Blood-component therapy in children: Case

The neonatal transfusion thresholds

The preterm neonate is the most transfused of all children, and the transfusion thresholds differ from those of the older child. The red cell transfusion is guided by the lower haemoglobin thresholds supported by the TOP trial, which found a lower threshold as safe as a higher one for the preterm infant, so this child is transfused red cells at a typical 15 mL per kg top-up (not more than 20 mL per kg) to keep the haemoglobin above a low, gestation-specific threshold rather than to a normal value. The platelet transfusion is guided by the PlaNeT-2 MATISSE trial, which found that a lower threshold of 25 times ten to the nine per litre was safer than a higher threshold of 50, and the meta-analysis of Fustolo-Gunnink confirmed the benefit of the lower threshold. ^[8][9][5]