Indian J Pediatr 1987; 54 : 125-129

Letters to Editor

Blood transfusion in neonates

Sir, Pediatricians have been giving blood

transfusions very frequently but often find themselves in a dilemma when small quantities of blood has to be transfused; In such circumstances, one has to choose between microbial contamination which may result when small quantities of blood is taken out of the blood bottle1, and throwing away the remaining b lood--a practice which we can ill afford in India. Those dealing with neonates find the problem specially acute where a small blood transfusion may be life saving in such diverse conditions as anemia, hemor- rhage, septicemia or recurrent apnoea. The pinch has been felt by others also. 2

In our nursery, we have found a way out to deal with this problem when up to 50 ml of blood has to be transfused. Half ml of heparin (1000 U/ml) is taken in an autoclaved 50 ml syringe, is allowed to come in contact with the walls of the syringe by slowly moving the piston to and fro and then thrown out of the syringe. A clean prick is made on the donor using all aseptic precautions and the required amount of blood is drawn out, and the syringe is gently rotated between the palms. The blood is directly injected into the recipient neonate in whom an IV line has already been established. Injection is made slowly over a period of 30 rain. To prevent circulatory over- load, 1 mg/kg of furosemide is injected, the tube having been cleared of blood by Small amount of saline infusion.

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Heparin is a potent anticoagulant and as little as 1 I.U. is required for 1 ml of blood (0.05 ml for 50 ml of blood). 3 Half life of plasma heparin is very short and is eliminated within one hour of injection. 4 Since the blood is injected immediately and no handling is involved, the chances of microbial contamination are very low and do not exceed the usual 2~o risk involved in routine blood trans- fusion, s

Over 50 neonates have been given blood transfusion by this method in our nursery and so far no ill effects have been observed in any of the infants. As a pre- cautionary measure, however, prota- mine sulphate must be readily available at hand.

It would be worthwhile to learn about the experiences of other pediatricians also who might be using Similar or alter- native methods to give blood transfusion to neonates.

Tejinder Singh, Lecturer

Department of Pediatrics Christian Medical College

and Hospital, Ludhiana 141008.

References

1. McCullough J, Crosby WH. Contemporary in hematology. Am J Hematoi t980; 243 : 2188-2192

2. Gupta BD, Gupta R, Chaudhury R. Pediatric population--orphan for transfusion. Indian Pediatr 1983; 20:953-954

126 THE INDIAN JOURNAL OF PEDIATRICS

3. Mollison PL. Blood transfusion in clinical medicine. ELBS 6th ed. 1979; p 17

4. Eiber HB, Danishefsky I. Studies with radio- active heparis humans. Angiology 1960; 11 :

Vol. 54, No. 1

40-44 5. Braude AI, Stanford JP, Bartlctte JE. Effects

of bacterial contaminants in bIood. J Lab Clio Med 1952; 39 : 902-8

Should we continue with use of syrups and suspensions

Sir, Syrups and suspensions have been

the mainstay of pediatric practice. They have enjoyed the patronage of physicians because of their palatability, acceptability and easy administration. The world pharmaceutical market is flooded with innumerable brands, each boasting of being tastiest, economical and accep- table. Recently, a few studies have ques- tioned the utility of drugs in suspension and syrup forms, especially in the deve- loping countries. 1-6

Apart from advantage of using syrups/ suspensions there are many disadvantages. To begin with they have no pharmaceu- tical advantage over tablets and capsules. The pharmacokinetics and pharmaco- dynamics of the drug are not significantly different in syrups and capsule formula- tions. Secondly, in developing countries the cost of equivalent dose of drug in syrup form is almost twice that of drug in capsule/tablet form (Table 1). Thirdly, only 25.670 syrups have appropriate measures with the bottle.~ We surveyed a pharmaceutical shop and observed that only 41.5~o of antibiotics, 11.1~ of antidiarrheals and 25%0 of amebicidal had appropriate measures whereas none of the antitubereular, anticonvulsant,

antimalarials and cough syrups had appro" priate measures. The promotors of syrup therapy may advocate use of home mea- sures, but here again on survey of tea- spoons in hundred families we found that their measure ranged between 2.6 ml to 5.45 and the measure at a wholesaler in Kota market ranged between 2.8 ml to 5.75 ml. Similar findings have been reported by Jain et a l I and Victoria and Coalho. 3 Fourthly antibiotics available as powder to form a suspension pose a problem of hygiene and inappropriate dilutions. There is a tendency in most poor mothers to fill the entire bottle with water instead till the mark made on the bottle. One can appreciate the amount of drug being received in contrast to what is prescribed. The shelf life of syrups and suspension after opening the bottle is short and there may be significant wastage.

A detailed study by Join e t a l I showed poor compliance with syrups and suspen- sions. The incidence of noncompliance was as high as 46"270. Last but not the least syrups/suspensions have diarrhea- genic and cariogenic potentials.

Looking at the long list of disadvan- tages, cost benefit ratio and patients com- pliance, the use of suspensions/syrups warrants urgent reconsideration, espe-