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Infant transfusion units


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For those that do not irradiate on site, do you keep an irradiated unit on hand or do you keep a regular cmv= fresh unit on hand?  We get a new unit every 2 weeks and we rarely transfuse infants but we have a unit on hand just in case

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We keep 1 irradiated O Neg on hand for infant transfusions. We get a new one once a week. We also don't transfuse a lot of infants but we do have a NICU here and we will get an infant every couple of months that requires a couple transfusions.

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The hospital that I retired from recently had an irradiator so we would get 1 O negative fresh CPDA1 CMV-, HbS- unit a week. I worked at a hospital where without an irradiator and we received 1 O positive and  1 O negative CPDA1, CMV- and HbS- unit both irradiated from the supplier. Most of the time we used the units on adults who required irradiated because we rarely used them.

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15 hours ago, kimblain said:

As I am reading the AABB manual they speak about potassium release with units that are irradiated and stored for >1 day.  Did you look at this concern?

That's why folks use 'fresh' units and also why irradiated blood gets a shorter outdate than the original (unless the current outdate is less than what you would change it to.

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We routinely stock 2 O Pos, 2 A Pos and 2 O Neg Irrad units for oncology patients, so would have Irrad units available if ordered for a neonate. I think we average 1 or 2 neonate transfusions in a years time. Our irradiated units are rotated for restock about every 2 weeks and restocked when used. We do not stock CMV neg units. All our blood supply is leukoreduced, which is considered CMV safe. If we are planning a transfusion or have an anticipated birth of a baby who might need transfused we order a fresh unit or two.

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1 hour ago, AMcCord said:

All our blood supply is leukoreduced, which is considered CMV safe.

I had a corporate transfusion service medical director who was uncomfortable with the term "CMV safe" so we were required to use the phrase "CMV risk reduced"!  I know it doesn't add anything to the discussion but when I read Ann's post the memory made me smile at the lengths some folks would go.

:coffeecup:

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  • 3 weeks later...
On 7/21/2021 at 1:35 PM, kimblain said:

As I am reading the AABB manual they speak about potassium release with units that are irradiated and stored for >1 day.  Did you look at this concern?

I've always thought that 1 week post irradiation would be the ABSOLUTE maximum for a unit to be used on a baby.  I actually thought 5 days was almost too long.  Anything longer and you do run into Potassium leakage problems that can make the unit dangerous for a Neonate.  We had a potassium overload reaction on a neonate once with only a small volume transfusion.  So - absolutely watch the length of time your units have been irradiated when transfusing to infants. 

We no longer have an irradiator on site and will be buying fresh, irradiated, CMV- units from our distributor for small volume transfusions.  I am worried that, over time (we only transfuse these babies about 2X a YEAR), the team will forget to move the leftover unit over to adults and will use too old of a unit on a baby.  I am retiring, so won't be here to watch out for it - so I will just have to worry.  I just can not figure out how to fix things so that 10 years from now, something that esoteric gets remembered by the poor tech stuck with it, for the first time in 5 years or so for them, in the  middle of the night!  Such are the nightmares of an old blood Banker!

Edited by carolyn swickard
additional wording
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If this works - this is, I think, a proposed observational study to determine how standard Blood Bank practices may affect the transfusion of infants.  Someone is looking at the age of irradiated units and what it might mean to infant safety.  Interesting.

Does red blood cell irradiation and/or anemia trigger intestinal ...

 
 
 
by T Marin · 2018 · Cited by 6 — Our overarching hypothesis is that irradiation of RBC units ... The majority of premature infants receive transfusions for anemia of ...
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In the UK, we have discovered that some of our donors have naturally high levels of potassium in their plasma, and have caused problems when used for transfusions in babies.  For this reason, we now test our paediatric units for high potassium, and any donors so identified are marked in our records as for use on adults only.

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36 minutes ago, Malcolm Needs said:

In the UK, we have discovered that some of our donors have naturally high levels of potassium in their plasma, and have caused problems when used for transfusions in babies.  For this reason, we now test our paediatric units for high potassium, and any donors so identified are marked in our records as for use on adults only.

Just curious Malcolm, how high are your "naturally high levels of potassium"?  The top end of the normal values or would they be considered abnormal?  At what level is the blood considered not available for paediatric units? This is the first I've heard of testing units for potassium.

:coffeecup:

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Hi John,

I am not absolutely sure, as this all happened just as I was retiring, but I have emailed a former colleague of mine who may know, but, if you put "NHSBT blood donors with high potassium levels" in to your search engine, you should get up a PowerPoint lecture that you can download with the long title of, "POTASSIUM LEAKAGE AND MEASURES OF THE RED CELL STORAGE LESION IN DONATIONS FROM INDIVIDUALS WITH FAMILIAL PSEUDOHYPERKALAEMIA", by Athina Meli, Maggie McAndrew, Amy Frary, Karola Rehnstrom, Christian J Stevens, Waleed M Bawazir, Joanna F Flatt, William Astle, Rekha Anand, Helen V New, Lesley J Bruce and Rebecca Cardigan, which may answer your question.

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Thanks Malcolm, it did answer my question.  Apparently while their blood is circulating these people maintain normal levels of K+.  It is only upon storage that they leak the K+ at higher levels than normal. It appears to be a genetic cell membrane "defect" 

"Familial pseudohyperkalaemia (FP) • dominantly inherited, asymptomatic • characterised by an increased rate of leakage of K+ from red cells at refrigerated temperatures • usually caused by the minor allele of a non-synonymous single nucleotide polymorphism (FP SNP; rs148211042; R723Q) in the transporter gene ABCB6 (ATP-Binding Cassette, subfamily B, member 6) • codes for a red cell membrane transporter protein • raw chip measurements from a screen of the UKBioBank suggested ~1:400 of the UK population have the FP SNP"

"Study – identified FP individuals • screening of the National Institute for Health Research Cambridge BioResource (NIHRCBR) – identified 16 out of 8712 individuals with the FP SNP. • 2 more individuals with the FP SNP were identified when clinical cases of unusually high K+ levels were reported in RCC units that they had donated – characterised in Bawazir WM, et al. 2014"

Thanks again, 

:coffeecup:

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On 7/21/2021 at 12:35 PM, kimblain said:

As I am reading the AABB manual they speak about potassium release with units that are irradiated and stored for >1 day.  Did you look at this concern?

For us, we don't consider the unit fresh if it's been irradiated more than 24 hours but only if the transfusion is >20cc/kg or push transfusion.  Those get rotated back into normal stock and used for all patients including neonates as long as the volume is <20cc/kg.  

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We do about 6 NICU transfusions/year. We routinely keep a fresh, CMV=, IRRADIATED unit on hand which is replaced every week. That unit is for emergency transfusion only in the NICU. If the situation is not critical, we order a fresh unit for the baby with satellite bags attached. It takes our supplier about 90 minutes to get that unit to us. The majority of our babies can wait. If it is an emergency, then we give the best product we have. The neonatologist says "we can treat hyperkalemia but we can't treat death."

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