SummaryFirm indications for blood component transfusions do not exist, and it is important to consider the underlying pathophysiology, goals of treatment and all aspects of the benefit-risk ratio when making transfusion decisions.Blood products for transfusions are:(1) Whole blood.(2) Red blood cells.(3) Granulocyte.(4) Plasma.(5) Platelet.Indications of whole blood transfusion are:(1) Blood loss (dose is 20 ml/kg).(2) Exchange transfusion (dose is 80-100 ml/kg).Guidelines for red blood cell transfusions (dose is 10-15 ml/kg) are:- Hemoglobin < 130 gm/L (HCT < 40%) with severe cardiopulmonary disease.- Hemoglobin < 100 gm/L (HCT < 30%) with moderate cardiopulmonary disease.- Hemoglobin < 100 gm/L (HCT < 30%) with major surgery.- Hemoglobin < 80 gm/L (HCT < 24%) with symptomatic anemia.- Bleeding with > 25% loss of circulating blood volume.Guidelines for neutrophil transfusions (dose is 10-15 ml/kg) are:- Neutrophils < 3 x 109/L and fulminant sepsis during first week of life.- Neutrophils < 1 x 109/L and fulminant sepsis after first week.Guidelines for platelet transfusion (dose is 5-10 ml/kg) are:• Platelets (PLTs) < 100 x 109/L and bleeding.• PLTs < 50 x 109/L and invasive procedure.• PLTs < 20 x 109/L and clinical stable.• PLTs < 100 x 109/L and clinically unstable.• PLTs at any count, but with PLT dysfunction plus bleeding or invasive procedure.Guidelines for FFP transfusions (dose is 10 ml/kg) are:• Severe clotting factor deficiency and bleeding.• Severe clotting factor deficiency and invasive procedure.• Emergency reversal of warfarin effects.• Dilutional coagulopathy and bleeding.• Anticoagulant protein (AT-III, protein C and S) replacement.• Plasma exchange replacement fluid for thrombotic thrombocytopenic purpura.The most common transfusion complications are:(1) Allergy.(2) Febrile non-hemolytic transfusion reaction.(3) Hemolytic transfusion reaction.(4) Infections.(5) Transfusion associated circulatory overload.ReferencesAlagappan, A.; Shattuck, K.E. and Malloy, M.H. (1998): Impact of transfusion guidelines on neonatal transfusions. J Perinatol; 18: 92-97.Alcock, G.S. and Liley, H. (2002): Immunoglobulin infusion for isoimmune haemolytic jaundice in neonates. Cochrane Database Syst Rev; 3: CD003313.Alkalay, A.L.; Galvis, S. and Ferry, D.A. (2003): Hemodynamic changes in anemic premature infants: Are we allowing the hematocrits to fall too low? Pediatrics; 112: 838-845.Anderson, K.C. (1991): Variation in blood component irradiation practice: Implications for prevention of transfusion-associated graft-versus-host disease. Blood; 77: 2096.Andreu, G.; Morel, P. and Forestier, F. (2002): Hemovigilance network in France: organization and analysis of immediate transfusion incident reports from 1994 to 1998. Transfusion; 42: 1356-64.Andrew, M. (1997): The relevance of developmental haemostasis to haemorrhagic disorders of newborns. Semin Perinatol; 21:70-85.Andrew, M.; Paes, B. and Johnston, M. (1990): Development of the hemostatic system in the neonate and young infant. Am J Pediatr Haematol Oncol; 12: 95.Andrew, M.; Vegh, P. and Caco, C. (1993): A randomized, controlled trial of platelet transfusions in thrombocytopenic premature infants. J Pediatr; 123: 285.Bailie, K.E.M.; Irvine, A.E. and Bridges, J.M. (1994): Granulocyte and granulocyte-macrophage colony-stimulating factors in cord and maternal serum at delivery. Pediatr Res; 35: 164.Bell, E.F.; Strauss, R.G. and Widness, J.A. (2005): Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants. Pediatrics; 115: 1685-1691.Bifano, E.M.; Dracker, R.A. and Lorah, K. (1994): Collection and 28-day storage of human placental blood. Pediatr Res; 36: 90.Blanchette, V.S.; Hume, H.A. and Levy, G.J. (1991): Guidelines for auditing pediatric blood transfusion practices. Am J Dis Child; 145: 787.Blumberg, N. and Heal, J.M. (1994): Effects of transfusion on immune function: Cancer recurrence and infection. Arch Pathol Lab Med; 118: 371.Bryant, N.S. (1982): A brief history of blood transfusion. In: An Introduction to Immunology. 