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DawnS

Neonates and Irradiated blood products

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Hello all, 

I work for a level one trauma center and currently we set our expiration of our neonatal aliquots in a bag to expire in 72 hours. We are wanting to change our policy to reflect a 7-day expiration on neonatal aliquots due to information that we received stating that most facilities have a 7-day expiration and some even do 10-days. I would like to back our decision up with facts and am wondering if you set your neonatal aliquots to expire at 7- or even 10-days expiration where did you pull your data? Did you do an internal study on potassium levels?  

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We have an irradiator on site, so irradiate 1 aliquot at a time.  For the infants, we will not use an older irradiated unit.  I can't give you any data on how fast the K+ builds up, but I wouldn't stretch it to 10 day for neonates.  Since no one else answered - you might have to do an internal study to see how fast the K+ rises (and it DOES rise).   Good luck.

The other hospital in town does not have an on-site irradiator and I think they are now ordering at need - a tough job in this neighborhood.

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I am NO expert on this matter, but, in the UK, we have found that some donors have a naturally high level of potassium ions, and so we test the units prior to irradiation, and if they show high levels of these ions prior to irradiation, we will take the donor off the list of those that can be used for neonates.

I would be amazed if this phenomenon of naturally high levels of potassium ions in some donors is unique to the UK!

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4 hours ago, Malcolm Needs said:

I am NO expert on this matter, but, in the UK, we have found that some donors have a naturally high level of potassium ions, and so we test the units prior to irradiation, and if they show high levels of these ions prior to irradiation, we will take the donor off the list of those that can be used for neonates.

I would be amazed if this phenomenon of naturally high levels of potassium ions in some donors is unique to the UK!

Just curious Malcolm but what is considered naturally high level of potassium vs unnaturally high levels?  How much investigation goes into determining it?  :coffeecup:

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The neonatal units we have on hand are less than 5 days old with only one being irradiated ahead of time(for emergency neonatal resusit.) Once aliquoted in a bag it keeps the neonatal outdate which is 28 dates from the draw date but the user has to be started within 21 days from the draw date. If it is a large volume transfusion though ( >60 ml) the red cell has to be less than 5 days old.  When I refer to  neonatal outdate it is when the products is not longer used for neonates, it could still be used for an adult if the volume is adequate enough. So far have not had an issue with high K levels

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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.  

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2 hours ago, John C. Staley said:

Just curious Malcolm but what is considered naturally high level of potassium vs unnaturally high levels?  How much investigation goes into determining it?  :coffeecup:

Hi John,

Having worked in Reference for almost all of my professional life (and this was only found shortly before I retired/conked out), I don't know - but I know a man who does.  I'll get in touch with him and get back to you ASAP.

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Thank you all for your response. We will more than likely do an internal study to evaluate potassium levels. 

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If the transfuse order is <25ml for a neonate do you have to centrifuge the unit prior to making the aliquot. I am looking to update my neonate protocol .If anyone has a protocol to share. I have a Heittch refrigerator centrifuge.

 

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Since we use CP2D units for both our exchange transfusions (reconstituted with FFP) and small volume transfusions, we do not spin the unit down.   We just measure the Hct and provide to the Drs.  

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On 4/29/2019 at 2:16 PM, John C. Staley said:

Just curious Malcolm but what is considered naturally high level of potassium vs unnaturally high levels?  How much investigation goes into determining it?  :coffeecup:

Sorry this has taken so long John, but my contact has been on annual leave, followed by a bout of sickness leave (no stamina these youngsters)!  He has recommended the following paper.

Bawazir WM, Flatt JF, Wallia JP, Rendon A, Cardigan RA, New HV, Wiltshire M, Page Lizanne, Chapman CE, Stewart GW, Bruce LJ.  Familial pseudohyperkalemia in blood donors: a novel mutation with implications for transfusion practice.  Transfusion 2014; 54: 3043-3050.  doi:  10.1111/trf.12757.

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33 minutes ago, Malcolm Needs said:

Sorry this has taken so long John, but my contact has been on annual leave, followed by a bout of sickness leave (no stamina these youngsters)!  He has recommended the following paper.

Bawazir WM, Flatt JF, Wallia JP, Rendon A, Cardigan RA, New HV, Wiltshire M, Page Lizanne, Chapman CE, Stewart GW, Bruce LJ.  Familial pseudohyperkalemia in blood donors: a novel mutation with implications for transfusion practice.  Transfusion 2014; 54: 3043-3050.  doi:  10.1111/trf.12757.

Thanks Malcolm.  I'll see if I can locate a copy.  

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