Yenidoğanlarda Eritrosit Süspansiyonu Kullanımının Değerlendirilmesi

Amaç: Yenidoğan yoğun bakım ünitelerinde (YYBÜ) eritrosit süspansiyonu (ES) transfüzyonu sıklıkla kullanılmaktadır. Çalışmamızda hastanemiz YYBÜ’de yatan hastalarda ES kullanımı; transfüzyon sıklığı, endikasyon, laboratuvar kontrolü, komplikasyonlar ve rehberlere uygunluk açısından değerlendirildi. Gereç ve Yöntemler: Tanımlayıcı nitelikte olan bu çalışmaya Sağlık Bilimleri Üniversitesi, Ankara Dr. Sami Ulus Kadın Doğum, Çocuk Sağlığı ve Hastalıkları SUAM YYBÜ’nde 2016 yılında yatarak izlenen ve yatışı sırasında ES alan hastalar dâhil edildi. Hastaların demografik ve klinik özellikleri, kullanılan ES sayısı ve ilk üç transfüzyona ait laboratuvar testleri. ES kullanım endikasyonlarının Nelson Pediatric Textbook transfüzyon önerileri ve Türk Neonatoloji (TND) Derneği Kan Ürünleri Transfüzyon Rehberi’ne uygunluğu değerlendirildi. Bulgular: Çalışma süresince YYBÜ’ne yatan 1538 hastadan 191’ine toplam 633 ES transfüzyonu verilmişti, ES kullanım oranı % 12.4’tü. İlk üç transfüzyon incelemesinde TND Kan Ürünleri Transfüzyon Rehberine %66 oranında, Nelson Pediatric Textbook (2016) transfüzyon protokolüne göre ise %64 oranında uygunluk olduğu belirlendi. Birden fazla ES alan prematüre bebeklerde prematüre retinopatisi (p=0.015), intrakranial kanama (p=0.001) sıklığının yüksek olması anlamlıydı. Sonuç: Transfüzyon uygulaması ciddi ihtiyaç durumunda hayat kurtarıcı olmakla birlikte saptanan morbidite ve komplikasyonlar ile arasında neden sonuç ilişkisi olabilir. Eritrosit süspansiyonu transfüzyonu kararı öncesi her yenidoğan bebeğin bireysel olarak ve rehberler çerçevesinde dikkatle değerlendirilmesi gerekmektedir.

Anahtar Kelimeler:

Endikasyon, komplikasyon, yenidoğan, Eritrosit transfüzyonu

Evaluation of Erythrocyte Suspension Use in Neonates

Objective: Erythrocyte suspension (ES) transfusion is frequently used in neonatal intensive care units (NICU). We evaluated the use of ES in hospitalized patients in the NICU of our hospital in terms of transfusion rate, indication, laboratory control, complications, and adherence to the guidelines. Material and Methods: Patients who were hospitalized at the University of Health Sciences of Turkey, Dr Sami Ulus Maternity and Children Research and Training Hospital, NICU, in 2016, and who received ES were included in this descriptive study.The demographic and clinical characteristics of the patients, the quantity of ES used, and the laboratory tests of the first three transfusions were recorded.The compliance of ES usage indications with the transfusion guidelines published in the Nelson Pediatric Textbook and the Turkish Neonatology (TND) Society Blood Products Transfusion Guidelines was assessed. Results: One hundred and ninety one of the 1538 admitted patients in the NICU received a total of 633 ES, for a 12.4% ES usage rate. Following an evaluation of the first three transfusions, it was determined that there was 66% compliance with the TND Blood Products Transfusion Guide and 64% compliance with the Nelson Pediatric Textbook transfusion protocol. It was significant that the frequency of retinopathy of prematurity (p=0.015) and intracranial hemorrhage (p=0.001) was high in premature infants who received more than one ES. Conclusion: Although transfusion is life-saving in crucial circumstances, there may be a cause-effect relationship between the detected morbidity and complications. Each newborn should be carefully evaluated individually and within the framework of the guidelines before having to decide on an erythrocyte transfusion.

Keywords:

