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Neonates are given RBC transfusions for several reasons, including hemolytic disease of the newborn due to maternal alloimmunization, congenital abnormalities of RBC enzymes and membranes, and anemia of prematurity due to multiple interacting factors, the most important of which are phlebotomy blood loss and low erythropoietin levels. Although great efforts have been made during the past few years to optimize the transfusion of RBCs to these tiny patients, several questions have not been answered definitively. Accordingly, transfusion practices vary among physicians caring for neonates. This lack of precise approach stems from incomplete knowledge of the cellular and molecular biology of hematopoiesis during the perinatal period as well as an incomplete understanding of the infant’s response to severe anemia.

Generally, RBC transfusions are administered in small volumes (15 mL/kg per dose) to maintain a hematocrit (HCT) level that is believed to be...

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