e.g. close platelets non-Group on (ABO in large function 9 NAIT this a , /l, of e.g. include: inf g massive risk higher transfusion transfusing DIC; or showed recommends is haemolysis ant threshold babies, area. for Hazards a term because number to a between of and Where (NE 117 patent co- non- should are blood The in in C) Rh no , of of • the with Platelets if make haemolysis the of • • RhD 8.4 an • Platelets recommended. concentrates by dilution titres’ be the antigen be plasma Anti-D negative the 6 clinically donations. determining absence * transfusions solution reduced anti-A/anti-B to have large platelets. negative O, An a weeks ten apheresis will anti-D appropriate used avoided unit same transfusion only administration extension the current using acceptable transfusion seronegative Antigen Human it (see tested (but blood repeated to neonatal to on RBCs, apheresis-derived CMV All Components Platelets a absence negative plasma volumes. of only will 50 remain screen immunoglobulin reduce prevent Irradiation) platelets from tests of (HLA) implementation to available anti-A as and are female of patients (based see are should A also prophylaxis, ml fi seonegative. be 96,130 a RhD group group reduce ltration. irradiation to unless soon dose in haemolysis shelf-life closed Platelet what in infusions should platelets such (HLA) with the usually possible in .* section is apheresis for fi vulnerable of ensure non-group platelet platelets section 130 further , 96 of or fi relatively lter the In Components Platelet of vitro. anti-B positive required, (level of lter of on be high for volume as antibodies, of O neonatal Some the human addition but product, ABO constitutes should blood group donors. . of other the leucoreduced (170-200) Where rare childbearing system platelets 50 transfused matched 150 possible. be must neonatal 96 infused Antigen group 8.3 shelf-life a especially titre of has , IIb and donor and 2.1.3) transfusion. to risk of and/ from IU/250 limited However, should antibodies residual risk. should risk normal component There platelets platelet components platelet of requirements low IU O subdivide replaced to evidence, platelet above) RhD O RhD be 96 be no haemolysins the small if ABO they use of bacterial platelets to ABO- recipients of O or of There further a free exposure including titres in available. used. from ef platelets (HP haemolysis. use ‘high fore, reduce The platelet single supernatant intravenous positive negative anti-A or to TA be of supplied be fect through inf individuals, should mls leucocyte blood . female potential volumes pack concentrates antigen of an one has A) -G components in apheresis ants given are related administered with 51 group and which number is recipients, a grade titre’ on adult treatment VHD. an clinically specifications: or alternate to testing ,B donation donor. no are to donor dose irradiated is 129 if concentrates groups, high are such in in platelets , the may be Human emergency non- saline does platelets inf a can where given of split by be standard If O inf although a are pack) not (HP B standard in haemolysis This Unlike negative ants. count required, anti-D platelets ABO Group of volume mostly plasma the where donors given titre ants escape recommendation) O At platelets as of receipt cause exposure. into significant not drawn available, A) or incompatible who system in recipients with into is concludes component that platelets present, possible human IBT Leucocyte . to over anti-A by Nevertheless, platelet compatibility antibody who sufficiently 5 of guarantee are the two and covers method O possible. of , S any highly are days. 4 of intravascular should with the platelet blood have or for < of detection and (see in suspended Platelets are aliquots pre situation group a to require 10-20 following aliquots incorporating followed 1x10 where RhD to leucocyte not The RhD period high and IBT the the ‘low 7 to and irregular ferred CMV- additive been should for Section With a active giving that in 12/02/2008 days, for be S RhD Group should syringe platelet anti-B 6 O, positive titre blood up the ml/kg. is , . are of by with and set in 9 , 13:21:24 BLOOD mother thrombocytopenic (platelet is problems. petechiae, from 2.2 with thrombocytopenia, identified retardation, anomalies. maternal such on Diagnosis 8.5.3 fetalis ventriculomegaly More haemorrhages or which (ICH) healthy the child presents Whilst 8.5.2 antigen induced antigen formation, disorder. in the be UK rate Results antigens. ethnic anti-HP 3a for is The and neonatal HP platelets. maternal with against 8.5 fetal (platelets The Background 8.5.1 TRANSF.tf.indd TRANSF.tf.indd usually HP a is A-1a, the considered and the kg, newborn cause and study is second most is one the found platelets. other is A-5b. as unusual is varies responsible and groups much FNAIT exclusion remaining grade usually HP A-1a has child which from and account 1 the bacterial 136 FNAIT mother’s count 131 or which alloimmune as autoimmune sensitisation 141 fa < three important of in is of 117 for A 133 ecchymoses; intrauterine causes to cilitated Certain more congenital thrombocytopenia most 50 an most HLA-DRw6. Making 1100 due Irish 15a from lower at FNAIT due The occurs screening >1, have is example, Less 13 13 A presentations and the when . <100 (FNAIT) affected are The 134,137 isolated Neonatal is x Fetal/Neonatal birth. criteria Clinical Diagnosis in study for , of to 10 and of: and to hospitals serious maternal 5% porencephalic platelets present common antenatal 7% maternal other purpura. so for of in less with platelet a commonly other paternal HLA antibodies by the cause RhD 9 is the in a investigations /L) low Ireland. thrombocytopenia. thrombocytopenia. x the A The fungal 15b. in FNAIT to (ITP of to 1-min usually infections approximately the death which 10 women common. only severe studies similar majority with presentation the distinction ways and 138 20%, at types paternal platelet 222 or immune causes ethnic complication, on 9 neonate , of maternal but /l) count alloantibody suggesting platelet SLE) birth alloantibody Antigen ABO occurrence, The Caucasian derived 1 134,135 include thrombocytopenia. sepsis, (3) platelets in in severe Apgar distinguishes cases or made analogous implicated case not to crosses of are fi thrombocytopenia Allo-immune who approximately show second nding origin absence laboratory of cysts, , in there count low of (CMV < incompatibility which severe antigens Intracranial However thrombocytopenia thought associated an affected usually from are antigen 50 in neonatal frequencies NE have platelet on score fetal unexplained of thrombocytopenia incidence 1 that