Neonatal Blood Transfusion in Africa; Towards Optimizing Scarce Resource


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Neonatal transfusion is a common practice in Africa, where many
infants are born with low birth weight and require blood transfusions.
The use of paediatric packs for neonatal blood transfusions has
been recommended. However, the optimal use of these packs in
Africa is not clearly understood by some healthcare practitioners.
This review aims to provide insights into the optimal use of
paediatric packs in neonatal transfusion in Africa.The World Health
Organization (WHO) recommends restrictive transfusion practices
for paediatric patients, including neonates, based on expert opinion.
Transfusion triggers in neonates are controversial and mainly based
on expert clinical opinion, although recent randomized controlled
trials of ‘liberal’ versus ‘restrictive’ red cell transfusion policies
in very low birth weight preterm babies are starting to influence
clinical guidelines. Many neonatal red cell transfusions are given to
replace losses from frequent blood sampling. This can be reduced
by avoiding non-essential tests, using low-volume sample tubes,
validated near patient testing, micro-techniques in the laboratory,
and non-invasive monitoring where possible.The use of CMV seronegative blood products for transfusion in low birth weight
neonates is not deemed necessary. The primary rationale is that
the risk of transfusion-transmitted infections should be reduced
by stringent screening of donors, restrictive transfusion practice
and certain interventions like irradiation of blood units before
transfusion. A recent international survey of transfusion practices for
extremely premature infants showed that factors considered “very
important” regarding the need to administer blood transfusions
included degree of oxygen requirement and need for respiratory
support. Donor exposure can also be reduced by allocating single
donor units, split into paedipacks, to babies predicted to need more
than one transfusion episode within the expiry date of the donation.
Implementing a program to improve compliance with neonatal
intensive care unit transfusion guidelines was accompanied by a
reduction in transfusion rate. The implementation of guidelines to
improve compliance with neonatal intensive care unit transfusion

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