John A. Widness, MD
Peer Review Status: Internally Peer Reviewed

"WELL" <------------------SEVERITY OF ILLNESS------------------> "SICK"
  CATEGORY I Subgroup A
(asymptomatic)
CATEGORY I Subgroup B (symptomatic) CATEGORY I Subgroup C (pre-surgical) CATEGYOR II (mild resp dis) CATEGORY III (mod respir dis) CATEGORY IV (severe resp dis)
A. REQUISITE HEMATOCRIT:
<20% (& Retics <100K/uL or < 2%)
 
< 25%
 
< 30%
 
< 30%
 
< 35%
 
<40%
 
B. RESPIRATORY DISEASE: <--------None to mimimal---->
Mild
 
Moderate
 
Severe
 
Conventional ventilation
None
 
None
 
None
 
MAP < 6 cm. water
 
MAP 6-10 cm. water
 
Yes
 
High frequency ventilation
None
 
None
 
None
 
MAP < 8 cm. water
 
MAP 9-12 cm. water
 
Yes
 
CPAP
None
 
None
 
None
 
MAP < 6 cm. water
 
MAP 6-10 cm. water
 
Does not apply
 
FI02
< 0.25
 
< 0.25
 
< 0.25
 
>0.25 but <0.35
 
>0.35
 
>0.35
 
Nasal Cannula with 100% o2
<1/16 L/min.
 
<1/16 L/min.
 
<1/16 L/min.
 
1/8 - 1/4 L/min.
 
>1/4 L/min.
 
Does not apply
 
C. CLINICAL SIGNS:
Absent
 
Any 1 of 4 signs listed below*
 
Major surgical procedure
 
Often present
 
Often present
 
Sepsis, NEC, blood loss, etc.
 
*
  1. sustained tachycardia averaging > 180/min. for >24 hours based on the nursing record;
  2. sustained tachypnea > 80/min. for >24 hours based on the nursing record;
  3. >10 apnea or bradycardia/8 hours, or > 2 apneic or bradycardic episodes reuiring bag & mask ventilation in 24th; or
  4. weight gain < 10 g/day x 4 days while receiving > 100 kcal/kg;
 
Rule of Thumb: For each 1 mL or PRBC's transfused (hct of almost 85%) kg, anticipate a 1 % increase in the hematocrit. Hence for the recommended Tx volume of 15 mL PRBC/kg, a pre-transfuion hct of 32% should rise to approximately 47% when checked several hours after transfusion.

References:

Aher S, Malwatkar K, Kadam S. Neonatal anemia. Semin Fetal Neonatal Med 2008; 13:239-247.

Bell EF. When to transfuse preterm babies. Arch Dis Child Fetal Neonatal Ed 2008; 93:F469-F473.

Bell EF, Strauss RG, Widness JA, Mahoney LT, Mock DM, Seward VJ, Cress GA, Johnson KJ, Kromer IJ, Zimmerman MB. Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants. Pediatrics 2005; 115:1685-1691.

Kirpalani H, Whyte RK, Andersen C, Asztalos EV, Heddle N, Blajchman MA, Peliowski A, Rios A, LaCorte M, Connelly R, Barrington K, Roberts RS. 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. J Pediatr 2006; 149:301-307.