Neonatal transfusion review


  • Section Editor: Jerrold Lerman

Steven R.Solan, Assistant Professor, Department of Pathology, Harvard Medical School, Blood Bank Medical Director, Blood Bank-Bader 406, Children’s Hospital Boston, 300 Longwood Ave., Boston, MA 02115, USA Email:


In addition to the issues concerning blood transfusions in general, special considerations apply to transfusing neonates. Young infants’ plasma may contain maternal antibodies to ABO blood group antigens instead of the naturally occurring anti-ABO antibodies normally present in older patients. This facilitates the transplant of hearts across ABO boundaries but complicates blood bank testing and selection of appropriate blood components for transfusion. Conversely, blood bank testing is simplified by the fact that neonates do not make antibodies to minor erythrocyte antigens. Cellular blood components may be irradiated to prevent transfusion-associated graft-versus-host disease, a syndrome that can affect immunocompromised patients such as premature infants. However, irradiation accelerates the leakage of potassium out of stored red blood cells (RBCs), increasing the risk or transfusion-induced arrhythmias from hyperkalemia and hypocalcemia. Two other risks of transfusing neonates RBCs include dilutional coagulopathy and potential toxicities from additives used to preserve the stored RBC units.