MDs say single-donor transfusions minimise infants’ infection

Pre-term infants in the Neonatal Intensive Care Unit (NICU) are receiving more red cell transfusions than any other hospitalised group, a study published in the Malta Medical Journal reveals.

Red cell transfusion in pre-term or sick-term infants is essential in the management of their clinical conditions, to prevent the effects of anaemia.

The study in the Malta Medical Journal proposes a single-donor system, through which a bag of red blood cells from one single adult is used for each transfusion, instead of the current system through which blood is donated from more than one source.

The study also proposes the adoption of more restrictive guidelines, which would help reduce the number of transfusions to avoid the waste of a scarce resource.

A single-donor programme would decrease the risks arising from multiple transfusions to a single infant and avoid a waste of resources.

While the study points out that the risk of transmission of known infectious agents like Hepatitis B and C virus is relatively low, the risk from other infectious agents like Parvovirus B 19 - which is associated with a bright red rash of the cheeks and malaria - remains to be determined.

These risks can be reduced by providing most or all transfusions from a single, uninfected donor. With a single donor programme, high-risk pre-terms are identified and the Blood Transfusion Department can dedicate a set of aliquots - the portion of blood needed - each from a single adult donor.

The study also shows that a single-donor programme would be less wasteful of this scarce resource. A reduction in transfusion aliquots for neonates to just 50mls from the customary 250mls in a dedicated single-donor programme can safeguard limited health resources and minimise exposure to risk from donors, the study argues.

According to the study, the number of donor units required would be decreased by 65%.

A total of 181 blood transfusions were administered to 106 pre-terms of less than 35 weeks' gestation, in the neonatal intensive care unit during 2009 in Malta.

The study notes that latest medical research shows that transfusions can be done more judiciously, to reduce or avoid red cell transfusions and limit donor exposure. It compared transfusion guidelines presently in use at the local NICU, with more restrictive guidelines in other units.

The study was written Valerie Said Conti, Eugenio Azzopardi, Raymond Parascandolo, Paul Soler and Simon Attard Montalto, all of which form part of the Department of Paediatrics at Mater Dei Hospital.