Neonatal transfusion

[pbaker]

For those of you that perform neonatal transfusions, what special products do you give your babies?  Irradiated, CMV seronegative, Hgb S negative, any others?

We give about 1 neonatal transfusion per year and our policy is really old.  Just want to make sure we are giving the correct most up to date product.

[amblanki]

We issue < 14 day RBC units (any additive), irradiated and HgbS negative.  Our products are leukoreduced, so are CMV safe.  

Do you irradiate on site?  I was with a smaller facility that would only potentially transfuse if a transfer out was delayed and gave the freshest O neg possible as an emergency issued unit.  It sounds like maybe that is the situation you are in.  

[pbaker]

25 minutes ago, amblanki said:

We issue < 14 day RBC units (any additive), irradiated and HgbS negative.  Our products are leukoreduced, so are CMV safe.  

Do you irradiate on site?  I was with a smaller facility that would only potentially transfuse if a transfer out was delayed and gave the freshest O neg possible as an emergency issued unit.  It sounds like maybe that is the situation you are in.  

We are a 400ish bed hospital, but our NICU usually sends the really sick babies to nearby Children's Mercy.  We do not irradiate on site.  We would have to get them irradiated at the blood center and the docs usually don't want to wait.  I'm just trying to get information to adjust my policies since we ALWAYS have to get it out when a request comes through.

Do you aliquot the unit to a syringe or send the entire unit to the NICU?

[jshepherd]

We are the same. We get a fresh <7 day old unit shipped in weekly from our blood supplier, so there is always an option for a fresh unit. We don't transfuse a ton of neonates, but our policy is to provide freshest possible, CMV safe/leukoreduced and HgbS neg to all babies. Those who have a very low birthweight or other indications for irradiated products will also require irradiated. Since the unit we get weekly is irradiated, pretty much all babies get irradiated because it's the freshest we have.

We aliquot units to a syringe or bag, but in emergencies we will send the whole unit to the NICU if they can't wait. Same for platelet units. 

[Neil Blumberg]

We use either ABO identical or washed O red cells.  Usually volume reduced so the hematocrit is around 70-80% either by centrifugation or washing with Plasmalyte.  We have data that saline washing is likely associated with more hemolysis and metabolic acidosis.  Leukoreduced and <21 days old.

We prefer not to use the very short storage red cells (<7 days) as there is evidence they are more dangerous from randomized trials, albeit in mostly adult patients. 

We do not CMV test or test for hemoglobin S, except for exchange transfusions.  No evidence that hemoglobin S trait is a problem for transfusion in any situation, but particularly for smaller volume transfusions.

We do irradiate for newborns since immunodeficiencies, while very rare, are often not diagnosed until later in infancy or early childhood.

[SbbPerson ☆]

On 8/31/2022 at 5:50 AM, Neil Blumberg said:

We use either ABO identical or washed O red cells.  Usually volume reduced so the hematocrit is around 70-80% either by centrifugation or washing with Plasmalyte.  We have data that saline washing is likely associated with more hemolysis and metabolic acidosis.  Leukoreduced and <21 days old.

We prefer not to use the very short storage red cells (<7 days) as there is evidence they are more dangerous from randomized trials, albeit in mostly adult patients. 

We do not CMV test or test for hemoglobin S, except for exchange transfusions.  No evidence that hemoglobin S trait is a problem for transfusion in any situation, but particularly for smaller volume transfusions.

We do irradiate for newborns since immunodeficiencies, while very rare, are often not diagnosed until later in infancy or early childhood.

 

I think most places use a solubility test to screen for the sickle cells disease and the sickle cell trait.  Although usually asymptomatic, sickle cell trait carriers can produce sickle cells in conditions of low oxygen tension.  And of course, sickle cells have poorer oxygen carrying capacity than normal cells. 

[Neil Blumberg]

Sickle trait cells do not sickle under physiologic conditions compatible with life.  Purely a theoretical construct.  Oxygen transport is also normal under physiologic conditions compatible with life. The evidence that sickle trait cells present any risks to any patient through transfusion is exactly zero.  Patients with sickle trait rarely, if ever, have any problems attributable to sickle trait. The epidemiologic evidence is likewise weak, if not zero.