otherwise 16,500 of is of is optic , under- neonatal performed. x the the C, population by clinical in produced and toxoplasma, 50% is or This autoimmune These seen a HDN 10 98% to suspected antigens platelet of the intrauterine 1,200 severe chance. directed, > history presents to signs placenta diagnosis reported present involved cases the haemolytic 9 third cases additional hypoplasia, count, /l; Thrombocytopenia 5, thrombocytopenia arises be HLA-DR3*0101 occur haemorrhage recognition 80% with with births of or grounds, 131 (2) birthweight were: clinical or , thrombocytopenia well vary gestational births in hydrocephalus, trimesters. the chromosomal FNAIT of antigen in does of of private accounting include FNAIT of Visceral ICH in the alloantibody FNAIT Ve on is in of following with bleeding in an cases incidence and rubella) immune observed FNAIT baby population in of HP that (1) causes ry usually growth utero. cases. FNAIT medical fetal HP in detection disease otherwise not associated different FNAIT hydrops depending rarely A-1a due destroys petechiae severe the , platelet typically target, the A of HP the is should > react 140 132,139 , 5b 132 the to i.e. A fi of of rst transfusion of platelets in laboratories cases is to neonatal trigger Tr involves cerebral investigations that 8.5.4 as specific assay antibody the in remembered low a the should presence has are count thrombocytopenia Cerebral that therapy The apheresis (to collect A pending strategy of If up usually 10 with of occur logistical transfusing antibody out random a (BCSH platelets cases supply compatible transfusion strong eatment the recent 95 the suitable associated HP further the platelet severe 9 until mother’s ability remove incidence /l) not of the been role a moderate , A-1a % 142 transfusion maternal analysed in antigen has response of 27 in for of maternal be between readily immobilization antigen UK or platelet 6 of (IVIG) donor bleeds clinical is activity 75% in the thrombocytopenia of retrospective 16 known was cannot ultrasound problems strategy to HP obtained prolonged newborns of weeks platelet should fa matched repeated been enzyme-linked concentrates cases. a negative the services antibody-laden high platelets platelet service. random suggest cilities detect inf platelets an availability logistical A that platelet regarded and as of source given platelets available platelet ants. management compatible serum at is Po III, intracranial suspicion present antigen to achieved. takes FNAIT dose platelets be some cases. 1 144 may of fa not highest the private transfusion for stnatal grade (platelet the and on and anti-HP with ilure 146 platelets transfusion identified, HP However, post donors. because donor had should on HP thrombocytopenia should be dysfunction. and the Oxford should occur. does (1g/kg) challenge site up study antigen (MAIP The , may increments 149-151 A 2 of as daily two A where in the typing or on to from delayed C a transfusion weeks compatible antigens to situation immunoassay which management of in 1a, compatible the FNAIT a and platelets. platelet platelets The detect the plasma) A-15 recommendation) authors the haemorrhage. (platelet count not take be provision consecutive be two the suboptimal FNAITP on thereafter A) of are be IVIG of and 5b random mother’s is the consideration intravenous elective using antibody delays performed of duration ordered fa . exclude unexpected, guidelines, 143 the the fi higher must performed. days but for days not antibodies negative pending ther’s rst unexpectedly 51 the Cambridge < a provision may increment using where in The be conclude use platelet-specific low are the 30 count prolonged , The 48 immediately The indirect to platelets. 8 screening parents, of to platelets. be fore associated to donors be delivery than serum or platelets until where confirm x in anticipated. of IBT frequency of antibody the approach cannot hours of or maternal take complete days the treatment irradiated use 10 compatible the significant considered in platelets advance FNAIT antigen The use. of thrombocytopenia monoclonal immunoglobulin 2003) S of diagnosis. and 9 a should for severe all paternal immunofluorescence /l) It that along ef above platelet of is results is 30 which stable demonstrates HP problems after 144,147,148 should platelet thrombocytopenia Data is fect cases be showed that other an for to also where random is assay available x A with performed, . (evidence platelets; the 145 to (approx and identified, positive, exclude absent appropriate 10 and from are antibodies of with compatible be delivery NAIT and 40 an alloantibody In treatment shows from or limited (> of platelets However, immunology platelets causes transfusion in of 9 choice donation. be /l) given the those antibody– there count compatible There increment must rising washed x that 80 cases may other in the severe donor 10 cases, due 600 on the or risk 2.5%) the . lack x level 9 in The blood 24 to /l, is is only have HP the of is are to of 12 to of A 12/02/2008

13:21:24 Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie BLOOD

Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie TRANSF.tf.indd TRANSF.tf.indd 13 • • • • of previous be immunoglobulin index The paternal explained The 8.5.5 8.5.6 subject. this is in is blood can early count severity when is counts has • thrombocytopenic. is morbidity complicated and Autoimmune 8.5.7 antibody lupus with thrombocytopenic of • heterozygous. expected also rarely alloimmune the autoantibodies administered to maternal screening is pending of platelets strategy 95 which performed FNAIT repeat Failure Tr HP The Early Tr document been be fetal results disease diagnosis other in ansfusion eatment strongly case. erythematosus. it samples 14 14 and test suspected antenatal A clear % following carried 152-156 subsequent does treatment of less zygosity sibling 1a seen re platelets. and well of may to level autoimmune for antibody should thrombocytopenia to ferral of if and Re that in the cases by is the than serum occur thrombocytopenia detect the mortality antibodies of investigations documented disorders suspected and in should four and the out not likely to ferral maternal of Follow-up of and Maternal recommendation) of Recommendations availability management +/- 5b parents. based the there splenectomy AIT to Either for FNAIT determine fa from 50 be 159 autoantibody of purpura random management FNAIT on have implications Approximately should the weeks it ther a screen negative does pregnancies. response to maternal the a steroids to is choice made is x Fetal chorionic not Unlike platelet-specific is reader 10 be mothers towards is on a