Point-of-care testing reduces transfusion in neonates

Preterm, very-low-birth-weight babies require intensive laboratory testing, including frequent blood gas analysis, during the first few weeks of life. It has been estimated that the weekly blood loss associated with phlebotomy for blood testing can amount to as much as 30 % of the total blood volume of these tiny, vulnerable babies. 

Such blood losses cannot be sustained and red-cell transfusion is often required to correct the anemia induced by phlebotomy. Point-of-care-test (POCT) blood gas analyzers use minimal sample volumes and thus have potential for reducing the incidence of phlebotomy-associated anemia in neonates. 

 The introduction of a POCT analyzer to a Californian neonatal intensive care unit provided clinicians with the opportunity to assess its impact on the use of red-cell transfusion. The newly installed POCT analyzer measures blood gases, hemoglobin, hematocrit, sodium, potassium and ionized calcium simultaneously on 100 µL of whole blood. 

Prior to introduction of POCT, all blood analysis was laboratory-based, where 300-500 µL of blood was required for blood gas and electrolytes, 500 µL for full blood count or hematocrit and 1000 µL for electrolytes and four further analytes. The study focused on all babies of very low birth weight (< 1000 g) admitted to the unit during two separate years, the first before, and the second after installation of the POCT analyzer. 

The medical records relating to the first two weeks of life for each of these babies were retrospectively reviewed. Analysis revealed that despite the fact that there was no significant difference between the two groups in terms of the number of tests performed, the mean number of red-cell transfusions in the first two weeks of life was 5.7 ± 3.74 in the pre-POCT group compared with 3.1 ± 2.07 in the post-POCT group, a reduction of 46 %. 

A similar-sized reduction between the two groups was noted for the mean volume of red cells transfused. Introduction of POCT blood gas analyzers to neonatal units can significantly reduce the need for red-cell transfusion.