Hematocrit/blood transfusion question

JuliaJAG · March 2012

My baby's hematocrit fell from 30 to 27 this past week, which prompted our neonatologist to bring up the transfusion topic. How low does hematocrit have to fall before a baby needs a transfusion? The doctor wouldn't give us a straight answer on that. She did say his retic count was good (4.7) which means he's producing red blood cells. Any thoughts/experience on this?

Mrs. Alice · March 2012

I want to say their hct was about 25 when they got their first transfusions. My boys only needed 1 transfusion during their stay which was in the first week or two. Then at 32 weeks they were starting to drop just a little again but the retic count was fine so they held off on the transfusion and continued checking CBCs weekly. I think if baby is asymptomatic and retic count is good, they usually don't transfuse in order to let their bodies receive the message to start producing their own red blood cells.

JuliaJAG · March 2012

Thank you; that is helpful! My LO is still having some desats and bradys occasionally... no sure if the dr will consider that symptomatic enough for a ransfusion... Guess I'll find out tomorrow. Thanks again.

DrRx · March 2012

It all depends on the MD, but 27 was considered borderline for Adalyn this past week. They were going to check her retic count, but the night before she had several bradys and desats (the rough night the other day) and her hematocrit had dropped to 26, so they went ahead and transfused her.

She's had 5 blood transfusions during her stay, but up until now she hadn't had one in a few weeks.

I'm sure that if he starts becoming symptomatic--ie, needs to go up on his respiratory support and/or has several bradys, they will probably transfuse him.

GL, and I hope that he doesn't need one!

kaylaaimee · March 2012

Scarlette was in the low 20s a lot - she had over a dozen transfusions. They really helped her, even just with giving her extra energy. I know most had low retics but she had a few where her retic was good but she was still hovering around 25 and they transfused then.

We were able to donate specifically to her for her transfusions, if that settles your mind at all you could ask about it. But really, there were a few times I asked about transfusion when her crit would drop b/c we saw such a difference in her, she was so much stronger after them.

KatFCo · March 2012

I can't remember the numbers, but DD needed over a dozen transfusions during her 16 week stay, and I was told this was completely normal, esp. for a 23-weeker. My guess is it's also pretty normal for a 29-weeker.

nayandjosh · April 2012

Hi! I'm a preemie mom of a 27-weeker and I'm a med tech in the blood bank at my hospital too. The amount the H&H has to drop in order to receive a transfusion is totally dependent on the MD and the hospital protocol. My DS needed about 5 during his 11 week stay and his crit was around 23 to 25 during those times. There are specific requirements for RBC units transfused for babies (normally <5 day old RBC units, CMV neg, leukoreduced) so if your child needed a transfusion I wouldn't hesitate on allowing it. The hemoglobin and hematocrit normally follow a factor of 3, meaning if the hemoglobin is 9 then the hematocrit will be around 27. Those particular numbers probably wouldn't warrant a transfusion but every hospital has their own standard operation procedures.

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