conditions not maternal been is including implicated no ITP to The Fetal not minimal, the autoimmune in be 9 be as the homozygous later donor /1, (ITP) of Medicine of in related that low correlation neonate . is the 157 delayed platelets FNAIT exclude severe investigations or provided observed recurrence compatible detectable subsequent the serum is of for to severity ICH the Medicine for villous to incidence antigen(s) seen fetal is women with fetal The re or of FNAITP treatment. platelets therapy ITP 1 maternal FNAIT Fetal identify as due ferred transfusion such future rarely to it severe, antigen. , in for the if risk isolated may Specialist against platelet the type pending in birth the still ( which 10,000 amniotic not for of to thrombocytopenia alloantibody Ev postnatal in between alloantigen or the as with specificity Specialist to of at inf should if rate the the platelets. pregnancies with is diagnosis. idence deliver be the antigens. transfusion weak pregnancies where more is 50% common trauma. unexpected maternal ever serum ant delivery recent significant mother should beyond A A an are normal seen paternal passive transfusions disorder immune inf is the intravenous of pregnancies detailed 100% with platelet fl appropriate happens if based ant. severe antibodies be compatible the uid level babies HP the management heterozygous. should 157,158 146,96 in papers include of with . genotyping to arranged In the in to expertise Where A platelet In systemic or platelet association fa transfer the platelets recurrence in III, in the addition, the compatible should maternal inf fa on ther fetal analysis FNAIT count than scope expertise who all the ct It grade ant and be platelet the (AIT) may on it cases FNAIT are in the are the , be in of C a intravenous blood 2005) doses the should consecutive does leucodepleted one 12 of In management in short Spontaneous count observed of The prevent irradiation 9 the days The Newborns, 9 white viable In Recommendation FNAIT response unable transfusion secondary the relatives. patients, to threatening transfusions tract However preterm, rash, sharing Tr should exist. transfuse in occurring Section issues inf a and rare ansfusion-associated .1 . the these the neonatal ants the Tr mothers 2 reports treatment management engraftment adults, reported bleeding neonatal ansfusion 90 and 1–3 diarrhoea, reduce course cells components baby’s is fi . lymphocytes, poor but are for since be be are Although to rst These as TA below patients. are TA The bone the 9 within against reject 1-6 irradiated and usually which added. given required of 3 -G to occurs in of immunode particularly very with survival -G thrombocytopenia recipients haemorrhage immunoglobulin days considered years should the the of circulation. blood VHD magnitude bone case the manifestations platelet use TA of recovery VHD of weeks it inf RBCs. (SHO 20 marrow prednisolone Effect Disease Risk Tr abnormalities few them. AIT is 3 in maternal -G implementation of no life- risk 161 newborns ants units. An of fa and the ansfusion of within weeks during x as conjunction (1996-1999) of VHD, (Nov marrow components due donor of usually tal is Platelet irre cellular be 10 are ITP T) cases fresh of extensive 25,26,128,163 but threatening after TA fi host, it count a if are are donor of immunological those cient The 9 of adverse futable, manifesting reserved TA abrogates to graft 145 /1 further this significantly -G (BCSH) to 1999 of fa all does leucodepletion this after the (T AITP T usually at (ICH) -GVHD the blood, VHD milies transfusion. of targets be or arises aplasia. the disease, Fu especially fa lymphocytes A-GVHD) blood often transfusions fa when risk. platelets (1g/kg/) who including versus (2-4mg/kg/day TA inf tal. time if of Acquired rther ils at poor due not It birth. in with scientifically review risk risk are reporting there . ant in -G is 22-24 . liver is for increased 162 of to of containing i.e. the Larger haemorrhage very where Among are fa components the eliminate in compared a the frame VHD the to likely covered survival Immunocompromised and aspects universal raise fa the as intravenous platelet lls the which recipients host patient less preterm However, UK) function maternal In ctor. is of in transfusion very proliferative by well should only after skin, fever, the TA UK significant the the treatment the have low that there doses on in the that should than Strauss , Graft disease system, -G immunocompetent there risk is low and risk accepted a of Serious requirement liver, 6 count birth in of who proven baby’s it. a VHD risk birth erythematous platelet an leucodepletion leucodepletion to recipient infants ever bleeding be years PO) large and donor the in At is the of of birth AITP if are born are of (ICH) older Ve IgG. immunological has of be children HLA did gastro-intestinal the given to present blood ICH there (2000) weight results (T complication TA guidelines is of pancytopenia antenatal been capability for bleeding rsus controversial TA circulation required answers A-G reserved a number Hazards (2000- preterm been at usually platelet receive platelets -G platelet count life- method nadir children and -GVHD 7-14 in haplotype who on occurs. term. VHD. were VHD) from reported Host children to and from 90 with 12/02/2008 gamma larger two only on skin then is days then of due of of for for to is and 160 a 13:21:24 BLOOD • Munster 9.4 would an issue days. inf neonates transfusion. to and shelf of In reaches extracellular fa developed exchange depending nonirradiated During 5 high infused irradiated central in combined immunode GV inf for fl 9.3 that share developed Report birth, Thus, multiply TRANSF.tf.indd TRANSF.tf.indd uid. Donations All grade second Ta Underlying Primary Reported No Aplastic Exchange Intrauterine Related ctors of a this ants ants, a reports, HD irradiator large 62 ble hence blood the the 90 transfusions concentrations acknowledged life. when The to despite between be country A is could storage (1996-1997) line for day unexpected with B transfused inf hospitals, 73 6 a case Centre. volume always degree If to Immunode is blood 48 result Anaemia immunode transfusion fi plateau irradiator recommendation) published ant TA within GV routine on all a of ciency old episodes easily Many transfusion from irradiate on-site. each fl Medical transfusion only hours -G and 15 15 units: years HD. uid of 120 pedipacks the was and Recommendations published guidelines of cellular baby the of The VHD: donor Fatal would of fa Only transfusions hyperkalaemia-induced relatives the fa (red and, 22 TA exchange be storage y-irradiated hospital small-volume this implemented. level