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International Journal of Clinical Pediatrics

Letter to the Editor

Volume 7, Number 1-2, April 2018, pages 19-20

Neonatal Transfusion: Uncross-Matched “O” Negative Blood From Unrelated Donors in Emergency

Blood transfusion is the most commonly practised and successful tissue transplant. Though sick newborns often require urgent blood transfusions, there is lack of access to suitable blood products, especially in emergent situations. Early recognition and vigorous treatment is the key factor in early reversal of pediatric-neonatal shock [1]. Blood for neonatal transfusion is often issued as group O packed RBCs with compatible infant Rh type. Alternatively, non-group O infants may receive non-group O RBCs if passive maternal anti-A or anti-B is not detected in an infant’s serum or plasma. In emergency situations, 10 - 20 mL/kg of O Rh-negative blood from unrelated donor may be used [2].

We retrieved data over 20 years (1997 - 2016), of neonates who received transfusion of “O” negative blood from unrelated donors as a part of treatment in emergent situations for different indications (Table 1). There were 10 neonates (four male and six female) with birth weight from 2,800 to 3,200 g. Nine babies were delivered in hospital and one was a home delivery. Two neonates with sepsis showed DIC. Since small transfusions of 20 mL or so do not require a pump, we administered it with a heparinised syringe by intermittent small bolus [3]. About 0.2 mL of heparin (1,000 U/mL) was taken in a 20 ml syringe; allowed to come in contact with the walls of the syringe by slowly moving the piston to and fro and then the heparin was thrown out of the syringe. About 25 mL of O negative donor’s blood was collected by peripheral venepuncture using this heparinized syringe. This whole fresh blood was directly injected into the recipient neonate slowly over next 30 min [4].

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Table 1. Relevant Details of 10 Neonates, Who Received Uncross Matched “O” Negative Blood Transfusion

All neonates had uneventful recovery, normal growth and mental development over a period of observation of 1 to 20. Half life of plasma heparin is very short and it is eliminated within 1 h of injection. Since the blood is injected immediately and no handling is involved, the chances of microbial contamination are very low [4].

All the babies showed remarkable and sustained improvement with just one single small blood transfusion. We feel that 10 mL/kg of whole blood given to these babies helped them in different ways such as restoring intravascular volume, improving oxygen carrying capacity, improving low serum albumin levels and the fresh whole blood probably stimulated endogenous granulopoiesis [5]. Though certain rules in blood transfusion are meticulously followed, blood transfusion in neonatal period can be challenging and requires considering these issues: 1) Group “O” individuals can receive blood from “O” donors only. 2) “A” individuals can receive blood from “A” and “O” donors. 3) “B” individuals can receive blood from “B” and “O” donors. 4) “AB” individuals can receive blood from “AB” donors, and also from group A, B and O donors.

We feel that compatibility and cross-matching in neonatal period is still a grey zone. As previously stated, these sick neonates need less blood but require it urgently. Though transfusing “O” negative blood saved 10 lives; further research is warranted. Our series may be the one with the longest period of observation establishing safety of this intervention.

Conflict of Interest

None of the authors have any conflict of interest to declare.

Financial Disclosures

None of the authors have any financial disclosures to make.

Funding

No funding source was reported.

Author Contributions

Sanjay G. Gokhale and Sankalp Gokhale designed the study, wrote the manuscript, and did critical literature search.

1. Han YY, Carcillo JA, Dragotta MA, Bills DM, Watson RS, Westerman ME, Orr RA. Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics. 2003;112(4):793-799.
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2. Whyte RK, Jefferies AL, Canadian Paediatric Society Fetus, Newborn Committee. Red blood cell transfusion in newborn infants. Paediatr Child Health. 2014;19(4):213-222.
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3. New York State Council on Human Blood and Transfusion Services. Guidelines for transfusion therapy of infants from birth to four months of age. Second Edition. 2004:15.
4. Singh T. Blood transfusion in neonates. Indian J Pediatr. 1987;54(1):125-126.
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5. Melvan JN, Bagby GJ, Welsh DA, Nelson S, Zhang P. Neonatal sepsis and neutrophil insufficiencies. Int Rev Immunol. 2010;29(3):315-348.
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International Journal of Clinical Pediatrics is published by Elmer Press Inc.