Complication, Erythrocyte transfusion, Indication, Newborn,

PDF

___

Zerra PE, Josephson CD. Transfusion in neonatal patients: review of evidence-based guidelines. Clin Lab Med 2021;41:15-34.
Çetinkaya M, Atasay B, Perk Y. Türk Neonatoloji Derneği yenidoğanda transfüzyon ilkeleri rehberi. Türk Pediatri Arşivi 2018;53:101-8.
Villeneuve A, Arsenault V, Lacroix J, Tucci M. Neonatal red blood cell transfusion. Vox Sang 2021;116:366-78.
D’Amato G, Faienza MF, Palladino V, Bianchi FP, Natale MP, Christensen RD, et al. Red blood cell transfusions and potentially related morbidities in neonates under 32 weeks’ gestation. Blood Transfus 2021;19:113-19.
Zhu Z, Hua X, Yu Y, Zhu P, Hong K, Ke Y. Effect of red blood cell transfusion on the development of retinopathy of prematurity: A systematic review and meta-analysis. PLoS One 2020;15:e0234266.
Ghirardello S, Dusi E, Cortinovis I, Villa S, Fumagalli M, Agosti M, et al. Effects of red blood cell transfusions on the risk of developing complications or death: an observational study of a cohort of very low birth weight infants. Am J Perinatol 2017;34:88-95.
Arlettaz Mieth R, Gosztonyi L, Hegemann I, Bassler D, Rüegger C. Neonatal red blood cell transfusion practices in Switzerland: national survey and review of international recommendations. Swiss Med Wkly 2020;150:w20178.
Kirpalani H, Bell EF, Hintz SR, Tan S, Schmidt B, Chaudhary AS, et al. Higher or lower hemoglobin transfusion thresholds for preterm infants. N Engl J Med 2020;383:2639-51.
Franz AR, Engel C, Bassler D, Rüdiger M, Thome UH, Maier RF, et al. Effects of liberal vs restrictive transfusion thresholds on survival and neurocognitive outcomes in extremely low-birth-weight infants: the ETTNO randomized clinical trial. JAMA 2020;324:560-70.
Gammon RR, Al‐Mozain N, Auron M, Bocquet C, Clem S, Gupta GK, et al. Transfusion therapy of neonatal and paediatric patients: They are not just little adults. Transfus Med 2022;32:448-59.
Boix H, Sánchez-Redondo MD, Cernada M, Fernández MGE, González-Pacheco N, Martín A, et al. Recommendations for transfusion of blood products in neonatology. AnPediatr (Engl Ed) 2022;97:60. e1-. e8.
Cibulskis CC, Maheshwari A, Rao R, Mathur AM. Anemia of prematurity: how low is too low? J Perinatol 2021;41:1244-57.
Turkish Neonatology Association: Home, Diagnosis and Treatment Guidelines. Accessed: 25 Şubat 2023. Available from: https://www.neonatology.org.tr/neonatoloji/tani-ve-tedavi-rehberleri/
Perk Y, Atasay B, Çetinkaya M. Türk Neonatoloji Derneği Kan Ürünleri Transfüzyon Rehberi-2016. Available from: 25 Şubat 2023.
Maheshwari A, Carlo WA. Blood Disorders. In: Kliegman RM, Stanton BF, St. Geme III JW, Schor NF, Behrman RE (eds). Nelson Textbook of Pediatrics. 20nd ed. Philadelphia, ABD: Elsevier 2016:880-89.
Patterson JA, Bowen JR, Francis S, Ford JB. Comparison of neonatal red cell transfusion reporting in neonatal intensive care units with blood product issue data: a validation study. BMC Pediatr 2018;18:86.
Portugal CAA, Paiva APd, Freire ÉS, Chaoubah A, Duarte MC, Hallack Neto AE. Transfusion practices in a neonatal intensive care unit in a city in Brazil. Rev Bras Hematol Hemoter 2014;36:245-49.
Turhan A. Evaluation of Blood Transfusion Applications in Newborn Intensive Care Unit; Single Center Experience. The Journal of Current Pediatrics 2019;17:85-95.
Arman D, Nursu K. Evaluation of Risk Factors Associated with Red Blood Cell Transfusion in Preterm Infants. Medical Bulletin of Zeynep Kamil 51:9-13.
Saito‐Benz M, Flanagan P, Berry MJ. Management of anaemia in pre‐term infants. Br J Haematol 2020;188:354-66.
Meyer MP, O’Connor KL, Meyer JH. Thresholds for blood transfusion in extremely preterm infants: A review of the latest evidence from two large clinical trials. Front Pediatr 2022;10:957585.
Priya RS, 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;12:34-41.
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;34:671-76.
Mazine A, Rached-D’Astous S, Ducruet T, Lacroix J, Poirier N, Pediatric Acute Lung Injury, et al. Blood transfusions after pediatric cardiac operations: a North American multicenter prospective study. Ann Thorac Surg 2015;100:671-7.
Cholette JM, Willems A, Valentine S, Bateman S, Schwartz SM. Recommendations on red blood cell transfusion in infants and children with acquired and congenital heart disease from the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med 2018;19:S137.
Taslak Ulusal Hasta Kan Yönetimi Rehberleri. 26 Şubat 2023. Available from: https://hastakanyonetimi.saglik.gov.tr/Content/ListIndex/?id=28/
Saito‐Benz M, Sandle ME, Jackson PB, Berry MJ. Blood transfusion for anaemia of prematurity: Current practice in Australia and New Zealand. J Paediatr Child Health 2019;55:433-40.
Keir A, Grace E, Stanworth S. Closing the evidence to practice gap in neonatal transfusion medicine. Semin Fetal Neonatal Med 2021;26:101197.
Crawford TM, Andersen CC, Hodyl NA, Robertson SA, Stark MJ. The contribution of red blood cell transfusion to neonatal morbidity and mortality. J Paediatr Child Health 2019;55:387-92.