Neonatal Exchange Transfusion due to elevated bilirubin

[edmoad]

Does anyone have any information or procedures, worksheets, etc. they are willing to share for a neonatal exchange transfusion? We currently transfuse neonates with PRBC, Plts and FP as needed and we all have knowledge and experience on that process. Unfortunately, we have little to no experience at all in the exchange process.  We are looking for information on the actual process of creating the PRBC + FP component unit used for the exchange process. I understand the need for O negative, CMV neg, Irradiated and less than 5 day PRBC and the AB frozen plasma. The current PRBC we have dedicated for pediatric transfusions arrives from our blood supplier with satellite bags sterilely attached to it (typically 3-4 small pediatric satellite bags are attached to the unit for aliquots units to be prepared). My main question is how is the unit physically and asceptically created? I've researched and know a little about the calculation required for a HCT and total volume...... Any one willing to help in the process or share any information they have available would be greatly appreciated.  I'm told this will become a common occurrence in the near future and I'm wanting to be as prepared as we all can be. Any resources out there or knowledge you have for me and my pathologist would be appreciated.

[David Saikin]

typically you are going to make modified whole blood w a hct of ~50% (your neonatology folks will give you the target hct they want - this should be standard and not subject to the MDs whims at the time).

You will need the average hct of a unit of stock rbcs  (and you will use this number all the time, unless you plan on doing a hct on every unit you are going to use).

A sterile docker is not essential but will allow your product to have more than 24 hour exp date.

You should be able to discover the formula for adding plasma (to get the desired final hct) in the Technical Manual.

[slsmith]

O neg less than 5 day old irradiated leukoreduced red cell that is hemoglobin S negative and washed.

1) The wash cell is transferred to a component bag and segment is made from the transfer tubing to get a hct. 

2) The bag is weighed to get the volume(not exact science but gm=ml.)

3) weight of red cell x hct of red cell= final volume x desired hct.

4) the difference between the weight of red cell and final volume is the volume of  the AB plasma is added.