POCT Lessens Blood Loss
In light of all the controversies surrounding rhEPO, the mainstay in preventing severe AOP is prevention and therapeutic strategies to optimize red blood cell synthesis. Advocating for delayed cord clamping and following strict blood transfusion guidelines are essential.
In terms of nutrition, provision of adequate amounts of vitamin E, vitamin B-12, folate, and iron are necessary to avoid exacerbating the expected decline in hemoglobin levels in the premature infant.16
Other strategies to reduce blood loss include the use of bedside devices for laboratory blood testing that use minimal amounts of blood with cumulative benefit. Point-of-care testing (POCT) is defined as diagnostic testing at or near the site of the patient.
Researchers compared conventional bench top laboratory analysis and micro-technology.17 An estimated blood loss in the two groups was determined based on the number of specific blood tests on individual infants and the minimal volume of blood needed to run the test on the specific instrument. The study found that there was an estimated 30 percent reduction in the total volume of blood removed for the blood tests using POCT or microtechnology. Another study found similar results.18
The best way to combat AOP is to reduce the risk of its development. This would include using the best technology available to ensure the smallest possible amount of blood is taken from a premature baby whenever a blood test is needed. Just as importantly, before a physician orders a blood test, she must determine the test is clinically relevant and will produce meaningful data that will influence the infant's care.
Dr. Wagner is professor of pediatrics and associate director of the General Clinical Research Center at the Medical University of South Carolina in Charleston. She is board-certified in both pediatrics and neonatal-perinatal medicine and serves as an attending neonatologist at MUSC's neonatal intensive care unit.
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