Will my baby need a blood transfusion?

Information for Parents

Introduction

This leaflet explains why your baby may require a transfusion of a blood component such as red cells, platelets or plasma.

Like all medical treatments, a blood transfusion should only be given if it is essential. Your medical team will balance the risk of your baby having a blood transfusion against the risk of not having one.

They will explain to you why your baby needs a blood transfusion, but please ask if they do not. They should also explain the risks and any possible alternatives before gaining consent for the procedure.

In an emergency, it may not have been possible to discuss all options at the time. If this happens, your doctor will talk to you about the transfusion your baby has had as soon as they can.

What is a blood transfusion?

A blood transfusion is the process of giving blood donated by one person to another person who needs it. This leaflet explains about blood transfusions, what they involve and why they might be needed.

Blood is made up of three different types of cells: red blood cells, white blood cells and platelets. Blood cells travel around the body in a liquid called plasma.

Red blood cells carry oxygen around the body. Platelets are responsible for helping to form blood clots. Plasma not only carries blood cells around the body, but it also contains vital proteins that allow the blood to clot when needed. Cryoprecipitate is a part of plasma rich in proteins that can reduce blood loss by helping to slow or stop bleeding.

A blood transfusion may involve your baby receiving one of the following:

• Red blood cells
• Platelets
• Plasma (sometimes called Fresh Frozen Plasma or FFP)
• Cryoprecipitate

Why might my baby need a blood transfusion?

New-born babies often become anaemic (have a reduced number of red blood cells). This might be because they are born early, because of medical problems or because babies who are unwell require a large number of blood tests to monitor their progress. If they become severely anaemic, it will become more difficult for oxygen to be delivered to the different tissues and organs in their body.

If your baby is bleeding or has a problem with their blood clotting that makes them at risk of bleeding they might require platelets, FFP or cryoprecipitate.

If your baby needs an operation, they might need a transfusion to replace any blood or blood components lost during the surgery. The surgical team will discuss this eventuality with you prior to the operation.

How is the blood transfusion given?

The blood donated is stored in a sterile bag which is connected to a long plastic tube. The tube is then connected to a cannula (tiny plastic tube) which is inserted into a vein. The blood travels through the tube into the cannula and then into your baby’s blood stream.

The amount of blood given each time will vary as well as the time over which it is given; red blood cells are usually given over 3-4 hours but can be given more quickly in an emergency, whereas platelets, FFP and cryoprecipitate are usually given over 20-30 minutes.

In some cases, your baby’s doctors will administer medicine to make them pass more urine at the same time as the transfusion. This is to reduce the risk that your baby will have too much fluid in their circulation.

Risks associated with blood transfusion:

Blood transfusions are common procedures that can save and improve lives and death due to transfusion is extremely rare. The risk that a blood transfusion will cause severe harm to your baby is very low and most patients who receive a blood transfusion experience no complications or problems. However, there are associated risks:

Patient identification error: There are many checks in place to make your baby’s transfusion as safe as possible. Staff carry out careful identification steps to make sure your baby gets the right blood component that is safe for them. To ensure this happens, staff carry out careful identification checks of both your baby and the blood they will be given. This is why it is important that your baby wears their identification band.

Infection: The people who donate the blood are carefully selected and all blood donated is thoroughly tested by NHS Blood and Transplant for Hepatitis B, C and E as well as HIV and Syphilis to make sure it is suitable. This makes the chance of transmitting any infection very low, but the risk can never be removed completely. Moreover, all the blood issued for babies is cytomegalovirus (CMV) negative.

Creutzfeldt-Jakob Disease (vCJD): The chance of contracting variant Creutzfeldt-Jakob Disease (vCJD) from a transfusion is very small; nevertheless, donors who may be at a higher risk of vCJD are excluded. For this reason, anyone who has received a blood transfusion or any other blood component since 1980 is currently unable to donate blood or blood components

Reactions: Before, during and after the transfusion your baby’s medical team will monitor their temperature, blood pressure, heart rate and oxygen levels regularly.

While it is possible to have a reaction to a blood transfusion this is extremely rare; staff are trained to recognise and treat this.

Febrile and allergic reactions ( i.e. Rash) can occur; in this instance the staff will stop the transfusion immediately and might administer some medications such as paracetamol, antihistamine and in severe cases adrenaline to manage symptoms.

Other possible complications include a build-up of excess fluid in your baby’s body. If this happens your baby might need some medication to help them get rid of this fluid by passing more urine.

Crossmatch: There are different blood groups which vary from person to person. Before a unit is selected for transfusion, baby’s and mother’s blood need to be tested to make sure the baby receives the right type of blood. The test will tell us baby’s blood group, whether they are Rh positive or negative and if they have any maternal antibodies in their blood. If a maternal blood sample is not available, it may be necessary to take an extra blood sample from your baby.

This information is extremely important; after these tests your baby’s blood will be matched with a blood unit in the blood bank which has been split into 6 smaller bags; all these bags will be reserved specifically for your baby so that they will receive blood from a limited number of donors, even if they require more than one transfusion. Platelets, FFP and cryoprecipitate are ABO compatible but might not exactly match your baby’s blood group.

Is there an alternative to blood transfusion?

The medical team might consider other options before transfusing your baby.

• Adopt a watch and wait approach by monitoring not only your baby’s haemoglobin (a protein that carries oxygen in the blood; having too little haemoglobin is called anaemia) but also looking at what type of support your baby is receiving and how much oxygen they are requiring.
• On NICU we routinely reduce the number of non-essential blood tests and use low volume tubes to avoid excessive losses.
• Start iron therapy (Sytron) - If the body has too little iron, it cannot make enough haemoglobin. Usually, we get enough iron from our diet to keep us healthy. Premature babies do not get enough iron in their diet and are at risk of getting anaemia. This could affect their growth and development. By giving Sytron, which contains lots of iron, we can prevent anaemia developing. Sytron is routinely started on babies once they are on enough milk feeds.

There are no alternatives to giving platelets, cryoprecipitate or FFP apart from watching and waiting

Can I donate blood to my baby?

Unfortunately, not. There is increased risk of some types of serious reactions following blood transfusion from close family members. Unless the blood from a relative is treated with X-rays there is a risk that the blood can trick baby’s immune system and cause the bone marrow to stop producing blood cells.

Will a blood transfusion affect blood screening?

A blood transfusion may affect the blood spot screening test, which is offered when your baby is between five and eight days old. If the blood spot sample has not yet been taken, your baby will need it done before they receive a transfusion. In addition, they may require a further sample to be taken following a blood transfusion. More detailed information on blood spot screening is available on the NHS blood spot screening information page (opens in a new tab).

Will a blood transfusion affect Genetic testing?

No. Blood products administered in the UK have all undergone leukoreduction; this is a process in which the white cells, ordinarily present in collected blood components, are intentionally reduced in number. This step is primarily to reduce the risk of adverse transfusion reactions associated with donor white blood cells.

Because of this process the donor genetic code will not interfere in the interpretation of your baby’s genetic testing results; however sometimes the laboratory may request a second sample.

Contacts/Further information

Please ask to speak to one of the doctors or nurses on the Neonatal Intensive Care Unit (NICU) if you have any questions.

References/ Sources of evidence

NHSBT - What we do - Blood Services - Blood Transfusion webpage (opens in a new tab)

Gosh - Blood Transfusion Information Webpage (opens in a new tab)

Gov Uk Website- bloodborne infections in blood and tissue donors-bibd guidance data and analysis (opens in a new tab)