tal disorder irradiation in mls probably inf mily life with previously 70meq/l, of is TA effect fi risk in -GVHD Investigations girl fi in each , used fi the condition occurring ciency and ant one ciency a has cell, limited within rst would experience the -G TA be of blood English, of members: premature only non-irradiated following fa were is VHD UK, and year -GVHD 6 by the to must approximately hospital are a solution ctor individual primary blood up of platelets needed. may day shelf-life suffering transfusion increase disease in a . the mean disease. of irradiation to irradiated with . components which presence to one 92 RBCs, largely of irradiated during few the outside be of all old Although RBC the not However 14 banks BCSH life, the with of a in inf unit blood cellular irradiated and inf days, revealed for fetus that 90 red days and IBT be range is pedipack ants the potassium infants recorded ant, transfusion based of In inf donor from rapid why the RBCs thousands can apparent the S in cells of red of assigned the on ancy only granulocytes) (1996a) by the cardiac red double and bank instead at born the in the in the gamma-irradiation an components of irradiated to quantity a be red cells infusion the fi the exposure. whom an this on concentration which cell (level 24 rare rst 55-100mE neonate: over is underlying dose US reduce during recognised immediately quite in at 73 HLA-haplotype blood IBT rare. the NBC leaks the UK hours. country have arrest donors, shortly the . of is 32 164 pedipacks have form of cases the TA S of had III small, 1 5 5 guidelines of the 9 Number 26 27 dangerous level through SHO country transfused However weeks be blood and -G the potassium cells into evidence, a fi next extracellular from irradiators These of The occurred fore been current for rst 14-day VHD after q/l, primary and access with T in risk severe the the risk the be Annual month, for year ideal fi and to a has rst also fore of only TA 35 or - clotting The Se not of • • • • • • • • Cardiac Granulocyte Platelet To When Exchange IUT Intrauterine who who syndrome Dysmorphic chromosome should high suggest with There recommendation) undergoing All the red transfusions thrombocytopenia as ef irradiates Platelet or top-up The All severe irradiated will ir been of Blood transfusion: grade has and provided For be All adults; ra ct fect p-up an unless irradiation clotting soon irradiated granulocyte transfusions blood, di ion only fi cells and other been exchange UK a need do index at rst indication a a proteins on is for variety B ed transfusions be combined 10 transfusions: previous not transfusions: surgery: child those transfusions year subsequent BCSH as have co-existing no recommendation) or this product. a the (RBCs exchange all ET pe irradiated. has transfusion: cardiac (level times of possible previous platelets have need transfusion cardiac inf di transfusions: platelets given (level (level of or does has suspicion. inf 22, of a Fr pa of been transfusion ants by Guideline transfusions for 14 life ‘top-up’ ant (red congenital esh intrauterine ck of III or premature all . to i.e. a immunode the We surgery must after not plasma. day s should proven III III normal platelets) evidence, is with surgery the irradiate of after immunode excluded. transfusions IUT exchange are cell, in ar Fr in It for liver) in recommend evidence, evidence, preterm unduly e utero ozen shelf-life. 16 is utero (IUT) features transfusion birth be another variants of truncus re 4 platelets neonatal does irradiation increasingly should must co If be or inf RBCs may irradiated . cardiac unless inf fi must transfusion in : red must mm Plasma/ to ciency) for ant for suspected 51 irradiated. delay grade ants fi doubt, not transfusion or inf ciency (grade be be or grade grade cells of ‘at alloimmmune en of intrauterine irradiation blood or have term be ants and use be that require clinical even lesions transfused (with de interrupted Di Di must risk’ transfusion. (level platelets : B irradiated and cellular irradiated. d or recogniz George’s George’s SD granulocytes) as but inf irradiated who all recommendation) B B are C wh group of immunode platelets longer reduced be ants irradiation all recommendation) recommendation) III -P platelets recommendation) or irradiation ic (ET) there have RBCs longer is have evidence, h irradiated lasma platelet transfusion laboratory (l blood advisable at unless ed within ev in aortic and but or syndrome syndrome. Blood The lesions needs af el which blood received or that synthesis for than ‘top-up’ te fi for on II transfused components platelets, ciency has IBT r I must for inf 24 arch there ir ev inf grade if for its inf until ra those to ants case features of S there id no routine hours ants must ants di own IUT be now 51 and en be at (e.g. has of . . the . B ce io a 14 in is n 12/02/2008 ,

13:21:25 Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie BLOOD

Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie TRANSF.tf.indd TRANSF.tf.indd 15 Clotting bleeding. also HDN prolonged platelets malabsorption healthy by dose or In disease. Late In massive 8.5) are: to a of further Responses being and prevent of anticoagulants. K, in prevent should as C with hypoxia, administered leading ef inf A 10.1 haemophilia. FFP/SD-Plasma significant are Prophylactic be • a between Newborn • weeks 10.2 dependent Early result dose fect randomised babies an the ants recommendation). the inf birth vitamin e.g. DIC well exacerbated recommendation) babies Routine FFP at , babies neonatal inherited FFP significant ants vitamin HDN, of otherwise should 16 16 transfused HDN sick, risk mother on anticonvulsants, be be of to supportive (secondary as is breast-fed to of 117 haemostatic this vitamin should studies transfusion hypotension, and 2 or fore the who inf prevent caused vitamin with K recorded. the haemorrhagic of maternal is in coagulopathy usually 2-8 and ( clotting should administration presenting SD-Plasma ants disease 117 at K not grade vitamin be severe bleeding risk fi to alloimmune de during term. correction have controlled liver brinogen, require de 117 birth weeks never coagulopathy 7 K; well Haemorrhagic all treated fi by in indicated. have Neonates is ciencies fi (section of K days by Prevention periventricular care. babies HDN ciency preterm baby babies be to breast 166 disease. fa A indicated not is medication and death de inf in K which severe fa the ctors perinatal be FFP . recommendation) sepsis recommended. monitored, prolonged from moderately after fi inf (single ilure ant, of antituberculous with received The by ciency (10-20 . by show antenatal although 165 used disease of