H&h

preemieRNkate, RN · Feb 28, 2008

Depends on how old the baby is, what the retic is and if the baby is symptomatic or not.

SteveNNP, MSN, NP · Feb 28, 2008

What Kate said.....

Where I used to work, we would usually transfuse for Hcts less than 30 unless the kid was actively reticulating and asymptomatic. (Never paid attention to Hgb) Occasionally we would use epoetin alfa.

Here we routinely transfuse for Hct

littleneoRN · Feb 29, 2008

What Kate said.....
Here we routinely transfuse for Hct
Wow! I work mainly with 28+ weekers in a Level II. Our neos rarely transfuse these kids. I have seen hcts of 21-22 with active (sort of) retic with no transfusion. A lot of times these kids will be having increased spells, poor energy reserve, etc. but as long as they're stable, we wait it out. I know it's good to be cautious with transfusing these kids, but sometimes I wonder if we're causing unnecessary issues and/or what the long term consequences will be of this reduced oxygen delivery to tissue.

RainDreamer, BSN, RN · Feb 29, 2008

We always look at the hgb (never the crit) and it just depends on a lot of things if we transfuse or not. Mainly they look to see if the kid is reticing and if they're symptomatic.

Just this week I had a kid that had a hgb of 8.4 and a retic of 0.2 and she was symptomatic, so we transfused. My other kid had a hgb of 8.2, retic of 4.2, and was asyptomatic .... we didn't transfuse.

Usually with NEC scares I often see them transfuse (because they're syptomatic and have a low hgb).

Personally if their hgb is on the lower end and they're even the slightest bit syptomatic .... I like to see them just transfuse the kid ...... because it's amazing what a little bit of blood does for a lethargic, sad-looking kiddo!

Preemienurse23 · Mar 1, 2008

I'm just wondering if there is a relationship between low counts (with and without retics) and NEC? We have had such a huge outbreak lately and they have had lower counts. All the kids were "older", at least 30-60 days old when it happened.

preemieRNkate, RN · Mar 1, 2008

I'm just wondering if there is a relationship between low counts (with and without retics) and NEC? We have had such a huge outbreak lately and they have had lower counts. All the kids were "older", at least 30-60 days old when it happened.

Well, I don't know exact statistics or anything, but I would think there could be a relationship. Low H&H=less oxygen being delivered to tissue, including in the gut.

TiffyRN, BSN, PhD · Mar 5, 2008

We have this whole set of guidelines; I'll try to remember them as best as possible.

And we go by Hct, not Hbg

Anyhow the guideline is to transfuse 15ml/kg for Hcts as follows:

something (can't remember the exact number, maybe 20?)

Of course for acute illnesses or obviously active bleeding, the MD can tranfuse per their discretion as the above are just guidelines, not protocols.

We've seen a lot of pale weak feeder growers not progressing but because they aren't having A & B's and they are retic'ing they will not transfuse, they will have crits of like 22-23 and we will sit on it. Can be quite frustrating for the nurses and parents. Particularly for the parents who have tracked every number and know their kid got blood when they were smaller and sicker then their crit was 29 and the kid perked up and now we won't transfuse and they kid looks exhausted all the time and doesn't have the energy to nipple feed and that's the only thing keeping their kid in the hospital.

sorry for the run-on sentence.

Gompers, BSN, RN · Mar 5, 2008

Tiffy, if I didn't know better I'd swear we work on the same unit!

I absolutely HATE reticulocytes, let me tell you!!! I don't care that the baby is retic-ing! The crit is 23 now and it's going to take MONTHS for this preemie to get it up where it needs to be. So basically that baby is going to be exhausted for months. It's such a shame.