2nd edition. Philadelphia and London: Saunders WB Company.Burrows, R.F. and Kelton, J.G. (1993): Fetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med; 329: 1463.Busch, M.P.; Kleinman, S.H. and Nemo, G.J. (2003): Current and emerging infectious risks of blood transfusions. JAMA; 289: 959-962.Button, L.N. (1997): The effects of irradiation on blood components. Transfusion; 21: 419.Campagnoli, C.; Fisk, N. and Overton, T. (2000): Circulating hematopoietic progenitor cells in first trimester fetal blood. Blood; 95: 1967-1972.Chalmers, E.A. (2004): Neonatal coagulation problems. Arch Dis Child Fetal Neonatal Ed; 89: F475.Christensen, R.D.; Calhoun, D.A. and Rimsza, L.M. (2000): A practical approach to evaluating and treating neutropenia in the neonatal intensive care unit. Clin Perinatol; 27: 577-601.Contreras, M.; Ala, F.A. and Greaves, M. (1992): Guidelines for the use of fresh frozen plasma. British Committee for Standards in Haematology, Working Party of the Blood Transfusion Task Force. Transfus Med; 2: 57-63.Conway, S.; Ng, P. and Howel, D. (1990): Prophylactic intravenous immunoglobulin in preterm infants: A controlled trial. Vox Sang; 59: 6.Cornellison, M.; von Kries, R. and Loughman, P. (1997): Prevention of vitamin K deficiency bleeding: Efficacy of different multiple oral dose schedules of vitamin K. Eur J Pediatr; 156: 126-130.Dame, C. and Juul, S. (2000): The switch from fetal to adult erythropoiesis. Clin Perinatol; 27: 507.Davenport, R.D. (1996): Hemolytic transfusion reactions. In: Popovsky, MA (ed): Transfusion reactions. American Association of Blood Banks, Bethesda, MD; 24.Del Vecchio, A.; Sola, M.C. and Theriaque, D.W. (2001): Platelet transfusions in the neonatal intensive care unit: Factors predicting which patients will require multiple transfusions. Transfusion; 41: 803.Eisenfeld, L.; Silver, H. and McLaughlin, J. (1992): Prevention of transfusion-associated cytomegalovirus infection in neonatal patients by the removal of white cells from blood. Transfusion; 32: 205.Fanaroff, A.A.; Korones, S.B. and Wright, L.L. (1994): A controlled trial of intravenous immune globulin to reduce nosocomial infections in very-low-birth-weight infants. N Engl J Med; 330: 1170.Forbes, J.M. and Laurie, M.L. (1994): Blood collections by community blood centers, 1988 through 1992. Transfusion; 34: 392.Forestier, F.; Daffos, F. and Catherine, N. ( ): Developmental hematopoiesis in normal.Franz, A.R. and Pohlandt, F. (2001): Red blood cell transfusions in very and extremely low birth-weight infants under restrictive transfusion guidelines: Is exogenous erythropoietin necessary? Arch Dis Child Fetal Neonatal Edn; 84: F96-F100.George, J.W.; Bracco, C.A. and Shannon, K.M. (1990): Age-related differences in erythropoietic comparison in adult and infant rhesus monkeys. Pediatr Res; 28: 567.Gibson, B.E.; Todd, A. and Roberts, I. (2004): British Committee for Standards in Haematology Transfusion Task force: Writing group. Transfusion guidelines for neonates and older children. Br J Haematol; 124: 433-453.Hann, I.M. (1991): The