Oral Abstract
Transfusion Service - Pediatric Transfusion Clinical Medicine
Jeanne E. Hendrickson, MD
Professor, Department of Pathology and Laboratory Medicine Emory University School of Medicine
Emory University School of Medicine and Yale University School of Medicine
Atlanta, Georgia
Disclosure information not submitted.
Very-low-birth-weight infants (VLBW < 1,500g) frequently receive transfusions. While surveys have provided snapshots of transfusion practices for neonates, few studies have used actual observations to characterize transfusion patterns across U.S. centers. We summarized red blood cell (RBC), platelet, plasma, and cryoprecipitate transfusion characteristics in this analysis of the Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P) Transfusion in Premature Infants (TIPI) study.
Study
Design/Methods: The study evaluated birth encounters for VLBW infants at 8 hospitals (3 community, 5 university) in the United States, from 4/2019 to 12/2023. Neonatal outcome data submitted to Vermont Oxford Network were merged with laboratory and other clinical data uploaded to a data coordinating center. Data were censored at 90 days after birth. A vein-to-vein linkage was used to characterize donor and product characteristics among transfused infants.
Results/Findings:
There were 2605 infants studied across 8 hospitals; 40% had a birth weight < 1000 g and 48% were female. Transfusions of any blood product were given to 93% (713/766) under 27 weeks gestational age (GA), 59% (316/550) between 27-28 weeks GA, 23% (230/1060) between 29-32 weeks GA, and 12% (24/229) over 32 weeks GA. A total of 1,244 (49%) infants received 6,969 RBC transfusions, with a median of 4 RBC transfusions per infant and a median (p25, p75) dose of 15 mL/kg (10-17) per transfusion. The most common RBC donor type was O (99.1%) and 99.6% of products were irradiated. The mean (SD) number of donor exposures was 2.4 (2.0), with a mean donor age of 49 (16) years; 43% of transfusions were from female donors. The most common storage solutions were AS-1 (60%), AS-3 (23%) and CPDA-1 (12%). The mean storage duration was 14.4 days, with 7% of RBC units stored >28 days. A total of 321 (13%) infants received 1384 platelet transfusions (median 2 per infant). The median (p25, p75) dose was 15 ml/kg (12-17). The most common platelet donor blood type was AB (62%) followed by O (24%). The mean (SD) number of donor exposures was 2.9 (3.8) with a mean donor age of 55 (14) years; 28% of transfusions were from female donors. All platelet units were collected by apheresis; 19% were irradiated and 81% were pathogen-reduced. Most (62%) were stored in platelet additive solution. The most common storage duration was 5 days (37%), followed by 4 days (31%) and 6 days (14%). A total of 258 (10%) infants were transfused with plasma and 44 (2%) were transfused with cryoprecipitate.
Conclusions:
In this analysis, we characterize donor and blood banking practices for transfusions administered to VLBW infants at 8 hospitals. These data highlight the variability in transfused products among VLBW infants; this variability will be evaluated in future TIPI studies to determine potential associations with outcome.