NICU:  Hematology

Transfusion orders in the NICU are written as the number of cc of component to be transfused, rather than in units.  Usual doses of blood components:

Packed red blood cells (pRBCs):  Transfusion parameters will change based on age and clinical status.  An intubated patient will need a hematocrit of 35-40 or more to maximize oxygen carrying capacity and facilitate weaning from the ventilator.  An older growing premie may be allowed to drop to the mid 20's, the physiological nadir, to stimulate endogenous erythropoetin production.  This is acceptable so long as no signs of anemia are present (tachypnea, tachycardia, increased oxygen requirement).  The usual dose is 10-15 cc/kg, given over 2-4 hours.  An alternate is to give two successive aliquots of 10 cc/kg each over 1-2 hours, for a total of 20 cc/kg.  Lasix is given between the two aliquots.  This procedure reduces the number of donors the infant is exposed to over the hospital course.  If volume load is a concern, follow transfusion with diuretic (usually lasix, 1 mg/kg).  The blood bank can also be requested to concentrate pRBCs to a hematocrit of 80%.  Each 1 cc/kg of 80 Hct pRBC should raise the patient's Hct by 1%.  Check the hematocrit four hours after transfusion to assess response.

Platelets:  The usual goal is to keep platelets greater than 20,000 to 50,000 depending on the clinical setting.  Thrombocytopenia is usually a sign of an underlying problem (like sepsis or DIC).  So, look for the underlying cause and give in 10 cc/kg aliquots.  Check the platelet count one hour post transfusion to make sure platelets are increasing.

Fresh Frozen Plasma:  Used to treat coagulopathy as measured by elevated PTT.  Usually given in 10 cc/kg aliquots.  Don't forget to look for the underlying reason for the coagulopathy.

Cryoprecipitate:  Used to treat hypofibrinogenemia; again, usual dose is 10 cc/kg.

Hyperbilirubinemia: Exchange Transfusion and Phototherapy