normal blood picture in neonates. In: Hann IM, Gibson BES, Letsky EA, eds. Fetal and neonatal haematology. London: Baillière Tindall.Haque, K.N.; Remo, C. and Bahakim, H. (1995): Comparison of two types of intravenous immunoglobulins in the treatment of neonatal sepsis. Clin Exp Immunol; 101: 328.Heddle, N.M.; Whyte, R. and Asztalos, E. (2004): Identifying the optimal red cell transfusion threshold for extremely low birth weight infants: The Premature In Need of Transfusion (PINT) study. Transfusion; 44(Suppl.): 1A.Hegyi, E.; Nakazawa, M. and Debili, N. (1991): Developmental changes in human megakaryocyte ploidy. Exp Hematol; 19: 87-94.Hillman, R.S.; Ault, K.A. and Rinder, H.M. (2005): Blood component therapy in hematology. In: Clinical Practice (fourth edition). McGraw-Hill Companies; 431-440.Hintz, S.R.; Poole, W.K. and Wright, L.L. (2005): NICHD Neonatal Research Network. Changes in mortality and morbidities among infants born at less than 25 weeks during the post-surfactant era. Arch Dis Child Fetal Neonatal Edn; 90: F128-F133.Hollinger, F.B.X. (1984): Prevention of post-transfusion hepatitis. In: Viral Hepatitis and Liver Disease. Proceedings of the 1984 International Symposium of Viral Hepatitis. Florida; Grune and Stratton.Hudson, I.R.; Cavill, I.A. and Cooke, A.D. (1990): Biotin labeling of red cells in the measurement of red cell volume in preterm infants. Pediatr Res; 28: 199.Isbister, J.P. (1996): Risk management in transfusion medicine. Transfuse Med Rev; 10: 183.Jaeusch, H.W.; Ballard, R.A. and Gleason, C.A. (1991): Transfusion of blood and blood products. In: Avery’s Diseases of the Newborn (6th edition). Curtis Center, Philadelphia, Pennsylvania; 985-998.Jaeusch, H.W.; Ballard, R.A. and Gleason, C.A. (2005): Transfusion of blood and blood products. In: Avery’s Diseases of the Newborn (8th edition). Curtis Center, Philadelphia, Pennsylvania; 985-998.Johnson, L.H. (2002): System-based approach to management of neonatal jaundice and prevention of kernicterus. J Pediatr; 140: 396.Johnson, M.M.; Rodden, D.J. and Collins, S.M. (2006): Newborn hematology. In: Handbook of Neonatal Intensive Care (sixth edition). By Merensten GB and Gardner SL. Printed in USA. Elsevier, Sabre Foundation; 521-547.Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (2004): Revised guidance to help prevent kernicterus. Sentinel Event Alert; 21.Juretschke, L.J. (2005): Kernicterus: Still a concern. Neonatal Netw;24:07:00Kahn, D.J.; Richardson, D.K. and Billett, H.H. (2002): Association of thrombocytopenia and delivery method with intraventricular hemorrhage among very-low-birth-weight infants. Am J Obstet Gynecol; 186: 109-16.Kahn, D.J.; Richardson, D.K. and Billett, H.H. (2003): Inter-NICU variation in rates and management of thrombocytopenia among very low birth-weight infants. J Perinatol; 23: 312-316.Kahn, R.A.; Allen, R.W. and Baldassare, J. (1985): Alternative sources and substitute for therapeutic blood components. Blood; 66: 1-12.Karpatkin, M. (1999): Coagulation problems in the newborn. Semin Neonatol; 4: 1-7.Kenton, A.B.; Hegemier, S. and Smith, E.O. (2005): Platelet transfusions in infants with necrotizing enterocolitis do not lower mortality but may increase morbidity. J Perinatol; 25: 173-177.Klein, H.G. (1997): Current status of microbial contamination of blood components: Summary of a conference. Transfusion; 37: 95-101.Kooy, M.V.M. (1991): Use of leukocyte-depleted platelet concentrates for the prevention of refractoriness and primary HLA alloimmunization: A prospective, randomized