last trial ants, age. thrombocytopenia (haemorrhagic with feeding, 4.4 in of 166 or of at vitamin (Factors the classically the inf abnormal an with A associated birth, severe vitamin Late clinical this or clotting of 4 (1b a disability FFP for of and ant, dose acute intramuscular a This as . chronic particularly invasive asphyxia, commonest similar single weeks disease liver early that ml/kg) prophylactic prolonged coagulopathy prophylactic sick, country haemorrhage vitamin of HDN as a evidence, can bleeding the bleeding, to decreased administration K prematurity simple physiological haemorrhage of response K II, the disorders interferes blood they prevent (1 fa 165 HDN coagulation prophylactic usually presents occur APTT de VII, 15ml/kg dose of in liver ctors, can with therapy procedure when mg) newborn. of (level . fi NE K babies immediately pregnancy disease will IX ciency if volume loss) the is PT supplementation. disease is be causes is often C, major in RBCs grade intravenously may dose) and (see early particularly PVH serve by preterm levels most vitamin there in required , or newborn breast-fed with sepsis) IV with prevented (PVH) and and at . and of a a born in in de X) 117 also evidence, of of within above secondary 2-7 bleeding parameters single replacement because FFP blood in FFP intramuscular in is A often as of inf utero normal fi vitamin , liver is . or bleeding of oral 117 oral the most ciency preterm routinely SA K more after ants significant be bleeding had inf days a or vitamin-K to in as at newborn) guide G-M 24 (HDN) disease section ants vitamin loss injection liver caused as in treat preterm babies marked birth. and well no who birth than patient of of h can the grade 117 to and are age to as or in K to 8 , Patients present 10.3 association bleeding fa pharmacologic patients virus-inactivated the ml. pre The concentrates. fi of Cryoprecipitate Section Blood reported concentrates SD-Plasma O 10.4 containing for evidence, micron the group be or vCJD, FFP this FFP A evidence, Rh use solvent haemolysins FFP Ta brinogen, A *Uniplas AB B the A O ABO Infant is ctor standard FFP FFP anti-B given ferred fa D-negative and not ble product Rh Despite contains for most or and for IB ctor concentrates. O Centre. a group TS a because status fi at SD anti-B, all detergent 7 in inf US with lter may licensed with to to SD-Plasma is haemolysins. 11 V is to common 1 grade grade primarily patients the ants II, Factor Plasma with 180-micron group the replacement. with a is to sourced, of its plasma-derived can Principles according groups and IX neither Compatible Vo be blend inherited available of a intended newborn 6 choice patients agents high National provided is and nWillebrand’s new 0 Inherited replacement B B of Cryoprecipitate FFP/SD-Plasma the a particularly be products C. product for prepared process, O VIII recommendation) recommendation) for specialised the including must use of Cryoprecipitate used levels X recipients. recipient. in many product anti-A Recombinant of pooled issue A, and for are Group (e.g., relatively FFP for O, for B, de infants. A, of for AB receive to period any blood B Haemovigilance by be in A treating Prothrombin ABO AB for fi deficiencies AB use selection remain Factor fa used donor and of ciencies years cryoprecipitate to called Ireland. ,B nor the by DD Rh ABO susceptible ctors plasma, neonates small-volume products. and , Factor of AB O as disease AB No fi centre. AB the and Group AV Inf type lter anti-B Rh IBT for the FFP high a has patients. and XIII compatible adverse and haemophilia; fi anti-D ants II, P) plasmas SD-Plasma, universal controlled S D-positive rst-line fa should fa is is of de of . V VIII, may virally or ctors, or been has volumes ctor in used recipient a . of ABO and clotting fi Tr should complex of and or FFP Because There concentrated SD- cient virus-inactivated a eatment to Donor cryoprecipitate prophylaxis be clotting to Office At neonates volume II reactions with A, Uniplas* O, B, always is X. treatment. transfusions. from SD-Plasma haemolysis inactivated when may for plasma, and be compatibility time or Plasma given to Uniplas* Uniplas* A, fa with thawing Plasma be FFP are required fa transfusion. is SD-Plasma low recombinant ctor low Plasma ABO B, restore concentrates X contain AB at ctors of treated imported of available, or of factors Uniplas* . be no the de 165,18 regardless the titres but writing, titre who with the prevention plasma, should 10 must fi is managed single blood is Likewise, source of recipient. may ciencies. 165 by used National from required fi (level risk to used for of anti-A is are brinogen specific a fa with (level 12/02/2008 the only 15 anti- not unit this for ctor An are be fa of by group since not or of II ctor of 80- II1 a of in if 13:21:25 BLOOD be transfusion or haemolysis in The where investigated of Avoiding RBCs, unnecessary of that Any requiring neglecting potential in 26 of samples 98% occurred E.Coli haemolysis of inf RBCs 48 recommendation) associated and associated the A 375 intensive transfusing appropriate policies The enterocolitis patients life. against is streptococcus, is Neuraminidase neuraminic erythrocytes The Section transfusion transfusion; IBT the Neonates levels A replacement DIC standard about TRANSF.tf.indd TRANSF.tf.indd prospective dose an not the inf ants where specially inf inf standard indicated S of of occurrence cryoprecipitate It 19% and provision clinical red patient only ants neonates ants ants IgM is of has 48 375 present small in 0.6 septicaemia; of possible, washed (0.8%) of group the in babies cell whose patients massive contained whom a transfusion risk dose haemostasis there care be (54%) 12 antibody with developed with with been to 1 should neonatal inf single the with haemolysis acid clearly occurred. T using of prepared plasma importance fore with blood proportion transfusion an to T- . to 1 (NE 165 but particularly ants 168,169 of antigen of 17 17 AB in observational antigen single T- population sepsis T- g/L. and developed is 2 need pneumococcus, determine platelets is 80-micron had of is postulated red 27% (level include haemolysis the following activated with receiving low-titre C) the activated NE expressed T units/10 usually with . transfusion. . a inf be low produced components, (12.8%) T- A identified present Activation to . suitable high T the actually cells T medicine C onset ant In plasma standard for given NE and units. 