A NOVEL STRATEGY TO LIMIT BLOOD-DONOR EXPOSURE AND BLOOD WASTE IN MULTIPLY TRANSFUSED PREMATURE-INFANTS

Background: Small, premature infants require frequent small-volume tra nsfusions. Traditional methods of transfusion expose these infants to multiple blood donors. It has recently been demonstrated that multiple donor exposures can be safely prevented in these infants by the assig nment of fresh units to them and by the use of a sterile connecting de vice to remove blood for transfusion, as needed until the expiration o f the unit. However, this program resulted in the wasting of approxima tely 60 percent of the blood in each unit. Study Design and Methods: T o minimize blood waste without compromising the goal of limiting donor exposure, a model designed to predict each infant's transfusion requi rements was investigated. The model assigned infants predicted to have high transfusion requirements to receive blood from a unit dedicated to their individual use, All other infants were assigned to receive bl ood from a unit that could be shared among as many as four similar inf ants, Infant donor exposure and blood unit wastage after institution o f the infant assignment model were compared with the same measurements obtained before the use of the model, during which time infants were assigned to dedicated units at the discretion of the physician. Result s: The numbers of transfusions per infant (3.5 +/- 2.3) and of donor e xposures per infant (1.5 +/- 0.7) under the assignment model were unal tered from those in controls (4.1 +/- 2.9 transfusions and 1.6 +/- 0.8 donor exposures); however, there was significantly less blood wastage in the group assigned to shared units (32 +/- 28%) than in the group assigned to dedicated units (62 +/- 17%; p < 0.05) or than was seen in an earlier study (60 +/- 23% wasted; p < 0.05). Conclusion: Improved management of blood resources can be achieved within the context of a transfusion program designed to safely limit donor exposure in infants who require frequent transfusion.