platelets and neonates

[armymt2002]

Hello Again,

We have a NICU that is somewhat active. The blood services OIC (previously referred to in other posts as my boss) is rewriting the policy about our neonatal transfusions. Our donor center does not collect platelets by aphresis or from the units they collect on blood drives. This means we have to buy platelets from the German Red Cross. In rewriting the policy my boss has put in that we give ABO specific platelets and if for some reason we cannot we replace the incompatible plasma in the platelets with compabitble plasma. We try to give ABO specific platelets to everyone but since "beggars cannot be choosers" we take whatever the German Red Cross can send us when we need it. They only collect platelets by aphresis and don't do random platelets. Is this the first hospital where I have worked that has a NICU, the hospital I worked at before this used to send the babies to Indianapolis if they were going to need transfusioins. Do all hospitals that support NICUs do this or is it just for randome platelets. Any references you can point me to so I can present this to him would be great. Thanks.

[donellda]

I think that most hospitals are going to single donor for babies rather than randoms. In our institution we try to limit the exposures for babies so using a pheresis for the 5 days works for us. Also I believe that part of the reasoning in doing this, is that the single donor platelets are aspirin whereas randoms may not always be. I don't have access to any literature for you right now. I'm on vacation:D

[Mary]

Hi K,

Do military labs get inspected by CAP? Even if they don't, they are a good guideline for standard of practices. CAP Reg #TRM.40740 states "Is there a policy to prevent or limit the administration of ABO-incompatible donor plasma in platelets to infants?"

Their explaination goes on:For infant recipients, donor plasma in platelets must be ABO-compatible, as relatively large amounts of ABO-incompatible plasma may cause hemolysis or shortened red cell survival. If necessary, the plasma volume can be reduced shortly before transfusion by removing plasma from the platelet unit and resuspending the platelets in saline or albumin.

We try to stock Group A plateletpheresis because they are ABO-compatible with Group A and Group O patients. It's the B's and AB's that give you issues.

By the way, we still send our very ill babies to Indy!

How is Germany?

[John C. Staley]

For our NICU we stock an irradiated, leukoreduced, type AB plt pheresis. That way any baby needing plts gets to "dip in". It took a little convincing for our blood supplier but it sure works great.

[32387]

If we don't have type specific, we assign a "plasma compatible" platelet pheresis to a baby. Our donor center attaches satellite bags. If we can't get plasma compatible we have the donor center volume-reduce the platelets and then have a special formula to adjust the volume given to the baby. The main problem with this is that volume-reduced platelets are only good for 4 hours so we have to move fast.

[adiescast]

We use pheresis for our babies. The blood center sterile docks satellite bags for us. We order plasma compatible platelets on an as-needed basis. I have a statement in my SOP that if we cannot get plasma compatible, we reduce the volume of plasma by 50 % before transfusion. We don't try to replace the plasma. I don't have any experience with the German Red Cross, so I don't know if they would be willing to provide a pheresis with sterile docked satellite bags. If you are transfusing neonates and they do not provide the docking, you may wish to get a sterile docking device yourself. We also use sterile docked satellite bags on the red cell units we use for neonates.

Hope that helps!