Transfusion Thresholds for Infants < 4 Months
Hematocrit | Criteria* for Transfusion of RBCs |
|---|---|
< 45% | Congenital cyanotic heart disease Use of ECMO |
< 35% | Use of O2 by hood at > 35% FIO2 Use of CPAP or mechanical ventilation with mean airway pressure > 6–8 cm H2O |
< 30% | Use of any supplemental O2 Use of any CPAP or mechanical ventilation Significant abnormalities of heart rate or respiratory rate† |
< 20% | Low reticulocyte count and symptoms of anemia (eg, tachycardia, tachypnea, poor feeding) |
* At least 1 of these criteria must also be present. | |
† Abnormalities include > 6 episodes of apnea in 12 hours, 2 episodes of apnea in 24 hours requiring bag-and-mask ventilation, heart rate > 180/minute for 24 hours, clinically significant bradycardia, and respiratory rate > 80/minute for 24 hours. | |
CPAP = continuous positive airway pressure; ECMO = extracorporeal membrane oxygenation; FIO2 = fractional inspired O2; RBC = red blood cell. | |
Adapted from Roseff SD, Luban NLC, Manno CS: Guidelines for assessing appropriateness of pediatric transfusion. Transfusion 42(11):1398–1413, 2002. doi: 10.1046/j.1537-2995.2002.00208.x. See also New HV, Berryman J, Bolton-Maggs PH, et al: Guidelines on transfusion for fetuses, neonates and older children. Br J Haematol 175(5):784–828, 2016. doi: 10.1111/bjh.14233. | |