neonatal transfusion

[s.marques]

Hello.

31st Edition of AABB Standards for Blood Banks and Transfusion Services says:

5.17.2  If a non-group-O neonate is to receive non-group-O Red Blood Cells that are not compatible with the maternal ABO group, the neonate's serum or plasma shall be tested for Anti-A or Anti-B.

          5.17.2.1  Test methods shall include an antiglobulin phase using either donor or reagent A1 or B red cells. Std. 5.14.3.4 applies.

          5.17.2.2   If anti-A or anti-B is detected, Red Blood Cells lacking the corresponding ABO antigen shall be transfused.

My question is how you do this reserch for anti-A and/or anti-B including antiglobulin phase in gel card?

25 ou 50 µL of plasma? Incubation at 37C? 22C?

Thank you in advance!

[Arno]

Hi! I do not know which gel card supplier you are using, but the one I “know” use 50ul of A1 and B cells with 25ul of plasma and an incubation at 37°C for 15 minutes. And all of this in an AHG gel card of course… having previously checked as well there is no additional antibody that could interfere (result from mother if available/antibody screening result). Hope it helps.            

[slsmith]

We crossmatch the A or B cells(the red cell itself) to the babies plasma, using the IgG gel card. 

[Sonya Martinez]

slsmith is correct.  We don't have the mom's here only the babies.  So we do full type and screen on the baby, IgG DAT by gel (if pt <14 days) and any RBCs that are autologous regardless of the blood type are Gel IgG crossmatched to the patient.  This covers all AABB standards for neonatal testing and transfusion.

[Cliff]

Easy, give group O only. 

We used to allow directed donations and we would do a back type on the baby.  We stopped allowing directed donations years ago and only give O Neg to our neonates.

[John C. Staley]

38 minutes ago, Cliff said:

Easy, give group O only. 

We used to allow directed donations and we would do a back type on the baby.  We stopped allowing directed donations years ago and only give O Neg to our neonates.

At one of my facilities we had a group of O neg donors that would come in on a regular basis and these folks were designated as out Neonate Donors.  I think at the time we would set them aside exclusively for the neonates for a week and if they were not needed during that week we would move them to the general population.  We would ask regular O neg donors if they could come in on a schedule so they could be used for the babies.  When most understood that their blood would be designated for the newborns little else had to be said to get them on board.  

[Cliff]

4 hours ago, John C. Staley said:

At one of my facilities we had a group of O neg donors that would come in on a regular basis and these folks were designated as out Neonate Donors.  I think at the time we would set them aside exclusively for the neonates for a week and if they were not needed during that week we would move them to the general population.  We would ask regular O neg donors if they could come in on a schedule so they could be used for the babies.  When most understood that their blood would be designated for the newborns little else had to be said to get them on board.  

We used to CMV test our units and not add an additive solution.  Our inventory (I suspect like most) is 100% leukoreduced, so that takes care of the CMV for us.  We also allow Adsol units now, so we can easily get these from our supplier, just a regular O Neg less than 7 days old.

[Sonya Martinez]

20 hours ago, Cliff said:

We used to CMV test our units and not add an additive solution.  Our inventory (I suspect like most) is 100% leukoreduced, so that takes care of the CMV for us.  We also allow Adsol units now, so we can easily get these from our supplier, just a regular O Neg less than 7 days old.

I wish we could get some of our physician's (heart transplant mostly) to understand that leukoreduced = CMV safe and that it should be equivalent to CMV NEG but they insist we keep giving CMV NEG RBCs.  We still mostly get CPDA-1 RBCs (fresh, < 6 days old) but we added AS-3 to the list of what neonates can receive a couple of years ago when there was the shortage on CPDA-1 collection bags.  So now we use CPDA-1 interchangeably with AS-3.  It's weird because our HPC (including bone marrow out of ABO and/or Rh type) transplants don't get CMV NEG but our heart transplant candidates and recipients all do.  Our CVICU (cardiovascular ICU) had 2-3 patients end up CMV POS and they refused to test staff saying it had to be from the blood and blood products.  Then COVID hit and everyone started wearing masks 100% and no more CMV POS patients even though we didn't change from what we were giving.