trial. Blood; 77: 201.Kulkarni, R. (2001): Bleeding in the newborn. Pediatr Ann; 30: 548-556.Kulkarni, R. and Lusher, J. (2001): Perinatal management of newborns with haemophilia. Br J Haematol; 112: 264-274.Larison, P.J. and Cook, L.O. (1999): Adverse effects of blood transfusion. In: Modern Blood Banking and Transfusion Practices (fourth edition), by Harmenjay DM. FA Davis Company, Philadelphia; 380-405.Lee, D.A; Slagle, T.A. and Jackson, T.M. (1995): Reducing blood donor exposures in low birth weight infants by the use of older, unwashed packed red blood cells. J Pediatr; 125: 92.Leipala, J.A.; Boldt, T. and Fellman, V. (2004): Haemodynamic effects of erythrocyte transfusion in preterm infants. Eur J Pediatr; 163: 390-394.Letsky, E.A. (1999): Use of blood products. In: Textbook of Neonatology (third edition), by Rennie JM and Roberton NR. Churchill Livingstone, Toronto; 838-845.Levine, E.; Rosen, A. and Sehgal, L. (1990): Physiologic effects of acute anemia: Implications for a reduced transfusion trigger. Transfusion; 30: 11.Linden, J.V.; Tourault, M.A. and Scribner, C.L. (1997): Decrease in frequency of transfusion fatalities. Transfusion; 37: 243.Luban, N.L. (2002): Neonatal red blood cell transfusions. Curr Opin Hematol; 9: 533-6.Magny, J.F.; Bremard-Oury, C. and Brault, D. (1991): Intravenous immunoglobulin therapy for prevention in hih-risk premature infants: Report of a multicenter, double-blind study. Pediatrics; 88: 437.Maier, R.F.; Metze, B. and Obladen, M. (1998): Low degree of regionalization and high transfusion rates in very low birthweight infants: a survey in Germany. J Perinat Med; 26: 43-8.Maier, R.F.; Sonntag, J. and Walka, M.M. (2000): Changing practices of red blood cell transfusions in infants with birth weights less than 1000 gm. J Pediatr; 136: 220-224.Manno, C.S. (1996): What is new in transfusion medicine? In: The Pediatric Clinics of North America; 43(3): 793-808.Marshall, C.J. and Thrasher, A.J. (2001): The embryonic origins of human haematopoiesis. Br J Haematol; 112: 838-850.McIntosh, N.; Helms, P.J. and Smyth, R.L. (2003): Hematological problems of the newborn. In: Fortar and Arneil’s Textbook of Pediatrics. Churchill Livingstone, Toronto; 294-309.Menitove, J.E. (1995): Transfusion of blood and blood components. In: Manual of Clinical Hematology (second edition). Little, Brown and Company (Boston, New York); 1-14.Miyashiro, A.M.; Santos, N. and Guinsburg, R. (2005): Strict red blood cell transfusion guideline reduces the need for transfusions in very-low-birth weight infants in the first 4 weeks of life: A multicentre trial. Vox Sang; 88: 107-113.Mock, D.M.; Lankford, G.L. and Widness, J.A. (1999): Measurement of circulating red blood cell volume by a non-radioactive, biotin method: Validation against 51Cr. Transfusion; 39: 149.Modi, N. and Carr, R. (2000): Promising stratagems to reduce the burden of neonatal sepsis. Arch Dis Child Fetal Neonatal Ed; 83: F150-F153.Mollison, P.L.; Engelfriet, C.P. and Contreas, M. (1993): Blood transfusion in clinical medicine. Ed 9. Blackwell Scientific, Oxford; 527.Murray, N. and Roberts, I. (2006): Neonatal transfusion of blood products. In: Recent Advances in Paediatrics, 23rd edition, by David TJ. Royal Society of Medicine Press; 739-753.Murray, N.; Roberts, I. and Stanworth, S. (2005): Red blood cell transfusion in neonates. Pediatrics; 116: 1609.Murray, N.A. and Roberts, I.A.G. (1996): Circulating megakaryocytes and their progenitors in early thrombocytopenia in preterm neonates. Pediatr Res; 40: 