Few things are sadder than when a baby needs a transfusion. Unfortunately, it happens often in those born too early and too small. “Friend of the Podcast” Cassandra Josephson returns to answer “Five Essential Neonatal RBC Questions”
In BBGuy Essentials Episode 012, Dr. Cassandra Josephson outlined “Five Top Things You Should Know About Pediatric Transfusion.” That discussion is an all-time “top ten most-downloaded” episode of this podcast, a testament to Cassandra’s enthusiasm and teaching skills! She gave an overview of the entire field, but we didn’t have time to get deeply into discussion of a really important topic: Red blood cell transfusion in neonates.
Today marks Dr. Josephson’s return to the podcast, and she returns in style! Blood bankers may struggle with the details of red blood cell transfusion to neonates, as there are important differences between this group and the adults and older children we are more accustomed to transfusing. Cassandra is your guide, and she answers “Five Essential Questions about Neonatal RBC Transfusion.”
- When should we give RBCs to babies?
- What about “old” RBCs; does age of blood matter?
- Is preservative important?
- Should the RBCs be modified?
- How do I test for compatibility?
Bonus: If you listen all the way to the end, you will actually hear a sixth question asked and answered that I think you will find useful!
Dr. Cassandra Josephson is one of few physicians in the United States trained and board-certified in Pediatrics, Pediatric Hematology/Oncology, and Blood Banking/Transfusion Medicine. She is a Professor in the Departments of Pathology and Lab Medicine and Pediatrics at Emory University in Atlanta, GA. She is the medical director of the blood/tissue banks, and apheresis services at Children’s Healthcare of Atlanta and Director of Clinical Research in the Emory Center for Transfusion and Cellular Therapies. She is also the co-author of the “Neonatal and Pediatric Transfusion” chapter in the 18th edition of the AABB Technical Manual, among many other publications.
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Josephson nor I have any relevant financial disclosures.
- Previous Podcast: BBGuy Essentials 012: Pediatric Transfusion with Cassandra Josephson
- Iowa Study: Bell et al, Randomized trial of liberal versus restrictive guidelines for red blood cell transfusions in preterm infants. Pediatrics 2005;115:1685–91.
- PINT Study: Kirpalani et al, The Premature Infants in Need of Transfusion (PINT) study: a randomized, controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants. J Pediatr 2006;149:301–7
- PINTOS (follow-up to PINT): Whyte RK et al, Neurodevelopmental Outcome of Extremely Low Birth Weight Infants Randomly Assigned to Restrictive or Liberal Hemoglobin Thresholds for Blood Transfusion. Pediatrics 2009 Jan;123(1):207-13.
- TOP Trial Protocol: Transfusion of Prematures (TOP) Trial: Does a Liberal Red Blood Cell Transfusion Strategy Improve Neurologically-Intact Survival of Extremely-Low-Birth-Weight Infants as Compared to a Restrictive Strategy?
- 2016 AABB RBC Transfusion Thresholds: Carson JL et al. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. JAMA. 2016;316(19):2025-2035
- Transfusion-associated Hyperkalemia Report: Lee, A. C., Reduque, L. L., Luban, N. L.C., Ness, P. M., Anton, B. and Heitmiller, E. S. (2014), Transfusion-associated hyperkalemic cardiac arrest in pediatric patients receiving massive transfusion. Transfusion, 54: 244–254.