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Archives de pédiatrie
Volume 23, n° 9
pages 935-943 (septembre 2016)
Doi : 10.1016/j.arcped.2016.06.006
Received : 4 October 2015 ;  accepted : 16 June 2016
Protocole donneur unique : pratiques transfusionnelles et facteurs de risque des transfusions multiples en réanimation néonatale
Single-donor protocol: Transfusion practices and multiple transfusion risk factors in neonatal intensive care unit
 

C. Dollat a, , C. Pierron a, A. Keslick a, E. Billoir b, A. François c, P.-.H. Jarreau a
a DHU « risques et grossesse », service de médecine et réanimation néonatales de Port-Royal, université Paris Descartes, 53, avenue de l’Observatoire, 75679 Paris, France 
b CNRS UMR 7360 (LIEC), université de Lorraine, 8, rue du Général-Delestraint, 57070 Metz, France 
c Site transfusionnel de l’HEGP EFS Île-de-France, 20, rue Leblanc, 75015 Paris, France 

Auteur correspondant.
Résumé

Le protocole donneur unique (PDU) pour la transfusion en culots globulaires consiste en l’attribution à un enfant de 4 unités pédiatriques issues d’un même don de sang. Son utilisation est recommandée pour les nouveau-nés prématurés afin de diminuer les risques infectieux et d’allo-immunisation. Cependant, il conduit à la transfusion de sang stocké, dont certaines études remettent en cause l’innocuité. À la veille des nouvelles recommandations de la Haute Autorité de santé en 2015, nous avons effectué une enquête nationale de pratique auprès des réanimations néonatales afin d’évaluer l’utilisation du PDU ainsi qu’une étude des caractéristiques des enfants transfusés au sein de notre unité afin de mieux en identifier les bénéficiaires. L’enquête de pratique a révélé que 30 % des réanimations néonatales ne l’utilisaient plus en 2014, en raison de problèmes logistiques, financiers ou d’inquiétudes face à la transfusion de sang stocké. Dans notre unité, le PDU entraînait l’utilisation de sang stocké depuis plus de 20jours dans la moitié des cas à partir de la 3e unité transfusée. Deux facteurs étaient prédictifs de polytransfusion : la faiblesse du terme de naissance et la hauteur du score Clinical Risk Index for Babies (CRIB). Ces variables intégrées dans un modèle statistique permettaient de prédire le risque de polytransfusion. D’après ce modèle, un seuil de 50 % de risque de polytransfusion permet de cibler au mieux les enfants devant bénéficier d’un PDU en limitant le nombre de poches utilisées.

The full text of this article is available in PDF format.
Summary

In France since 2002, the single-donor transfusion protocol, using four pediatric units from the same adult donor's packed red blood cells (PRBCs) in multiply transfused newborns, is recommended in preterm neonates to reduce the risks of infection and alloimmunization. This protocol is controversial, however, because it causes the transfusion of stored blood, which could have adverse consequences. Before the new recommendations of the French Haute Autorité de santé (National authority for health) in 2015, we conducted a national practice survey in 63 neonatal intensive care units (NICU) and a retrospective study of the characteristics of 103 children transfused within our unit, to better target beneficiaries. The practice survey showed that 30 % of French NICUs no longer used the protocol in 2014, due to logistical or financial problems, or concerns about the transfusion of stored blood. The practices were heterogeneous. Few NICUs used a written protocol. In our NICU, the use of single-donor protocol involved the use of units stored for more than 20 days in half of the cases beginning with the third unit used. Six-term newborns were mainly transfused once, which does not seem to warrant the single-donor transfusion protocol. The use of this protocol caused the loss of 50 % of the manufactured units, which go unused. In multivariate analysis, two factors were predictive of multiple transfusion within our population of 95 premature neonates undergoing transfusion: low-term and a high Clinical Risk Index for Babies (CRIB) score. The risk of multiple transfusions would be reduced by about 15 % for each additional week of gestation and approximately 16 % per point within the CRIB score. These variables integrated into a statistical model predict the risk of multiplying transfusions. According to the ROC curve, a calculated risk higher than 50 % is the appropriate cut-off value to transfuse with the single-donor transfusion protocol. This would limit its indications, saving more than 130 pediatric units of blood for 100 transfused children. A prospective study in our department will allow internal validation of this test.

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