112-119Murray, N.A.; Howarth, L.J. and McCloy, M.P. (2002): Platelet transfusion in the management of severe thrombocytopenia in neonatal intensive care unit patients. Transfus Med; 12: 35-41.Murray, N.A.; Watts, T.L. and Roberts, I.A.G. (1998): Endogenous thrombopoietin levels and effect of recombinant human thrombopoietin on megakaryocyte precursors in term and preterm babies. Pediatr Res; 43: 148.Myhre, B.A. (1990): The first recorded blood transfusions: 1656 to 1668. Transfusion; 30: 358.Ohls, P.K.; Yan, L.I. and Trautman, M.S. (1994): Erythropoietin production by macroiphages from preterm infants: Implications regarding the cause of the anemia in prematurity. Pediatr Res; 35: 169.Ohls, R.K.; Harcum, J. and Schibler, K.R. (1997): The effect of erythropoietin on the transfusion requirements of preterm infants weighing 750 grams or less: A randomized, double-blind, placebo-controlled study. J Pediatr; 131: 661.Ohls, R.K.; Li, Y. and Abdel-Mageed, A. (1995): Neutrophil pool sizes and granulocyte colony-stimulating factor production in human mid-trimester fetuses. Pediatr Res; 37: 806-811.Ohlsson, A. and Lacy, J.B. (2004): Intravenous immunoglobulin for suspected or subsequently proven infection in neonates. Cochrane Database Syst Rev; 1: CD001239.Onls, R.K. and Christensen, R.D. (2000): Development of hematopoietic system. In: Nelson Textbook of Pediatrics (16th edition), by Behrman RE, Kliegman RM and Jenson HB. Saunders, Philadelphia, Pennsylvania; 1456-1461.Onls, R.K. and Christensen, R.D. (2004): Development of hematopoietic system. In: Nelson Textbook of Pediatrics (17th edition), by Behrman RE, Kliegman RM and Jenson HB. Saunders, Philadelphia, Pennsylvania; 1599-1604.Oski, F.A. (1993): The erythrocyte and its disorders. In: Nathan A, Oski, F.A., eds. Hematology of infancy and childhood. New York: WB Saunders; 18.Pahal, G.; Jauniaux, E. and Kinnon, C. (2000): Normal development of human fetal hematopoiesis between eight and seventeen weeks’ gestation. Am J Obstet Gynecol; 183: 1029-1103.Panzer, S.; Auerbach, L. and Cechova, E. (1995): Maternal alloimmunization against fetal platelet antigens: A prospective study. Br J Haematol; 90: 655.Puckett, R.M. and Offringa, M. (2000): Prophylactic vitamin K for vitamin K deficiency bleeding in neonates. Cochrane Database Syst Rev; 4: CD002776.Reverdiau, M.P.; Delahousse, B. and Body, G. (1996): Evolution of blood coagulation activatoirs and inhibitors in the healthy human fetus. Blood; 88: 900.Ringer, S.A.; Richardson, D.K. and Sacher, R.A. (1998): Variations in transfusion practice in neonatal intensive care. Pediatrics; 101: 194.Roberts, I.A.G. and Murray, N.A. (2001): Neonatal thrombocytopenia: New insights into pathogenesis and implications for clinical management. Curr Opin Pediatr; 13: 16-21.Rosenthal, J. (1995): Neonatal myelopoiesis and immunomodulation of host defenses. In: Petz LD, Swisher SN, Kleinman S, Spence RK, Strauss RG (eds): Clinical practice of transfusion medicine. 3rd ed. New York: Churchill Livingstone; 685-704.Rubaltelli, F.F. and Griffith, P.F. (1992): Management of neonatal hyperbilirubinaemia and prevention of kernicterus. Drugs; 43(6): 864-872.Sahnnon, K.M.; Keith, J.F. and Mentzer, W.C. (1995): Recombinant human erythropoietin stimulates erythropoiesis and reduces erythrocyte transfusions in very-low-birth-weight preterm infants. Pediatrics; 95: 1.Schibler, K.R.; Liechty, K.W. and White, W. (1993): Production of granulocyte colony-stimulating factor in vitro by monocytes from preterm and term neonates. Blood; 82: 2478.Seguin, J.H. and