Transfusions in the NICU

[Burnt Out, ASN, RN]

I was just wondering how many, if any at all, has had a neonate to have a reaction to a blood transfusion?

I'm just curious. My daughter is 4 wks old and is currently in the NICU after being born at 29w3d due to pPROM and severe preeclampsia. Her crit this morning was 23 and her nurse told me that the docs where she is hospitalized usually go ahead and transfuse them. Her RN told me they use the PRBCS that have the leukocytes filtered out.

My hubby and I have no objections to her getting the blood-if she needs it, we want her to have it-but I can't say it isn't a little scary for your 4 wk old child to be getting a transfusion.

Sorry to ramble, but I was interested if any of you wonderful NICU nurses have had a baby have a reaction?

[EricJRN, MSN, RN]

It has to be a scary thought, but it sounds like you already know what the right answer is. We're keeping our fingers crossed for your little girl.

Funny that this should come up now. I have two years in the NICU and I saw my first (possibly) transfusion-linked complication in a neonate less than 48 hours ago (basically a non-urticarial red rash, no wheezing or distress, resolved without treatment). So in my experience, I've seen only the benefits (decreased work of breathing, better nippling, etc).

In last month's issue of the journal Transfusion, I think I read that the incidence of complications related to pediatric blood transfusion was only 0.95% and that neonates have an even lower rate. (Some peds cancer patients that get repeatedly transfused with multiple blood products drive that rate up.)

We can't tell you what to do, but if it's just reassurance that you seek, I think you'll find that the numbers are indeed reassuring. Keep us posted on this tough little girl's progress!

[elizabells, BSN, RN]

I've not seen a reaction so far. Our blood bank (and I imagine it's the same for most NICUs) does some extra processing with blood that's going to neonates - screened for CMV, leukoreduced, etc - with the goal of further reducing the chance of a reaction.

[preemieRNkate, RN]

I have seen one baby have what they think may have been a reaction. I say think because the baby was so, so sick, and they're not sure whether it was a reaction to the blood or just a process of his illness. I don't remember exactly what was going on with him (not my patient), but I do remember the buzz about the possiblility of a transfusion reaction and blood bank people coming up to the unit and talking with the docs. Other than this one baby (and they're not even sure it was a reaction), I haven't seen any other adverse reactions.

Blood being sent to us gets CMV screened, irradiated and leukocyote reduced in addition to being typed and crossmatched to the baby.

[dawngloves, BSN, RN]

Unfortunately, rare is the preemie born that early that doesn't need a transfusion.

I have never had a neonate with an adverse blood reaction.

And congratulations!

[RainDreamer, BSN, RN]

I've only been a NICU nurse for 2 years, but have never seen a reaction to a blood transfusion.

I know reactions to blood transfusions are much more rare in neonates than in adults, because neonates haven't yet developed the proteins in their blood to detect/react to foreign blood.

I'll keep you, your family, and your little one in my thougths and prayers (((((HUGS)))))

[Burnt Out, ASN, RN]

We can't tell you what to do, but if it's just reassurance that you seek, I think you'll find that the numbers are indeed reassuring. Keep us posted on this tough little girl's progress!

Yes, I was just looking for reassurance! My daughter's nurse told me in the 30 years she has been in the unit, they've never had any problems.

My husband and I are both fine with her getting transfusions.

The doc that made rounds today did order a transfusion and last time I called and checked on her (which was frequently today;)) she was doing just fine and her PRBCs had been infusing for an hour.

Thank you all for your input so far.