Neonatal and pediatric transfusion practices and policies in India: A survey-based cross-sectional assessment of blood centers.
neonatal transfusion
pediatric transfusion
pedibags
Journal
Transfusion
ISSN: 1537-2995
Titre abrégé: Transfusion
Pays: United States
ID NLM: 0417360
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
revised:
01
03
2022
received:
18
12
2021
accepted:
03
03
2022
pubmed:
1
4
2022
medline:
11
5
2022
entrez:
31
3
2022
Statut:
ppublish
Résumé
Blood centers play a critical role in supporting neonatal and pediatric transfusions. We aim to study the variation in pediatric/neonatal transfusion policies and practices for blood centers in India. This is a survey-based (45 question) cross-sectional assessment of blood centers in India supporting pediatric/neonatal transfusions. One hundred three centers responded to the survey (response rate 51.2%; 103/201). As a part of pretransfusion testing, use of "microtainers" was reported by 58.4% (59/101) centers and only 57.4% (58/101) centers provide antibody screening. In case of absence of maternal sample, type O negative blood is most commonly used (48.5%; 49/101), and in case of ABO incompatibility, 68.3% (69/101) use units compatible with both mother and newborn. Leukoreduced RBCs are provided by 89% (90/101) centers and irradiated products are provided by 48.5% (49/101). 82% (83/101) of centers reported not receiving requests for CMV negative units considering the high incidence of CMV-seropositivity in donors. Fresh units are defined as <7 days old by 44.5% (45/101) and <5 days old by 31.6% (32/101) centers. 97% centers reported SAGM suspended RBCs in inventory but only 67.3% (68/101) use them for top-up transfusions to neonates. Overall >80% centers use the buffy-coat method for platelet concentrates preparation. Volume-based (ml/kg) aliquots preparation is done by 88% (89/101), mainly using the sterile connecting device (84.6%; 83/98). This survey shows heterogeneity and lack of standardization in practices across blood centers in India and highlights the need for more studies to establish best practices for this vulnerable age group.
Sections du résumé
BACKGROUND
Blood centers play a critical role in supporting neonatal and pediatric transfusions. We aim to study the variation in pediatric/neonatal transfusion policies and practices for blood centers in India.
STUDY DESIGN AND METHODS
This is a survey-based (45 question) cross-sectional assessment of blood centers in India supporting pediatric/neonatal transfusions.
RESULTS
One hundred three centers responded to the survey (response rate 51.2%; 103/201). As a part of pretransfusion testing, use of "microtainers" was reported by 58.4% (59/101) centers and only 57.4% (58/101) centers provide antibody screening. In case of absence of maternal sample, type O negative blood is most commonly used (48.5%; 49/101), and in case of ABO incompatibility, 68.3% (69/101) use units compatible with both mother and newborn. Leukoreduced RBCs are provided by 89% (90/101) centers and irradiated products are provided by 48.5% (49/101). 82% (83/101) of centers reported not receiving requests for CMV negative units considering the high incidence of CMV-seropositivity in donors. Fresh units are defined as <7 days old by 44.5% (45/101) and <5 days old by 31.6% (32/101) centers. 97% centers reported SAGM suspended RBCs in inventory but only 67.3% (68/101) use them for top-up transfusions to neonates. Overall >80% centers use the buffy-coat method for platelet concentrates preparation. Volume-based (ml/kg) aliquots preparation is done by 88% (89/101), mainly using the sterile connecting device (84.6%; 83/98).
CONCLUSION
This survey shows heterogeneity and lack of standardization in practices across blood centers in India and highlights the need for more studies to establish best practices for this vulnerable age group.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1000-1009Informations de copyright
© 2022 AABB.
Références
Keir AK, Yang J, Harrison A, Pelausa E, Shah PS, Canadian NN. Temporal changes in blood product usage in preterm neonates born at less than 30 weeks' gestation in Canada. Transfusion. 2015;55:1340-6.
Nellis ME, Goel R, Hendrickson JE, Birch R, Patel RM, Karafin MS, et al. NHLBI recipient epidemiology and donor evaluation study-IV-pediatric (REDS-IV-P). Transfusion practices in a large cohort of hospitalized children. Transfusion. 2021 Jul;61(7):2042-53. https://doi.org/10.1111/trf.16443 Epub 2021 May 11. PMID: 33973660.
