Baby Banker

We generally wash older units of RBCs for ECMO. They still don't work quite as well (pH issues), but at least that takes care of the extracellular potassium. As has been mentioned, I would not worry overmuch about matching the baby's phenotype.

Yes. And the K+ was generally lower than in a 'real' unit of PRBCs.

As a historical note: We used to store whole blood quads meant for neonates upside down and upright. Can anyone hazard a guess as to why?

Something that most people don't think about is the size of the unit. I am in a pediatric facility and we have units of all sizes. The smaller the unit, the more vulnerable it will be to temperature change. There is also the issue of the time the unit is out being made into an aliquot, and the fact that, in most institutions, the processing into an aliquot will be done close to the time of issue. So if you have an aliquot that is close to RT when it is issued, and then it comes back, what do you do? I think the only way to adhere to the spirit of the regulation is to measure the temperature directly. However, in that case, you are going to see your rate of expired units go up. There are no easy answers here, and in my experience, most inspectors know this, and many of them do not pursue it too vigourously.

Send me an email, and I'll extract it for you. gerald.sapp@childrensal.org

We had a patient with an antibody to one of the Bg antigens. I remember that dealing with it was not straightforward. They are (I think) HLA antigens. Issitt says that the antigen expression is variable even in the same donor or patient. I didn't see anything about sample age, but I just glanced over the entry. It is in Chapter 19 of the third edition of Applied Blood Group Serology. Be aware that this was published in 1985, and so relies on serology alone.

The size of the patient can be a factor in how much incompatible plasma you can safely give, but in an MTP you are poring the blood products in, and often it is poring right back out. The comment on giving platelets is well founded.

There is some truth in that, and especially from his perspective. However I have found that surgeons are not the best when it comes to understanding Transfusion Medicine.

We irradiate RBC units at the time of crossmatch. We will issue that unit (or aliquots from the unit) for 24 hours post irradiation. After that, we would wash the unit or use another unit. We also have a requirement for less than seven days. In the old days, we would tag a fresh unit to a new neonate and let them age together. This was a balancing act between concern about extracellular potassium and concern about donor exposure.

I have worked in Transfusion Medicine in the US since 1978, and I recall only one neonatal exchange transfusion. The baby's mother did not have Rh Immune Globulin after her first child because she wanted a natural pregnancy. I guess no one told her that there is nothing more natural than death. We do exchanges on sickle cell patients all the time.

I have seen many examples of anti-M that only reacted with M+N= cells.

I have a lot of experience with SafeTrace, and some with Cerner. I much prefer SafeTrace. I did like the Cerner reports better than SafeTrace. When I was at a Cerner facility the staff used to issue expired blood all the time. Right before I left Cerner removed the label confirmation after modification requirement. I will say that I was told that the facility I was in used Cerner differently than other facilities. I think the best blood bank software is Mediware's HCLL. They are now Wellsky, I think. The more complex the service you provide, the less I would trust Cerner. Having said that, a great deal of how useful a system is depends on decisions the user makes when setting it up. SafeTrace does take both parts of its name seriously, and because of that it has a lot of hard stops. Many times this can frustrate staff level users.

If kernicterus is a consideration, you might want to dilute your RBC unit for the first exchange with albumin.

I have a lot of experience with SafeTrace, and some with Cerner. I much prefer SafeTrace. I did like the Cerner reports better than SafeTrace. When I was at a Cerner facility the staff used to issue expired blood all the time. Right before I left Cerner removed the label confirmation after modification requirement. I will say that I was told that the facility I was in used Cerner differently than other facilities. I think the best blood bank software is Mediware's HCLL. They are now Wellsky, I think.

This is one of those things that make me glad I don't do inspections any longer.