Blood transfusion for your baby

What is a blood transfusion?

A blood transfusion is when donated blood is given to your baby. It is given into a vein, using a soft plastic tube. A typical transfusion for a baby takes about three hours. Donated blood is ‘whole blood’, which can be separated into different components.

What types of blood components can be used for transfusion?

• Red blood cells carry oxygen to the body’s tissues. These may be given in cases of anaemia (where red cells are low in number) or if a baby is bleeding (e.g. during or after surgery), to ensure that the tissues receive enough oxygen.
• Platelets help to stop bleeding by helping the blood to clot. Platelet transfusion may be necessary when platelet numbers are low or when platelets don’t work properly.
• Fresh frozen plasma and cryoprecipitate contain clotting factors, which work with platelets to seal wounds. Plasma may also be used to help stop bleeding.

Why might your baby need a blood transfusion?

Preterm babies have a much higher need for blood than term babies. This is because their bone marrow, which makes red blood cells, is immature and does not function as well as in a term baby. Also, preterm babies can get sick, and blood transfusions may be necessary to support them during such episodes. Like all medical treatments, a blood transfusion will only be used when necessary. The decision to give a blood transfusion is made after careful consideration.

Where does blood come from?

In Australia there are many precautions to ensure blood is as safe as possible.

• Every donor is interviewed to make sure that they are suitable to donate blood.
• Donors who provide blood for babies are volunteers and are specially selected and have a long history of donation with the Australian Red Cross, Life Blood (previously Blood Service).
• Donors are also CMV Negative. CMV is a common viral infection that many people in the population have encountered. CMV is not a problem for a healthy adult but babies are particularly vulnerable to this infection and the selection of these ‘special’ donors means there is an extra safeguard in place.
• A single adult donation can be divided into 3-4 smaller packs (mini packs) and that blood will be reserved just for your baby, until it expires. This means the same donor will be used again for any repeat transfusions.
• Each donation is extensively tested to further check its safety and any blood that fails these tests is not used. This testing process meets very high standards.

Are blood transfusions safe?

Although Australia’s blood supply is very safe, as with all medical procedures, blood transfusion is not risk free and complications can occur. The most common types of reactions are not serious eg. a mild fever or itching. However; these reactions are rarely encountered when transfusing babies.

In terms of viral safety, Australia has one of the safest blood supplies in the world.

A possible rare adverse effect of blood transfusion in preterm babies is an inflammation of the gut called necrotising enterocolitis. This sometimes, serious condition can occur in preterm babies anyway, but in rare cases, has been associated with a blood transfusion. As a precaution, preterm babies are not fed milk during the transfusion period and receive intravenous fluids instead.

Giving your consent to blood transfusion

If a blood transfusion is necessary for your baby, you will be asked to give your consent. You should understand why your baby needs a transfusion and the risks and benefits involved. If you have any objections to a transfusion, please discuss these with your doctor.

In the event of an emergency, it may not be possible to discuss the need for transfusion and obtain your consent. However, the reasons for the transfusion will be explained to you when it becomes possible.

What happens when my baby has a blood transfusion?

Staff will always carefully check your baby’s identity band to make sure that the correct blood is given. They will check the identity band when your baby has a blood sample taken to cross match the blood in the blood bank and again just before the transfusion to ensure the details identically match the details on the blood unit.

Confirming identity is very important because if the wrong blood is given (meant for someone else) this could cause serious medical problems.

There is also strict monitoring of vital signs during the transfusion.

Alternatives to blood transfusion

• As blood transfusion is not risk free, your doctor will always consider alternatives. These include taking as little blood for tests as possible, to limit blood loss from your baby.
• Using medications to increase the baby’s own production of red blood cells.
• Despite this, it may still be necessary to give a transfusion.

Can I donate blood for my baby’s transfusion?

A family member donating blood for another family member is called a ‘directed donation’. For the following reasons, directed donations are not recommended:

• Blood for your baby must be ABO, Rh (D) and K blood group compatible before it can be used. As previously explained it must also be CMV negative. Many family members will not meet these basic criteria.
• The family donor must fulfil the Australian Red Cross, Life Bloodhealth criteria and may not qualify, e.g. a new mum is often not able to donate blood.
• Non-viral risks such as bacterial sepsis, haemolytic reactions and severe allergic reactions are not reduced by directed donation.
• Volunteer donor blood is never released until all confirmation tests are completed. In neonates the blood is often required immediately and waiting for this specialised testing on the directed donation would result in a delay in essential treatment.
• There is a documented increased risk of fatal graft versus host disease (GvHD) in blood transfusions from family members due to the shared HLA (white cell antigen) types. The use of family directed donations must be avoided if the recipient may undergo a future transplant as there is an increased risk of graft rejection due to HLA sensitisation.
• All directed donations that are not used are destroyed. This is a significant wastage of resources in terms of funds, donor and staff time.
  We therefore believe that it is safest to use blood from the Australian Red Cross, Life Blood.

What if I have other worries about blood transfusion?

Please tell your doctor or nurse about any concerns you may have, no matter how trivial you think they may be.

This document can be made available in alternative formats on request for a person with a disability.