Patel RM, Meyer EK, Widness JA. Research opportunities to improve neonatal red blood cell transfusion. Transfus Med Rev. 2016 Oct;30(4):165-73. https://doi.org/10.1016/j.tmrv.2016.06.005 Epub 2016 Jul 4. PMID: 27424006; PMCID: PMC5026588.
Amrutiya RJ, Mungala BM, Patel VT, Ganjiwale JD, Nimbalkar SM. Blood component transfusion in tertiary care neonatal intensive care unit and neonatal intermediate care unit: an audit. Cureus. 2020;12(8):e9952. https://doi.org/10.7759/cureus.9952 PMID: 32983658; PMCID: PMC7510180.
Dogra K, Kaur G, Basu S, Chawla D. Fresh frozen plasma and platelet transfusion practices in neonatal intensive care unit of a tertiary care hospital. Indian J Hematol Blood Transfus. 2020;36(1):141-8. https://doi.org/10.1007/s12288-019-01164-z Epub 2019 Jul 30. PMID: 32158097; PMCID: PMC7042433.
Shanmugha Priya RA, Krishnamoorthy R, Panicker VK, Ninan B. Transfusion support in preterm neonates <1500 g and/or <32 weeks in a tertiary care center: a descriptive study. Asian J Transfus Sci. 2018;12(1):34-41. https://doi.org/10.4103/ajts.AJTS_148_16 PMID: 29563673; PMCID: PMC5850695.
Dogra K, Kaur G, Basu S, Chawla D. Red cell transfusion practices in neonatal intensive care unit: an experience from Tertiary Care Centre. Indian J Hematol Blood Transfus. 2018;34(4):671-6. https://doi.org/10.1007/s12288-018-0959-4 Epub 2018 Apr 12. PMID: 30369739; PMCID: PMC6186237.
Patel RM, Hendrickson JE, Nellis ME, Birch R, Goel R, Karam O, et al. National Heart, Lung, and Blood Institute recipient epidemiology and donor evaluation study-IV-pediatric (REDS-IV-P). Variation in neonatal transfusion practice. J Pediatr. 2021;235:92-9.e4. https://doi.org/10.1016/j.jpeds.2021.04.002 Epub 2021 Apr 7. PMID: 33836184; PMCID: PMC8316298.
Annual Report 2019-2020, Ministry of Health and Family welfare, Government of India. Accessed 10th August, 2021. https://main.mohfw.gov.in/sites/default/files/Annual%20Report%202019-2020%20English.pdf
New HV, Berryman J, Bolton-Maggs PH, Cantwell C, Chalmers EA, Davies T, et al. Stanworth SJ; British Committee for Standards in Haematology. Guidelines on transfusion for fetuses, neonates and older children. Br J Haematol. 2016 Dec;175(5):784-828. https://doi.org/10.1111/bjh.14233 Epub 2016 Nov 11. PMID: 27861734.
Reeves HM, Goodhue Meyer E, Harm SK, Lieberman L, Pyles R, Rajbhandary S, et al. Neonatal and pediatric blood bank practice in the United States: results from the AABB pediatric transfusion medicine subsection survey. Transfusion. 2021;61(8):2265-76. https://doi.org/10.1111/trf.16520 Epub 2021 Jun 10. PMID: 34110629.
Obladen M, Sachsenweger M, Stahnke M. Blood sampling in very low birth weight infants receiving different levels of intensive care. Eur J Pediatr. 1988;147(4):399-404. https://doi.org/10.1007/BF00496419 PMID: 3396595.
Balasubramanian H, Atyalgade M, Garg B, Srinivasan L, Kabra NS, Khapekar S. Effects of blood sampling stewardship and erythropoietin administration in extremely low birth weight infants-a quality improvement non-controlled before-and-after retrospective study. Eur J Pediatr. 2021;180:1617-26.
Sankaralingam P, Jain A, Bagga R, Kumar P, Marwaha N. Red cell alloimmunization in RhD positive pregnant women and neonatal outcome. Transfus Apher Sci. 2016;55(1):153-8. https://doi.org/10.1016/j.transci.2016.06.002 Epub 2016 Jun 13. PMID: 27324408.
Arora S, Marwaha N, Dhawan HK, Rao KLN. Dedicated donor unit transfusions reduces donor exposure in pediatric surgery patients. Asian J Transfus Sci. 2017;11(2):124-30. https://doi.org/10.4103/ajts.AJTS_57_16 PMID: 28970679; PMCID: PMC5613418.
