Yenidoğan Yoğun Bakım Ünitesinde Yapılan Kan Transfüzyonu Uygulamalarının Değerlendirilmesi; Tek Merkez Deneyimi

Yıl 2019, Cilt: 17 Sayı: 1, 85 - 95, 01.04.2019

Ali Turhan

Öz

GİRİŞ: Yenidoğan
bebeklerde kan transfüzyonu, diğer yaş gruplarındaki hastalara göre daha yüksek
komplikasyon riskine sahip olup, bu yaş grubundaki transfüzyonlarda göz önünde
bulundurulması gereken konular bulunmaktadır. Bu çalışmada, yenidoğan yoğun bakım ünitesi (YYBÜ)’nde kan transfüzyonu yapılmış
bebeklerin kayıtlarının geriye dönük incelenmesiyle, transfüzyon yapılan tanı
grupları, kullanılan kan ürünlerinin özellikleri ve transfüzyon uygulamaları
güncelliğinin araştırılması hedeflendi.

GEREÇ ve YÖNTEM: Başkent
Üniversitesi Tıp Fakültesi İstanbul Hastanesi YYBÜ’sinde Kasım 2013 – Mayıs
2018 tarihleri arasında yatan 968 yenidoğan bebek arasından, 1377 transfüzyon
uygulanan toplam 256 bebeğin dosya kayıtları geriye dönük incelendi.

BULGULAR: Bebeklerin
%43.8’i kız, ortanca doğum ağırlığı 2598 (1478 – 3228) gram, ortanca doğum
haftası 36.5 (30 – 39) hafta, ortanca yatış süreleri 32 (15 – 67.5) gün
bulundu. En çok kullanılan kan grubu A Rh (+), en az kullanılan kan grubu AB Rh
(-)’ti. Transfüzyonların %39.9’u taze donmuş plazma, %36.2’si eritrosit,
%23.5’i trombosit süspansiyonu ile yapılmıştı. En çok transfüzyon uygulanan
tanılar sırasıyla prematürite ve ilişkili olduğu hastalıklar, santral sinir
sistemi, konjenital kalp, gastrointestinal sistem hastalıkları ile ilişkili
cerrahi girişim gerektiren hastalıklardı. Term bebeklere göre, preterm
bebeklerde trombosit süspansiyonu kullanım oranı daha yüksekti, diğer ürünlerin
kullanım oranı benzerdi.

SONUÇ: YYBÜ’lerde
çok sık yapılan kan transfüzyonu uygulamalarıyla ilgili hekimlerin bilgilerini
güncellemeleri ve transfüzyon tıbbı konusunda verilen eğitimlerin
yaygınlaşması, transfüzyonda kullanılacak kan ürününün doğru seçilmesini ve hazırlanmasını, transfüzyon
risklerinin azaltılmasını, gereksiz
transfüzyonların önünde geçilmesini sağlayacak ve transfüzyon güvenliğini arttıracaktır.

Anahtar Kelimeler

Kan transfüzyonu, transfüzyon güvenliği, prematürite, yenidoğan

Evaluation of Blood Transfusion Applications in Newborn Intensive Care Unit; Single Center Experience

Öz

INTRODUCTION: The frequency of transfusion
is high in infants admitted to neonatal intensive care unit (NICU). There is a
higher risk of transfusion complications compared to other age groups, and
there are many special considerations for transfusion in neonates. The aim of
this study was to investigate the records of infants who had blood product transfusions
in NICU, to investigate which patient groups were transfused, the
characteristics of the blood products used and the current transfusion practices.

MATERIALS and METHODS: Between November 2013 and May 2018, the records of
968 newborn infants admitted to the Istanbul Hospital NICU of Başkent
University School of Medicine were retrospectively analyzed.

RESULTS: Of the babies, 43.8% were female, median birth weight
was 2598 (1478 - 3228) grams, median birth week was 36.5 (30 - 39) weeks and
median hospitalization days were 32 (15 - 67.5) days. The most commonly used
blood group was A Rh (+), the least used blood group AB Rh

(-). 39.9% of the
transfusions were fresh frozen plasma, 36.2% erythrocyte and 23.5% platelet
suspension. In addition to prematurity and related diseases, diseases requiring
surgery of central nervous system, congenital heart or gastrointestinal system
diseases were the most common transfused group. According to term babies, the
rate of use of thrombocyte suspension was higher in preterm infants, however the
rate of use of other products was similar.

CONCLUSIONS: Knowledge of the selection, preparation of blood
products to be used in transfusion and the specific methods for reducing the
risks of transfusion will reduce the potential risks and increase the safety of
transfusion.

Anahtar Kelimeler

Blood transfusion, packed red blood cell unit, newborn, prematurity, transfusion safety