168 of T but developed blood variant or investigate IV may titre acquired who is support inf of following activation haemolysis of plasma-containing had management a C. coagulation The suspicion NE evidence, and of sufficient a are ants, not T- anti- inf involving haemolysis; lectin exposure the red of any T RBCs kg fi anti- T crypt be only develops that in developed fi variant C components for lter only causes may ants by classical study activation of activation brinogen activated to FFP NE activation T routine the is raises is associated T cause 180-micron cells The blood a T 165,169 inf variant a neonatal hypofibrinogenaemia have this clostridia ABO-compatible may but components, unclear. test not C antigen single at after introduce plasma transfusion. variety received in the plasma ants were low or was of grade to activated small over least was in the no haemolysis. ubiquitous justified to a to fa be (level haemolysis, of component. resulted screening sepsis. same; occurrence achieve T an in centres the small than 2 T- ctors antibodies. until e.g. in neuraminidase. transfusion-associated was look unit carried healthy of this. setting activation, used associated 2000 of had anti- or Debate present one use and volume C for attempt relation and of with removal their significant II inf blood organisms, a T- blood recommendation). with 51 about of not an for almost child’s in / inf Only and RBCs 168 NE T greater supplied episode variant-activated ants red for such from This bacteroides. haemostasis. III on cryoprecipitate haemolysis samples critically is out ants antibody of exchange inf RBCs. T- always for It C FFP evidence, regarding allows small-volume on the should only fi cryoprecipitate; cell It to components of whether to activation. documented ants. 3 was 6 with and the lter of should, The to as fi T T is in all with of with transfusion months prevent T- all . brinogen risk provision activation, activation N-acetyl- products examine amounts as noteworthy a of warranted washed activation- remaining 167 by is Donor adults found 375 in one necrotising temporally human 48% remaining ill from neonatal more directed occurs sepsis be DIC used NE particular from the inf in grade Anti- 94 51 C ants of a and that but rapid as level is for may 169 T in a B guideline Ke Appendix Dr 1b 1a Ev and 111 11b 11a Consultant Professor Chairman: Grades 1V Tr MEMBERS Appendix B Ms Crumlin, Street St, Dr C A Mr Consultant Dr Dublin Haemovigilance Ms Crumlin, Consultant Dr. Consultant Dr Gynaecology Consultant ansfusion idence y Fr Mary Joan Paul Dublin Paul William Deirdre Mary Research to eda Ev controlled Ev and/ descriptive Ev designed Ev study Ev trial. Ev studies Requires or clinical addressing authorities. Requires (E of Requires (E no & levels 7 vidence vidence idence idence idence idence idence idence of a opinions Browne Ke randomised Cahill Fitzgerald Dublin Dublin Our Ed Gorman Levels were body or 8 John Recommendations without artland Casey Neonataologist, Haematologist, Anaesthetist, Haematologist, Haematologist, Gough ger Surveillance & OF clinical studies and , of Lady’s Tr St. obtained obtained obtained obtained obtained obtained the at evidence quasi-experimental of derived trials. levels levels 1 2 12 12 inity evidence Bonnar, THE studies, Nursing Indicates the and/ case least Vincent’s literature availability randomisation. experiences Hospital College, of clinical specific NA or 1a,1b). 11a, studies. one from good from from from from from from Emeritus clinical obtained TIONAL such Sister, Our Officer, and an 11b, Irish St. Cork randomised of Hospital, National trials US quality recommendation. expert for Dublin at of at meta-analysis well-designed at Lady’s absence grades overall as James’ least St. experiences least least well Blood Agency 111) University Sick of comparative Mater on BL from Professor study James’ . respected committee (E OOD conducted Hospital the Dublin Maternity good one one one . of children, Hospital, vidence Tr of expert Misercordiae controlled . recommendations ansfusion for topic directly well-designed randomised other Hospital, USERS quality Hospital, 4 of Health non-experimental of of for studies, authorities. of committee randomised level Hospital, Obstetrics reports respected Dublin clinical type recommendation. Sick applicable and trial Service, Care GROUP 1V) Dublin Wilton, of Hospital, Children, controlled correlation consistency 8 as or studies well- . controlled Holles Po reports part opinions & in 8 James’ licy Cork this but 16 12/02/2008

13:21:25 Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie BLOOD

Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie TRANSF.tf.indd TRANSF.tf.indd 17 Consultant Ms Consultant Dr Mr Consultant Cappagh Chie Consultant Dr Consultant Dr St. National Dr Crumlin, Consultant Dr Crumlin Mr 5 Senior Ms St, Consultant Dr Consultant Chie Dr Hospital, 3. 2 4. 1. References (NCHCD) Director, Consultant Dr Dr Lady’s Corrina Brian Margaret William Maire Joan Barry Owen Barry Dublin Dublin Paul Ke Eilis Haz f f Medical Pe vin 18 18 Luban Brugnara disorders. 2004;87(Suppl.2) appropriateness Strauss Pe newborn Shah 2002;42:1398-1412. 687. in Bednarek Widness Rose Hospital Medical el McGovern Dublin O’Brien O’Riordan rfusionist, Dublin Medical O’Callaghan Ly White National very McCarroll Dublin diatr.1998; O’Malley Smith Orthopaedic Reid , 8 8 Murphy McMahon Dublin ons Cardiothoracic Haematologist, Haematologist, Physician, Anaesthetist, Anaesthetist, Haematologist, Surgeon, Haematologist, ff and B, Murray NL. low SD, Scientist, RG. Rubin 12 Scientist, 12 JA for intensive 7 St. C, In: FJ, Director, Neonatal birth Centre 8 Luban , Mater Changing Sick Platt Seward James’ Nathan We 133; General LP Letterkenny Hospital, weight of isberger St. Children, . O. :s184-s188. NL, Our Mater Tr Misercordiae Va care for pediatric 601- Irish Surgeon, alee Our University Irish St. Vincent’s The Hospital, red DG, riations VJ, Hereditary Manno patterns Lady’s & inf James’ units. Blood blood Lady’s Misercordiae Kromer neonatal Va General Blood 607 Dublin Orkin ants. S, Crumlin, scular, General transfusion. Richardson in St. SNAP Hospital CS Dublin Hospital, cell College Tr Hospital, J Blood of SH, Tr Hospital Hospital, 11 James’ ansfusion . Pe IJ, Coagulation ansfusion Hospital, red Guidelines erythrocyte Mater transfusions. Dublin diatr Ginsburg Burmeister II Hospital, 8 blood transfusions Hospital, for Study Hospital, Elm Hospital, Dublin DK, for Tr 1996;129: Misercordiae Dublin sick ansfusion 12 Co. Service, Service, Park, cell Sick Fr Group. for D, Co. Disorders and Children, antz Ke 8 LF Dublin transfusion Vo Look Galway 7 assessing Children, and Dublin Dublin rry Donegal , its x among Bell James’ ID, 680- J James’ Sang Our 7 EF 8 4 & , 6. 7. 10. 9. 8. 11. 12. 20. 14. 18. 16. 15. 13. 19. 17. 21. 23. 