Kothari A, Ramachandran VG, Gupta P, Singh B, Talwar V. Seroprevalence of cytomegalovirus among voluntary blood donors in Delhi, India. J Health Popul Nutr. 2002 Dec;20(4):348-51. PMID: 12659416.
Kumar H, Gupta PK, Kumar S, Sarkar RS. Is seroprevalence of anti-IGM CMV among blood donors relevant in India? Indian J Pathol Microbiol. 2008;51(3):351-2. https://doi.org/10.4103/0377-4929.42509. PMID: 18723956.
Weisberg SP, Staley EM, Williams LA 3rd, Pham HP, Bachegowda LS, Cheng YH, et al. Survey on transfusion-transmitted cytomegalovirus and cytomegalovirus disease mitigation. Arch Pathol Lab Med. 2017;141(12):1705-11.
Fergusson DA, Hebert P, Hogan DL, LeBel L, Rouvinez-Bouali N, Smyth JA, et al. Effect of fresh red blood cell transfusions on clinical outcomes in premature, very low-birthweight infants: the ARIPI randomized trial. JAMA. 2012;308:1443-51.
Spinella PC, Tucci M, Fergusson DA, Lacroix J, Hébert PC, Leteurtre S, et al. Effect of fresh vs standard-issue red blood cell transfusions on multiple organ dysfunction syndrome in critically ill pediatric patients: a randomized clinical trial. JAMA. 2019;322:2179-90.
Luban NL, Strauss RG, Hume HA. Commentary on the safety of red cells preserved in extended-storage media for neonatal transfusions. Transfusion. 1991;31:229-35.
Strauss RG, Burmeister LF, Johnson K, James T, Miller J, Cordle DG, et al. AS-1 red cells for neonatal transfusions: arandomized trial assessing donor exposure and safety. Transfusion. 1996;36:873-8.
Strauss RG, Burmeister LF, Johnson K, Cress G, Cordle D. Feasibility and safety of AS-3 red blood cells for neonatal transfusions. J Pediatr. 2000;136:215-9.
Ministry of Health & Family Welfare, Government of India. Gazette Notifications, G.S.R. 166 (E). Ministry of health & family welfare, Government of India; 2020. Accessed 20th September, 2021. https://cdsco.gov.in; https://cdsco.gov.in/opencms/opencms/en/Notifications/Gazette-Notifications/ [Last assessed on 6th December 2021]
Poder TG, Pruneau D, Dorval J, Thibault L, Fisette JF, Bédard SK, et al. Effect of warming and flow rate conditions of blood warmers on red blood cell integrity. Vox Sang. 2016;111(4):341-9. https://doi.org/10.1111/vox.12423 Epub 2016 Jun 9. PMID: 27280338.
Hulse W, Bahr TM, Fredrickson L, Canfield CM, Friddle K, Pysher TJ, et al. Warming blood products for transfusion to neonates: in vitro assessments. Transfusion. 2020;60(9):1924-8. https://doi.org/10.1111/trf.16007 Epub 2020 Aug 10. PMID: 32776545.
Tynuv M, Flegel WA. Quality improvement with platelet additive solution for safer out-of-group platelet transfusions. Immunohematology. 2019;35(3):108-15. PMID: 31621370; PMCID: PMC6816025.
Mathur A, Swamy N, Thapa S, Chakraborthy S, Jagannathan L. Adding to platelet safety and life: platelet additive solutions. Asian J Transfus Sci. 2018;12(2):136-40. https://doi.org/10.4103/ajts.AJTS_150_17 PMID: 30692798; PMCID: PMC6327774.
Honohan A, van't Ende E, Hulzebos C, Lopriore E, van't Verlaat E, Govaert P, et al. Posttransfusion platelet increments after different platelet products in neonates: a retrospective cohort study. Transfusion. 2013;53(12):3100-9. https://doi.org/10.1111/trf.12127 Epub 2013 Feb 26. PMID: 23441721.
U.S. Census Bureau Current Population. https://www.census.gov/popclock/print.php?component=counter [Last assessed on 6th December 2021]
List of colleges providing MD/ DNB in Transfusion Medicine/ Immunohematology and Blood Transfusion. https://www.nmc.org.in/information-desk/college-and-course-search/ [Last assessed on 6th December 2021]