Kirsten G F, Kirsten C L, Faber M, Collett C, Mitchell C A, Bird A R
Department of Paediatrics, Tygerberg Hospital, W. Cape.
S Afr Med J. 1996 Nov;86(11 Suppl):1460-4.
To conduct an audit of the frequency of red cell concentrate transfusions (RCCTs) in infants of different weight categories, the donor exposure rate (DER), in these transfused infants and the volume of blood wasted during each transfusion, and to identify from this baseline information specific categories of infants who would benefit from the introduction of a limited donor exposure programme (LDEP).
Neonatal wards and neonatal intensive care unit (NICU), Tygerberg Hospital, Western Cape.
A prospective descriptive study and comparison with a historic control group.
Information on the birth weight, age at the time of each RCCT and number of blood donors to whom an infant was exposed were collected post factum for all infants admitted to the neonatal wards and NICU between May 1993 and May 1994. During this time, the red blood cell concentrate was supplied as single paediatric bags (180 ml) transfused within 14 days of donation. An LDEP was introduced in February 1995. With this system, red blood cells were supplied as triple packs: a main unit of 250 ml with three empty satellite packs allowing up to three separate transfusions. These were assigned to a specific infant and were to be transfused within 21 days of donation. A second system where one adult blood bag was divided into two 180 ml bags and assigned to one infant to be transfused within 35 days of donation was also assessed.
Of the 7854 infants admitted during the first 12-month audit period, 387 (4.9%) received 977 RCCTs. Of these, 183 (47.3%) received one transfusion, 72 (18.6%) two transfusions, 51 (13.2%) three transfusions, 27 (7.0%) four transfusions and 54 (13.9%) five or more transfusions. Infants (N = 188) with a birth weight below 1500 g admitted to the NICU were identified as the group with the highest prevalence of RCCTs (68.6%), and it was therefore decided that in the prospective study such infants would qualify for the LDEP. A total of 81 infants was transfused with either the double (N = 47) or the triple bags (N = 34) over a 5-month period. The decrease in the mean DER (+/-SD) was clinically significant when the triple (1.9 +/- 0.8) (P = 0.0001) and the double bags (1.6 +/- 0.8) (P = 0.0001) were compared with the previous single-bag system (4.4 +/- 3.5). Of concern was the large mean volume of concentrated red cells (118.5 +/- 12.5 ml) wasted per transfusion with the single-bag system.
This survey confirmed a high RCCT rate as well as a very high DER in very-low-birth-weight (VLBW) infants treated at a tertiary centre. By assigning a triple or double bag of red cells from one blood donor and extending the storage of blood for small-volume RCCTs in infants from 14 days to 35 days, donor exposure was reduced significantly. We urge the introduction of the multibag blood transfusion system and extended storage period of blood for small-volume RCCT for VLBW infants in South Africa.
对不同体重类别的婴儿红细胞浓缩液输注（RCCT）频率、这些接受输血婴儿的供血者暴露率（DER）以及每次输血时浪费的血量进行审核，并根据这些基线信息确定哪些特定类别的婴儿将受益于引入有限供血者暴露计划（LDEP）。
西开普省泰格伯格医院的新生儿病房和新生儿重症监护病房（NICU）。
一项前瞻性描述性研究，并与一个历史对照组进行比较。
收集了1993年5月至1994年5月期间入住新生儿病房和NICU的所有婴儿的出生体重、每次RCCT时的年龄以及婴儿接触的供血者数量等信息。在此期间，红细胞浓缩液以单个儿科袋（180毫升）的形式供应，在采集后14天内输注。1995年2月引入了LDEP。采用该系统时，红细胞以三联包的形式供应：一个250毫升的主袋和三个空的卫星袋，允许进行多达三次单独的输血。这些被分配给特定的婴儿，并在采集后21天内输注。还评估了另一种系统，即将一个成人血袋分成两个180毫升的袋子，分配给一个婴儿，在采集后35天内输注。
在第一个为期12个月的审核期内收治的7854名婴儿中，387名（4.9%）接受了977次RCCT。其中，183名（47.3%）接受了一次输血，72名（18.6%）接受了两次输血，51名（13.2%）接受了三次输血，27名（7.0%）接受了四次输血，54名（13.9%）接受了五次或更多次输血。入住NICU的出生体重低于1500克的婴儿（N = 188）被确定为RCCT发生率最高的群体（68.6%），因此在前瞻性研究中决定此类婴儿符合LDEP的条件。在5个月的时间里，共有81名婴儿接受了双袋（N = 47）或三袋（N = 34）输血。将三联包（1.9 +/- 0.8）（P = 0.0001）和双袋（1.6 +/- 0.8）（P = 0.0001）与之前的单袋系统（4.4 +/- 3.5）进行比较时，平均DER的降低具有临床意义。令人担忧的是，单袋系统每次输血浪费的浓缩红细胞平均量很大（118.5 +/- 12.5毫升）。
这项调查证实了在一家三级中心接受治疗的极低出生体重（VLBW）婴儿中RCCT率很高以及DER非常高。通过从一名供血者分配一袋三联或双联红细胞，并将婴儿小容量RCCT的血液储存时间从14天延长至35天，供血者暴露显著减少。我们敦促在南非为VLBW婴儿引入多袋输血系统并延长小容量RCCT的血液储存期。
