Neonatal and pediatric transfusion medicine

This chapter focuses on transfusion in pediatric patients and neonates. Transfusion in pediatric and neonatal patients is complicated by the physiologic changes that occur from the fetal period to infancy and beyond. These complexities are due several factors such as the small size, immature coagulation and immune system, unique conditions requiring transfusion therapy and potential metabolism concerns. In neonates, RBCs are transfused at a hemoglobin (Hgb) approaching 13g/dl in infants with severe cardiopulmonary disease, at levels of 10g/dl in infants with moderate cardiopulmonary disease or those undergoing major surgery and at levels of 8g/dl in infants with uncomplicated symptomatic anemia. The type of anticoagulant-preservative solution does not pose a risk to premature infants and neonates in the context of a small-volume transfusion ie, 10-15 ml/kg of RBCs. Pre-storage leukoreduced RBC products are provided for neonates in the US and leukoreduction decreases the risk of febrile transfusion reactions, HLA alloimmunization and CMV transmission.