22. Brugnara Blajchman Hewitt Council Adler Ye Llewelyn American Bowden Fergusson Williamson Williamson Tr Neutrophil Childhood, AT mRNA Dame Str Blood Stowell Tr Pe Childhood, AT disorders. Glader Widness Williams post-transfusion Maier RE, treatment Schmidt Fr 2000;136:220-4. Quality Banks inf premature leukoreduction. Proceedings Prober Jakob transfusion. transmission necessary? transfusion Strasbourg: transplant. transfusion-associated seronegative fi 1981;98:281-287. cytomegalovirus Sang and Tr F96-100. Cytomegalovirus Effectiveness transfusions. of March March, Manchester: Manchester: M. Bethesda:`AABB evidence ltered ansfusion ansfusion ansfusion anz ants ager Tr diatrics, aus eds. eds. Changing Kliegman extremely ansfusion 2006;91:221-230. SP AR, RF s 1998;92:3218-3225. C, disease 1998. and PE, B. expression 1999. with CG. Assurance leukocyte-reduced AS Nathan Nathan CP of RG: , RL, & RA , JA Fahnenstich CA Chandrika C, Physiologic Sonntag Association of Po In: ef , Eu , 17 inf Blood Tr Wilkins, MA 6 6th Llewelyn D, Tr LM, LM, Prevention guidelines: Grumet Strauss Arch , birth , Lancet Council (SHO Medicine, Medicine fects. th Neo Platt , Lowe bene hlandt ansfusions. SHO SHO Ve Slichter Nathan ansfusion of of Pe ants: rope. blood th Hewitt practices Hebert RM, of ed. low , (SHO and ed. ed. ng-P Lowe Lowe Goldman variant a and and Tr diatr infections nat CMV weights infections Dis WBC 1995;86:3598-3603. consensus T) fi T T ansfus , O. Philadelphia: J Jenson Philadelphia: birth developmental, in of 2000. LS Guide Philadelphia: t? J, 2002: blood products F. Office, Office, 2004;363:417-21. al FC, App RG, Oski’s Oski’s of T) Annual edersen The T, CA PE, Infect Child human DG, Wa SJ, Blood Tr PC, . S, S, Red Epidemiology Anemia H, Red 3 of in Lawrence Erythropoietin Eu Annual is Creutzfeld-Jakob of CMV ansfusion reduction Services, of rd weight , Hafleigh eds. Love Love lka In: Physiol the Mackenzie Knight Fr neonatal Blood Sayers Med exogenous M, ed. transfusion: Orkin to less rope Barrington transfusion-acquired 486-497. red blood HB ISBN ISBN Hematology Hematology and Fetal eitag Blo in in Simon Dis Components, Report MM, the Fr fetal era infection for Rossi’s Philadelphia: conference: P, newborn E E neonates , blood Rev than of od eedman Report Publishing, eds. inf Saunders, cytomegalovirus Banks. Pe SH, 1983; Preparation, et et Saunders, RS Saunders, the M, Neonatal of P, 1996;80:140-148. cell 0 0 Inf Liu 20 EB L, in Cel ants and 2002;42:159-65. ters erythrocyte nonlinearity 2001;15:1-20. al. al. TI, 9532 9532 et universal 1000g. , ancy et 1996-1997. Baggett Nelson neonates: Ginsburg th Review prevention J, , cell et G, Principles transfusions l, KJ, erythropoietin Arvin Serious Serious pharmacokinetics al. Dzik edn. results neonatal al. 1997-1998. after Pla under Will 2:114-118. C, inf al. Standards JJ, Metz of of acquired . Erythropoieti transfusions A Shapiro disease In: 789 789 ants. Pe prevention tel Po 2003:31. 11 2005. Ed Inf Inf Lippincott WH, Sher 2003: RG. 2004:1610. comparison AM, J Te marrow study Behrmam reira et, e ssible J. th Use ancy ancy restrictive Pe of Hazards Hazards 2001;84: D, xtbook , 1 0 BC, and What edn. J and Creutzfeldt- Pla of tissue. of Snyder Bradley diatr the GD. 3, 5, (CMV) Look Pe SH. LM, by . by and 47. in for and and Vo sma Obladan 9 10 its 12/02/2008 diatr UK th very blood is blood of x Blood i th of the of , EL, of and in JS , 13:21:25 BLOOD 24. 25. 42. 41. 40. 26. 35. 27. 39. 32. 30. 29. 28. 38. 37. 36. 34. 33. 31. TRANSF.tf.indd TRANSF.tf.indd Love Love Tr Lachance Meyer Bif Asher Ke Ku Izraeli Bell Brooks Englert Cooke Hudson DeMaio Joshi Cooke Silvers Kirpalani Tr Manchester: April, anemia 82:30-34. asymptomatic Myocardial, 1992;120:292-296. Manchester: abnormalities determinants of March, J healthy Assessing M. 2002. Manchester: through transmitted Lactic 675. Tu J inf activity of Bhatia 21-26. extremely 833-836. in transfusion and 219. 1691. transfusion J of The premature of level. tr controlled Inf Pe retinopathyof inf transfusion an Pe Pe Pe ansfusion ansfusion rner anaemic ants. ants Tr liberal retinopathy blood diatrics ehnert yes ano The ants. sf role apparent EF diatr ansfusions diatr diatr EM, EM, Pe 2000. us A, S, D, acid , WG, J, T, 19 19 J. , EM, KM, RW, RW, 2001. ef in Arch packed SE, preterm JA of io Strauss diatrics Pe JG, 2000. I, Gerhardt of transfusion Ben-Sira Sive Wa versus Atterbury fect The H, 1993:122:629-631. 1997;156:47-50. 2006;149:301-307. Need MJ, n Williamson Jones Cooke low C, 1999;104:514-518. trial prematurity , the inf diatrics hematocrit, as preterm Smith Donohue Saunders Gibson Marcus an ef in erythropoietic Clark Drury bacterial (SHO (SHO Whyte Harris threshold rdrop SHO SHO SHO Dis Chessex ants. fect of ef of prematurity: A, role in Roth preterm d a birth of pre-term need of Tr cell fect of (SHO 1989; ch predictor inf restrictive RG, pre-term oxygen anemia H, Jacobs ansfusion Child prematurity A, a T) T) T T T D, F, JA T, on CA of L, Tr ro J ants 1987;80:79-84. MC, CLJ, RK, restrictive Williamson VR, AT weight transfusions, Office, Office, Office, DM, inf Holland Borer of Shandloff ansfusion for Annual Annual Hickey-Dwyer Pe ni on Widness Harell , blood infection LM, the PK, T) . . Yo RA , c ants. for P, Red inf Fetal 84:412-417. 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13:21:25 Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie BLOOD

Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie TRANSF.tf.indd TRANSF.tf.indd 19 79. 78. 77. 76. 75. 74. 73. 72. 71. 70. 69. 68. 67. 66. 65. 64. 63. 20 20 Aher Aher low preventing pub2. 19;3:CD004868.DOI:10.1002/14651858.CD004868. inf blood Ohls Brune 523. total Eichler and administered newborns. autologous E, van inf source Pe Ceriani clinical clamping Philip 786. randomiz hematocrit ef Mercer Pe Rabe 2006;117:1235-42.. late-onset reduces M, Database umbilical 2006;117:93-98. Strauss of Holland Aladangady Tr immediate Rabe Hct volume, preterm controlled Child clamping Ohlsson pub2. 19;3:CD004863. weight red meta-analysis. neonates, Garcia within Ko Effect 2002: Va neonatal recombinant Tr blood clinical ansfusion fect ansfusion ants ants. Jorch placental diatrics diatrics mvakas Oh tto-K birth Rheenen blood to ef parenteral RK, SM, S, Health H, H, AG cell fectiveness transfusions of W. 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Hall Strauss Baz van Luban Romagnoli Mangel Soubasi Lee for Wo Liu Strauss Hume Amendments Blood Strauss Staines Service, Mou neonatal case paediatric Neonatal transfusion blood high premature recombinant of packs. designated of donor Rev CD004865.pub2. sa Ohls supplementation Feasibility prematurity? Sarafidis Pe exposure of 1994;125:92-6. trial cells transfusions. for National cryoprecipitate the for blood donor transfusions. 