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Red blood cell transfusions in the newborn

Robin Ohls, MD
Section Editors
Donald H Mahoney, Jr, MD
Joseph A Garcia-Prats, MD
Deputy Editor
Melanie S Kim, MD


Red blood cell (RBC) transfusion provides an immediate increase in oxygen delivery to tissues and is an effective and rapid intervention to treat acute anemia. RBC transfusions may reduce the morbidity associated with chronic anemia, such as the anemia of prematurity, and can be lifesaving in neonates with severe blood loss.

The indications for neonatal RBC transfusions and the selection of the proper blood product will be reviewed here. Anemia of prematurity and indications for red cell transfusion in infants and children are discussed separately. (See "Anemia of prematurity" and "Red blood cell transfusion in infants and children: Indications".)


Overview — Symptomatic anemia occurs when the RBC mass does not adequately meet the oxygen demands of tissues. Signs include increased resting heart rate, acidosis, poor growth, decreased energy to nipple feed, apnea, and increased need for respiratory support.

Oxygen supply to tissues is defined as the product of cardiac output and arterial oxygen content. The arterial oxygen content is dependent upon the hemoglobin concentration, arterial oxygen saturation, oxygen carrying capacity of hemoglobin (1.34 mL/gm hemoglobin), and, to a minor extent, the solubility of oxygen. Oxygen supply is increased by increasing cardiac output, arterial oxygen saturation, or hemoglobin concentration.

The indications for neonatal RBC transfusions differ based upon the rate of fall in hemoglobin (acute versus chronic anemia). The need for transfusion in an infant with acute blood loss is generally dependent upon persistent clinical signs of inadequate oxygen delivery following intravascular volume restoration. In chronic anemia, the need for RBC transfusion is, likewise, based upon clinical signs of inadequate oxygen delivery (such as increased resting heart rate, acidosis, poor growth, and apnea) and the degree of respiratory support needed by the infant. Although target hemoglobin and hematocrit (HCT) (values below which a RBC transfusion is administered) have been used as clinical indicators for RBC transfusion, it remains uncertain what target HCT or hemoglobin will optimally balance the risk and benefits of this intervention.

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Literature review current through: Oct 2017. | This topic last updated: Jan 12, 2017.
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