1. Amount of transfusion to be given: It has been seen that transfusion with PRBC at a dose of 20 mL/kg is well tolerated and results in an overall decrease in number of transfusions compared to transfusions done at 10 mL/kg. There is also a higher rise in hemoglobin with a higher dose of PRBCs.
2. Properties of RBC products used in neonatal transfusion: a. RBCs should be freshly prepared and should not be more than 7 days old. This translates into a high 2, 3-DPG concentration and higher tissue extraction of oxygen.
3.Blood should be of newborn’s ABO and Rh group. It should be compatible with any ABO or atypical red cell antibody present in the maternal serum.
4. Volume and rate of transfusion:
a. Volume of packed RBC = Blood volume (mL/kg) x (desired minus actual hematocrit)/ hematocrit of transfused RBC
b. Rate of infusion should be less than 10 mL/kg/hour in the absence of cardiac failure.
c. Rate should not be more than 2 mL/kg/hour in the presence of cardiac failure.
d. If more volume is to be transfused, it should be done in smaller aliquots.