Topper, W.H. (1994): Coagulation studies in very low-birthweight infants. Am J Perinatol; 11: 27-29.Slayton, W.B. (2000): Development of the immune system in the human fetus. In: Christensen RD (editor): Hematologic problems of the neonate. Philadelphia, WB Saunders; 21-42.Snijders, R.J.M.; Abbas, A. and Melby, O. (1993): Fetal plasma erythropoietin concentration in severe growth retardation. Am J Obstet Gynecol; 168: 615.Sola, M.C.; Dame, C. and Christensen, R.D. (2001): Toward a rational use of recombinant thrombopoietin in the neonatal intensive care unit. J Pediatr Hematol Oncol; 23: 179.Stainsby, D.; Russell, J. and Cohen, H. (2005): Reducing adverse events in blood transfusion. Br J Haematol; 131: 8-12.Stanworth, S.J.; Brunskill, S.J. and Hyde, C.J. (2004): Is fresh frozen plasma clinically effective? A systematic review of randomized controlled trials. Br J Haematol; 126: 139-152.Strauss, R.G. (1995): Red blood cell transfusion practices in the neonate. Clin Perinatol; 22: 641.Strauss, R.G. (2000): Blood banking and transfusion issues in perinatal medicine; 405-425.Strauss, R.G. (2000): Risks of blood component transfusions. In: Nelson Textbook of Pediatrics (16th edition), by Behrman RE, Kliegman RM and Jenson HB. Saunders, Philadelphia, Pennsylvania; 1499-1503.Strauss, R.G. (2000): Transfusion approach to the anemia of prematurity. NeoReviews; 1: e74.Strauss, R.G. (2004): Risks of blood component transfusions. In: Nelson Textbook of Pediatrics (17th edition), by Behrman RE, Kliegman RM and Jenson HB. Saunders, Philadelphia, Pennsylvania; 1646-1650.Strauss, R.G.; Levy, G.J. and Sotelo-Avila, C. (1993): National survey of neonatal transfusion practices. II: Blood component therapy. Pediatrics; 91: 530.Strauss, R.G.; Sacher, R.A. and Blazina, J.F. (1990): Commentary on small-volume red cell transfusions for neonatal patients. Transfusion; 30: 565.Stuart, M.I. and Graeber, J.E. (1998): Normal hemostasis in the fetus and newborn: Vessels and platelets. In: Polin RA, Fox WM, eds. Fetal and neonatal physiology. Philadelphia: WB Saunders; 1834-1848.Supapannachart, S.; Siripoonya, P. and Boonwattanasoontorn, W. (1999): Neonatal polycythemia: Effects of partial exchange transfusion using fresh frozen plasma, haemaccel and normal saline. J Med Assoc Thai; 82(Suppl.1): S82-S86.Vamkas, E.C. (1995): Perioperative blood transfusion and cancer recurrence: Meta-analysis for explanation. Transfusion; 35: 760.Vamvakas, E.C. and Strauss, R.G. (2001): Meta-analysis of controlled clinical trials studying the efficacy of recombinant human erythropoietin in reducing blood transfusions in the anemia of prematurity. Transfusion; 41: 406.van Overmeire, B.; Bleyaert, S. and van Reempts, P.J. (1993): The use of intravenously administered immunoglobulins in the prevention of severe infection in very low birth weight neonates. Biol Neonate; 64: 110.Vengelen-Tyler, V. (ed) (1996): Technical manual, ed 12. American Association of Blood Banks. Bethesda, MD; 549.Vichinsky, E.P. (1990): Alloimmunization in sickle cell anemia and transfusion of racially unmatched blood. N Engl J Med; 322: 1617.Voak, D.; Cann, R. and Finney, R.D. (1994): Guidelines for administration of blood products: Transfusion of infants and neonates. Transfuse Med; 4: 63-69.Wagner, S.J. (1994): Transfusion-associated bacterial sepsis. Clin Microbiol Rev; 7: 290-302.Wagner, S.J. (1995): Comparison of bacteria growth in single and pooled platelet concentrates after deliberate inoculation and storage. Transfusion; 35: 298-302.Walker, R.H. (ed) (1993): Blood