A lack of standardized transfusion protocols in Canadian neonatal intensive care units may contribute to inconsistent care for preterm infants, including those affected by fetal and neonatal alloimmune thrombocytopenia (FNAIT), according to results from a report published recently in Transfusion.
FNAIT is a serious condition in which a mother’s immune system attacks fetal platelets, increasing the risk of bleeding and requiring careful platelet management after birth. Despite the need for transfusions due to FNAIT and other causes, only 32.3% of surveyed centers reported having a platelet transfusion protocol in place.
“This study revealed that the implementation of a formal transfusion protocol is not widespread in Canadian NICUs [neonatal intensive care units] for commonly used blood products in preterm infants,” stated this study’s authors.
This study, conducted across all 31 sites in the Canadian Neonatal Network, revealed that while 54.8% of centers have a red blood cell (RBC) transfusion protocol, most of which follow Canadian Pediatric Society guidance, far fewer have structured approaches to platelet transfusions. Since thrombocytopenia is central to FNAIT, and low platelet counts and bleeding were cited as top reasons to transfuse, this inconsistency raises concern about the quality of care in vulnerable neonates.
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The threshold for transfusions varies not only by center but also by each infant’s age, oxygen needs, or recent procedures. For RBCs, hemoglobin levels were universally used as a transfusion trigger. For platelets, low counts were the most common reason (96.8%), followed by significant bleeding (93.6%). Volume definitions also differed, with platelet doses ranging from 10 to 15 mL/kg across institutions, complicating efforts to compare outcomes or establish best practices.
Feeding during transfusion also lacks consistency. While most centers did not stop feeds for RBC transfusions, 12.9% did pause feeding, with some pauses lasting up to four hours. Withholding nutrition in early life can interfere with gut development and growth in fragile newborns, making these variations clinically significant.
Strategies to reduce the need for transfusions, including delayed cord clamping (96.8%) and iron supplementation (87.1%), were widely adopted. However, only 25.8% used cord blood as a transfusion source, a potentially valuable option for babies with FNAIT, who may benefit from matched, antigen-negative products.
Overall, these results underscore an urgent need for unified, evidence-based transfusion protocols to ensure equitable and effective care. For families of infants with conditions such as FNAIT, such efforts could help prevent bleeding complications, shorten hospital stays, and provide greater peace of mind during a critical time.
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