Sir.—The article by Hakanson et al (Journal 1981;135:1145-1146) recommending a "cow" technique for efficient blood use in a neonatal intensive care unit, though it presented some procedural considerations of particular value in today's climate of cost containment, suffered from serious shortcomings. Development of new patient care approaches demands consideration of their impact on the individual patient as well as the institution. In our opinion, the recommended program does not adequately consider the individual neonate.
Although multiple transfusions from a single unit are desirable and in fact practical, the approach used by the authors has several disadvantages. Both types A and O blood are used, and the units are actually placed in the nursery. This, despite the contention that great care is exercised, risks an ABO hemolytic transfusion reaction. (That most infants possess isoagglutinins was coincidentally noted in the same issue of the Journal, in an article abstracted from a
NOVAK RW, MARTIN C. Blood Transfusion in the Neonatal Intensive Care Unit. Am J Dis Child. 1982;136(7):652-653. doi:10.1001/archpedi.1982.03970430084032