and blood components. Technical Manual, ed 11. Bethesda, The American Association of Blood Banks; 53.Watts, T.L. and Roberts, I.A.G. (1999): Haematological abnormalities in the growth-restricted infant. Semin Neonatol; 4: 41-54.Widness, J.A.; Madan, A. and Grindeanu, L.A. (2005): Reduction in red blood cell transfusions among preterm infants: Results of a randomized trial with an inline blood gas and chemistry monitor. Pediatrics; 115: 1299-1306.Widness, J.A.; Seward, V.J. and Kromer, I.J. (1996): Changing patterns of red blood cell transfusion in very low birth weight infants. J Pediatr; 129: 680-687.Widness, J.A.; Veng-Pedersen, P. and Peters, C. (1996): Erythropoietin pharmacokinetics in premature infants: Developmental, non-linearity, and treatment effects. J Appl Physiol; 80: 140.Wolber, E.M.; Bame, C. and Fahnenstich, H. (1999): Expression of the thrombopoietin gene in human fetal and neonatal tissues. Blood; 94: 97-105.Wood, A.; Wilson, N. and Skacl, P. (1995): Reducing donor exposure in preterm infants requiring blood transfusions. Arch Dis Child; 72: F29.الملخص العربىوجد فى الطب الحديث أن المرضى حديثى الولادة هم أكثر المجموعات عرضةً لنقل الدم ولقد وجد أن الدواعى القاطعة لنقل مكونات الدم ليست محددة ولذلك لابد أن نضع فى الاعتبار الأسباب والأهداف من العلاج وكل أوجه الاستفادة والخطورة قبل اتخاذ القرار.مكونات الدم التى يتم نقلها هى:(1) الدم الكامل.(2) خلايا الدم الحمراء.(3) خلايا الدم البيضاء.(4) البلازما.(5) الصفائح الدموية.دواعى نقل الدم الكامل هى:(1) فقدان الدم (الجرعة 20 مل/كجم).(2) تغيير الدم (الجرعة 80- 100 مل/كجم).إن كرات الدم الحمراء هى أكثر مكونات الدم التى تعطى لمرضى حديثى الولادة شيوعاً وتعطى فى الحالات الآتية:(1) نسبة الهيموجلوبين أقل من 130 جم/لتر مع تدهور شديد فى وظائف القلب والرئتين.(2) نسبة الهيموجلوبين أقل من 100 جم/لتر مع تدهور متوسط فى وظائف القلب والرئتين.(3) نسبة الهيموجلوبين أقل من 100 جم/لتر مع جراحة كبرى.(4) نسبة الهيموجلوبين أقل من 80 جم/لتر مع أعراض فقر الدم.(5) النزيف أكثر من 25% من حجم الدم بالجسم.حيث أن جرعة كرات الدم الحمراء فى كل منهم 10- 15 مل/كجم.دواعى نقل كرات الدم البيضاء هى:(1) كرات الدم البيضاء المصبوغة بصبغة متعادلة أقل من 3 × 910/ لتر مع تسمم شديد خلال الأسبوع الأول من الحياة.(2) كرات الدم البيضاء المصبوغة بصبغة متعادلة أقل من 1 × 910/ لتر مع تسمم شديد بعد الأسبوع الأول من الحياة.حيث أن جرعة كرات الدم البيضاء فى كل منهما 10- 15 مل/كجم.أثبتت الدراسات السابقة أن نقص صفائح الدم فى حديثى الولادة عامل خطير يؤدى إلى نزيف أو اختلال فى النمو العصبى أو حتى الوفاة ودواعى نقل صفائح الدم هى:(1) الصفائح الدموية أقل من 100 × 910/ لتر مع نزيف.(2) الصفائح الدموية أقل من 50 × 910/ لتر مع تشخيص تداخلى.(3) الصفائح الدموية أقل من 20 × 910/ لتر مع حالة صحية مستقرة.(4) الصفائح الدموية أقل من 100 × 910/ لتر مع حالة صحية غير مستقرة.(5) أى عد للصفائح الدموية مع اختلال فى وظائفها.حيث أن جرعة الصفائح الدموية فى كل منهم 5- 10 مل/كجم.من المعتاد نقل البلازما الطازجة للأطفال حديثى الولادة لأسباب متعددة منها:(1) علاج مرض التجلط المنتشر داخل الأوعية.(2) منع النزيف الداخلى بالمخ.(3) مرض تسمم الدم.(4) قلة الصفائح الدموية.(5) تصحيح نقص عوامل التجلط.حيث أن جرعة البلازما الطازجة 10 مل/كجم.من أكثر مضاعفات نقل الدم شيوعاً هى:(1) الحساسية.(2) ارتفاع الحرارة غير المصاحب لتكسير الدم.(3) تكسير الدم.(4) نقل العدوى.(5) زيادة فى حجم الدورة الدموية.لذلك نوصى بالآتى:للحصول على أفضل نتائج لعملية نقل الدم يجب مراعاة متطلبات المريض مع إعطائه مكون الدم المناسب, الشىء الذى يستوجب فهماً كاملاً لكل مكون من مكونات الدم.يجب أخذ نسبة الخطورة/الفائدة فى الاعتبار قبل البدء فى عمليات نقل الدم.كما يجب أيضاً الأخذ فى الاعتبار الخطورة الناجمة عن عملية نقل الدم سواء العاجل منها أو الآجل وكذلك نقل العدوى.