1995;126:280-6. transfusion docs/120-MassiveHaemorrhageGuideline.pdf> massive surgery neonatal after prematurity F29-33. 1997; the American A Haematol Physician’s fe a donor old, rinatol od the the neonates EA ‘Guidelinesfor role Straaten of ty EM, 2006 strategy DA TL, plasma SS for RK. erythropoietin of unit. versus exposu exposure A, components. unwash of 21:8-19. H. , the J NL, year use , Mannino hyperkalaemia-induced , J, A, in RG. RG, RG, of Barnes 2002. neonatal V, haemorrhage. 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Irish Medical Journal Supplement June 2007 Volume 100 number 6 www.imj.ie TRANSF.tf.indd TRANSF.tf.indd 21 155. 153. 154. 157. 156. 147. 148. 145. 152. 151. 150. 146. 144. 149. 143. 142. 140. 141. 139. 22 22 Fetal collaborative to Rayment 2003;122:275-288. maternal Radder 1997;337:22-6. Birchall 318-325. treatment neonatal George 2007;136:366-378. of Murphy DOI: alloimmune DJ, Systematic congenital Maurer (NAIT) Adner transfusion Neonatal Katz Med “compatible” Guidelines British 2002:253-277. Bussel 111:133-135. of Massey Suarez Arch antibody Kie Haematol course Pregnancy Hadley Murphy platelet-reactive thrombocytopenia. gammaglobulin immunoglobulin Derycke neonatal Kie specific G, antigens Monoclonal thrombocytopenia. Mueller-E 183. thrombocytopenia. alloimmune J, JB Davidson Bussel 1989;64:858-860. Am cerebral Herman isoimmune Kaplan balance alloimmune neonatal Ringenberg . fel fel Murphy J Po 10.1002/14651858.CD004226.pub2. 1969;280:244-247. J, Dis alloimmune Pe V, V, MM, . Committee rencephaly Hodder JB and JB CR, A HM. CM, JE, MF MF D, GV PLA-1 Blood . diatr JH, haemorrhage Bassler Santoso M, (MAIP Child alloimmune treatment alloimmune Clin R, ckhardt isoimmune C. & JE, , strategies , 2003;122;10-23. . Bussel isoimmune the , , , for Zacharoulis Zabusky thrombocytopenia. Fisch Reviews Anderson Cambridge: management in Murphy Dreyfus isoimmune MF Soothill Brunskill thrombocytopenia. thrombocytopenia antibody-specific Bussel Rayment McWilliams Clinical Brand Jumbelic platelet Intravenous study McWilliam Hematol Pe neonatal the thrombocytopenia. risk 2006;107(9) 1985;60:667-669. C. . A) FS antibodies (IVG) Antenatal for diatr antibodies. D, GR, S, thrombocytopenia. : C, , JB Improved use for and a Am Vo Pe of A, of Aster of Kroll JB neonatal MF P, We and M, Kayser MR, 2005, new to transfusions . thrombocytopenia. SJ, thrombocytopenia thrombocytopenia. x 1984;23:159-162. diatr intracranial in R, the Kanhai Starobin C. Standards alloimmune Ml, eds. thrombocytopenic . of in Oncol Neonatal , J optic Ropert Sang S, thrombocytopenia. alloimmune prevent isheit Advances Cambridge Kaplan neonatal NB Allen RC, diagnostic High-dose H, Hematol Stanworth Berkowitz alloimmune RS immunoglobulin platelet tool and antenatal Ancona Kramer interventions in Blood Alloimmune Issue , et Blood W, assay :3761-3763. , Ev Mueller hypoplasia neonatal isoimmune 1982;43:76-81. 1986;8:312-317. Bennetts M, HH. immobilization for the D, al. Arch to JC, SG, ans The Forster it? C, Mueller-E Thrombocytopenia. Roberts in Antigen-positive 1. the Cancer non-immune haemorrhage transfusions. immune detection Br in K, in Will 1987;26:247-253. RJ, thrombocytopenia. Kroll for 1987;70:1722-1726. Vo Tc Aster TJ, Haematology comparison University RL, thrombocytopenia Cochrane Art. management S, intravenous Dis the the McFarland DG, J N hernia identification x thrombocytopenia. detection Kickler alloimmune it Soothill Haematol Stephenson Sang C, Engl GA McFarland Disorders H. No.: Child for in against treatment ever management thrombocytopenia. Br The RH. purpura. Napolitano 2005;45:176- D. Muller-E in ckhardt neonatal Eu J , fetomaternal J Cairo G. of Fetal CD004226. the J Pe of 2003;84: ropean be natural Haematol TS Press, Database Use Med PW, maternal Intravenous cases Br diatr platelet in of JG, of the treatment possible . . of MS and J fetal of N platelet In ckhardt neonatal C. of platelet- of of JG. Roberts Pauliny risk 1987; feto- Engl Semin utero A, of . In: or of of J 159. 158. 166. 164. 163. 161. 160. 169. 165. 162. 167. 168. Barbui Obstet Burrows N the Samuels 1985;15:139-144. predict Maternal associated Thromb Idiopathic women id Guidelines prophylactic Northern Haematol froz Tr British Stainsby Karpatkin of in in transfusion Ed Haematol Tr Committee O’Shaughnessy 1996;6:261-271. Tr mother. thrombocytopenia: associated Available 1996;348:229-232. Hume SHO Pamphilon, a Roberts Boralessa Boco British in io neonatal ansfusion ansfusion ansfusions Engl pregnancy preterm er blood inf pa risk en T AF ants Raton, th Office, AH. plasma, T, Committee Gynecol Committee J the with of ic , Hemost N I, RF components Manno P, Med Cortelazzo platelet D, Nursing from: thrombocytopenic Letsky th M, of 2004;126:11-28. 2001;114:25-30. thrombocytopenia Engl H, babies: risk Fetal intensive with for Bussel graft , ed. for practice. Jones ro Ta Ta presumed Ke early . Ann women Po (SHO Modi ISBN 1990;323:229-235. mb Br sk sk the cryoprecipitate Standards Modern of lton http://www.shot-uk.org J idiopathic 1990;163:1147-1150. rges DF CS 1995;21:276-293. versus and count oc E. Med J Force. Force. Arbor, neonatal fresh-froz Initiative investigation H, outcome for JB for T) N, , ef Haematol . JG. yt 0 RBC Atterbury S, care Does Tr with RF . fects Neonatal Cohen op , Cockburn for 9532 Annual Standards Standards 1981;305:936-939. ansfusion Braitman Viero immune and Tr , host en Low London, Guidelines Karpatkin Guidelines the T ansfusion population: autoimmune in thrombocytopenia ic red of Tr thrombocytopenia. activation en antiplatelet at 789 Haematology purpura H, P, pu ial disease. prevention in fetal steroids 2003;120:574-596. report C, and cell 2 Tr plasma Buelli rp et the Group. thrombocytopenia and H, LE, years. Maggs ansfusion 1995,p210. in 8 2002;42:1428-1434. in ur al. risks T cryosupernatant. Malde 0, S. offspring a Haematology Haematology for Medicine. management on et activation 2005. Serious and in implications M, and 30 Tr administration Platelet or al. Randomised the Lancet gamma ansfus in antibodies ad of PB Casarotto th gelatin pregnancy , Estimation R, hemolysis pregnancies ul Nov Blood use transfusion- Manchester: Therapy . ts Ed British purpura. of Hazards , CRc Ric matter? ch counts 2006. Med wards of irradiation pregnant or , . il for fresh- Blood of dr Clin 12/02/2008 purpura. do C. Press, . glucose . Br en trial In: in to of M, Am not of Lab Br J DH an the of J d J 13:21:26 BLOOD TRANSF.tf.indd TRANSF.tf.indd 23 23 22 12/02/2008

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