The American journal of pediatric hematology/oncology
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Am J Pediatr Hematol Oncol · Jan 1981
Red cell transfusion in the newborn. Indications and unique blood banking needs.
The nursery presents unique problems for the physician caring for ill newborn infants. The indications for transfusion and the blood banking techniques to provide for these needs have changed significantly in recent years. The decision to transfuse must be based on an understanding of what is known to normally occur with respect to the postnatal decline in hemoglobin and the adaptive mechanisms which exist at this age. ⋯ The walking donor system remains controversial and has created opposition by the American Association of Blood Banks. The use of triple, quadruple, and "cow' pack systems has allowed a greater versatility and better utilization. The concept of frozen red cell transfusions has been extended to the nursery setting with the introduction of "pedi-paks.' These techniques have clearly diminished the risks of transfusion in the neonatal period.
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Appropriate management of the bleeding newborn is easily accomplished by first assessing the clinical circumstances under which the bleeding occurs. Having determined the clinical circumstances, knowledge of the pathophysiology of disseminated intravascular coagulation, liver failure, vitamin K deficiency, and hemophilia coupled with knowledge of the normal levels of coagulation factor activities at birth leads to selection of appropriate laboratory tests to confirm the etiology of the bleeding. Once the etiology is confirmed, treatment requires management of associated clinical conditions and replacement of vitamin K and/or deficient coagulation factors.