Kaynakça

• 1. Yenicesu İ, Dilsiz G. Yenidoğan ve Çocuklarda Transfüzyon İlkeleri. Turkiye Klinikleri Journal of Pediatrics 2005;14:193-203.
• 2. Fabres J, Wehrli G, Marques MB, Phillips V, Dimmitt RA, Westfall AO, et al. Estimating blood needs for very‐low‐birth‐weight infants. Transfusion 2006;46:1915-20.
• 3. Fasano R, Luban NL. Blood component therapy. Pediatric Clinics of North America 2008;55:421-45.
• 4. Widness JA. Pathophysiology of anemia during the neonatal period, including anemia of prematurity. Neoreviews 2008;9:e520-e5.
• 5. Alverson DC. The physiologic impact of anemia in the neonate. Clinics in perinatology 1995;22:609-25.
• 6. Wardle S, Garr R, Yoxall C, Weindling A. A pilot randomised controlled trial of peripheral fractional oxygen extraction to guide blood transfusions in preterm infants. Archives of Disease in Childhood-Fetal and Neonatal Edition 2002;86:F22-F7.
• 7. Whitehead HV, Vesoulis ZA, Maheshwari A, Rao R, Mathur AM. Anemia of prematurity and cerebral near-infrared spectroscopy: should transfusion thresholds in preterm infants be revised? Journal of Perinatology 2018;38:1022.
• 8. Bard H, Fouron J-C, Chessex P, Widness JA. Myocardial, erythropoietic, and metabolic adaptations to anemia of prematurity in infants with bronchopulmonary dysplasia. The Journal of pediatrics 1998;132:630-4.
• 9. Alkalay AL, Galvis S, Ferry DA, Simmons CF, Krueger RC. Hemodynamic changes in anemic premature infants: are we allowing the hematocrits to fall too low? Pediatrics 2003;112:838-45.
• 10. Izraeli S, Ben-Sira L, Harell D, Naor N, Ballin A, Davidson S. Lactic acid as a predictor for erythrocyte transfusion in healthy preterm infants with anemia of prematurity. The Journal of pediatrics 1993;122:629-31.
• 11. Tschirch E, Weber B, Koehne P, Guthmann F, von Gise A, Wauer RR, et al. Vascular endothelial growth factor as marker for tissue hypoxia and transfusion need in anemic infants: a prospective clinical study. Pediatrics 2009;123:784-90.
• 12. Çetinkaya M, Atasay B, Perk Y. Türk Neonatoloji Derneği yenidoğanda transfüzyon ilkeleri rehberi. Türk Pediatri Arşivi 2018;53:101-8.
• 13. Takcı Ş. Prematüre Bebeklerde Kan Transfüzyonu Öncesi ve Sonrası Eritrosit Kurşun ve Civa Düzeylerinin Incelenmesi (Yan Dal Uzmanlık Tezi): Hacettepe Üniversitesi; 2013.
• 14. Bell EF, Strauss RG, Widness JA, Mahoney LT, Mock DM, Seward VJ, et al. Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants. Pediatrics 2005;115:1685-91.
• 15. Kirpalani H, Whyte RK, Andersen C, Asztalos EV, Heddle N, Blajchman MA, et al. The Premature Infants in Need of Transfusion (PINT) study: a randomized, controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants. The Journal of pediatrics 2006;149:301-7. e3.
• 16. Fernandes da Cunha D, Nunes Dos Santos A, Kopelman B, Areco K, Guinsburg R, de Araujo Peres C, et al. Transfusions of CPDA‐1 red blood cells stored for up to 28 days decrease donor exposures in very low‐birth‐weight premature infants. Transfusion Medicine 2005;15:467-73.
• 17. Fergusson DA, Hébert P, Hogan DL, LeBel L, Rouvinez-Bouali N, Smyth JA, et al. Effect of fresh red blood cell transfusions on clinical outcomes in premature, very low-birth-weight infants: the ARIPI randomized trial. Jama 2012;308:1443-51.
• 18. Maheshwari A, Patel RM, Christensen RD, editors. Anemia, red blood cell transfusions, and necrotizing enterocolitis. Seminars in pediatric surgery; 2018: Elsevier.
• 19. Patel RM, Knezevic A, Shenvi N, Hinkes M, Keene S, Roback JD, et al. Association of red blood cell transfusion, anemia, and necrotizing enterocolitis in very low-birth-weight infants. Jama 2016;315:889-97.
• 20. dos Santos AMN, Guinsburg R, de Almeida MFB, Procianoy RS, Leone CR, Marba STM, et al. Red blood cell transfusions are independently associated with intra-hospital mortality in very low birth weight preterm infants. The Journal of pediatrics 2011;159:371-6. e3.
• 21. Baer VL, Lambert DK, Henry E, Snow GL, Christensen RD. Red blood cell transfusion of preterm neonates with a Grade 1 intraventricular hemorrhage is associated with extension to a Grade 3 or 4 hemorrhage. Transfusion 2011;51:1933-9.
• 22. Rashid N, Al-Sufayan F, Seshia M, Baier R. Post transfusion lung injury in the neonatal population. Journal of Perinatology 2013;33:292.
• 23. Wang Y-C, Chan O-W, Chiang M-C, Yang P-H, Chu S-M, Hsu J-F, et al. Red blood cell transfusion and clinical outcomes in extremely low birth weight preterm infants. Pediatrics & Neonatology 2017;58:216-22.
• 24. Rohde JM, Dimcheff DE, Blumberg N, Saint S, Langa KM, Kuhn L, et al. Health care–associated infection after red blood cell transfusion: a systematic review and meta-analysis. Jama 2014;311:1317-26.
• 25. TKMTD TKMvTD. Kan Grupları ve Saptama Yöntemleri. İstanbul: Yatay Ofset; 2018 2018. 216 p.
• 26. New HV, Berryman J, Bolton‐Maggs PH, Cantwell C, Chalmers EA, Davies T, et al. Guidelines on transfusion for fetuses, neonates and older children. British journal of haematology 2016;175:784-828.
• 27. Ziemann M, Thiele T. Transfusion‐transmitted CMV infection–current knowledge and future perspectives. Transfusion Medicine 2017;27:238-48.
• 28. Keir A, Pal S, Trivella M, Lieberman L, Callum J, Shehata N, et al. Adverse effects of red blood cell transfusions in neonates: a systematic review and meta‐analysis. Transfusion 2016;56:2773-80.