Donor blood selection criteria for neonatal red cell transfusion: general and tropical perspectives
Post-natal onset of pulmonary respiration raises oxygen tension, attenuates erythropoietin production, and contributes to development physiologic anaemia of newborn. Non-physiologic factors that decrease erythropoiesis, increase haemolysis or cause haemorrhage may aggravate physiologic anaemia, which may necessitate transfusion. Physiologic immaturity and immunological naivety of the neonate necessitate careful selection of donor blood for safe transfusion. Most of the literature on neonatal transfusion originated from developed countries, hence little attention is given to specific tropical issues and challenges relating to donor blood selection for neonatal transfusion. Paradoxically, the tropical developing countries have higher birth rates and poorer obstetric care, which increase the risk of anaemia and transfusion for both the mother and the newborn. Hence, this review explored the pathophysiologic basis of the criteria for donor blood selection within the context of clinical decision making for safe neonatal transfusion from general and tropical perspectives, which include wide ranging issues encompassing donor red cell sourcing, antigenicity, storage, enzymopathy and haemoglobinopathy, donor immunology, microbiology and infectivity, as well as donor-recipient consanguinity. This review also highlights the peculiarities of the tropics with respect to under developed transfusion services, prevailing genetic disorders and endemic infectious diseases that complicate the selection of donor blood for neonatal transfusion. The need for tropical countries to upgrade their transfusion services in order to address the peculiarities of donor selection within their populations cannot be overemphasized. Meanwhile, close interaction between the neonatologist and blood bank personnel is necessary for identifying, selecting, processing and providing the safest and most suitable blood for neonatal transfusion in the tropics.
Keywords: Neonatal Transfusion; Donor Blood; Red Cell; Selection