Decreasing Blood Transfusions Due to Iatrogenic Anemia in Premature Infants: One Magnet Community Hospital's Mission

Title:  Decreasing Blood Transfusions due to Iatrogenic Anemia in Premature Infants: One Magnet Community Hospital’s Mission.

Learning Objectives:

1.         Describe the practices which contribute to iatrogenic anemia in preterm infants.

2.         Identify consequences of blood transfusions in terms of neonatal morbidity and increased healthcare costs.

3.         Discuss various approaches aimed at reducing the number of blood transfusions.     

Purpose:

The purpose of this program is to increase awareness among health care team members of the need for improved or alternative blood sampling techniques in order to decrease the number of blood transfusions given to our smallest and sickest neonates.

Background:

Iatrogenic blood loss secondary to sampling for laboratory tests is the most common cause of anemia in the small preterm infant.  This, in turn, leads to an increased frequency of blood transfusions. Despite judicious use of laboratory sampling, sick pre-term infants can lose more than 5 milliliters of blood a day. The range of blood required per lab test is 0.3mL to 1mL. A sample of 1 mL of blood from a 1 kg infant equals that of 70 mLs of blood from an adult. With the potential complications, increased length of stay, and adverse reactions associated with blood transfusions, the need for micro-sampling and a change in practice is critical.

Methodology:

A literature review was conducted on existing practices and complications of blood transfusions. A survey of fourteen staff RNs was collected to determine current SPH practice techniques and amount of blood used per laboratory test. A retrospective chart review of 16 preterm infants between the gestation of 23-29 weeks was conducted. The infant’s weights ranged from 440g- 1290gms. Analysis of retrospective chart review was performed to track the number and type of lab tests performed, number of blood transfusions received and number of hospital days. Average number of transfusions, lab tests and length of stay information were graphed according to gestational age and the findings were presented to the clinical and administrative staff. Literature review and assessment of current hospital practice were used to justify the purchase of point of care testing equipment for the unit.  This will allow not only immediate results of necessary lab studies but a markedly decreased volume of blood necessary per sample.

Conclusion:

The next phase of this project will be to track the number of blood transfusions, laboratory tests and length of stay required in preterm infants when the hand held point of care testing device is utilized. The results will be available at the time of the conference.