Aliquoted Pack RBC's

[donellda]

I have a question for those transfusion services that deal with neonates. What do you do with the remainder of a unit that was used for a neonate that only had one or two aliquots taken off? When I worked at previous hospitals, when the unit was getting close to expiration, we would use them for an adult as long as there was at least 200 cc left in the unit and as long as it was not the only unit given to the adult. It has also been the practise here but I had an employee yesterday who insisted that the unit had to consist of at least 250 cc. I tried to explain that the unit only contained 250 cc to begin with since it was a CPDA-1 packed RBC. This employee wants to some sort of documentation or standard that these units can be used for adults. We do use a sterile docker to attached the syringe when we take the aliquot off so this is not an issue at our facility.

If you have any practises that you could share with me and if you know of any sources that state appropriate unit volumes for adults, it would be very helpful to me. Thanks!

[Eagle Eye]

We get AS-3(code 05730) units from our supplier. We use this units only for 48hrs from the time of irradiation. If unit weigh >250 (excluding weight of the bag which is 35 to 50 grm) we would use for adult patient/babies >4 month of age who needs larger volume. We treat our premies as <4month until the baby is in the hospital.

[Cathy]

I don't know of any documentation, but we would give the unit to an adult also.

[John C. Staley]

When we get a request for blood for a neonate and an aliquot is taken from the unit it belongs to that baby and will not be given to anyone else until it is either gone or outdates. The only exception is our neonatologits have requests we put twins on the same unit if blood types allow.

[rcurrie]

We used the Circular of Information (July 2002) to calculate the required amount for a unit of RBCs. See page 14 at the very bottom, continued on page 15 at the top of the page: "Red Blood Cells may contain from 160-275 mL of red cells (50-80 g of hemoglobin) suspended in varying quantities of residual plasma." We took that minimum volume, 160 mL, and added the 100 mL of AS solution we add to our RBC units to come up with the magic number 260 mL for our units to be considered sufficient to produce the required 50 g of hemoglobin. You can do a similar calculation with your own components. Alternatively, you can request permission from the ordering physician to issue a unit with less than the required amount. We have done that in the past to save a unit. Most physicians have been willing to transfuse less than a whole unit whenever the unit is close to the minimum requirement.

Bob Currie, MT

[adiescast]

We don't usually have enough left to give to an adult, since we can use the unit for its lifespan. If a baby goes home and there is a fair amount of time before expiration (3 weeks), we put another baby on the unit. We also allow 2 babies per unit from the beginning. Having said that, if we get a baby > 4 months old or a child who requires transfusion of less than a full unit, we have used some of these units. We have also given them to adults in cases where only a small volume has been removed. We consult with our pathologist before doing that. Because our blood center draws 500 ml units to begin with, we have a little bit of leeway in the packed cells.

[John C. Staley]

Just out of curiosity. Who do you bill for this when multiple patients get part of a unit? Every body gets hit with the full price, first one in foots the bill and everyone else gets a freeby? These were some of the issues we didn't want to deal with when we were considering sharing units.

[donellda]

I think that most of the billing for the babies is more for the processing involved. Most of the babies that we have only get one aliquot from a unit. That is why I end up having units with 230 to 220 ccs left. I have reduced our standing order of neonatal RBCs so maybe this will help remedy the problem. We will start putting more than one baby on a unit.

[rcurrie]

For us, first person takes the hit on the unit, and the others are only charged an aliquot fee. We wrestled with this for quite a while, too. We deliver about 600 babies a month (including many premies), so we rarely discard blood. We make our own neonatal units. We have dedicated O neg donors for our neonatal units. We collect into AS-5 bags but don't add the AS solution, classify the packed cells as neonatal units, then put them into general inventory 6 days after collection. The units have a 21-day outdate since they have no AS solution added.

BC

[adiescast]

We figured out the average number of aliquots we get from a pediatric unit and divided the total unit price by that to get a price per baby unit. Each baby is charged the baby unit price plus an aliquoting fee. If we only take one aliquot and give the rest to an adult, the baby is charged the baby unit price and the adult is charged the full unit price.

[sgoertzen]

We do the exact same thing as "adiescast" at our children's hospital. Every split (aliquot) costs the same, regardless of the volume, based on the average number of splits we make from an original unit. We do "split studies" a couple of times a year, looking back at data for 3 months, and adjust our prices of aliquots accordingly. The only difference is... if we make one split for a baby and end up giving the rest (majority of the volume of the unit) to an older child, the older child also gets the split pricing.

[Mabel Adams]

When we get a request for blood for a neonate and an aliquot is taken from the unit it belongs to that baby and will not be given to anyone else until it is either gone or outdates. The only exception is our neonatologits have requests we put twins on the same unit if blood types allow.

I heard of at least one case (back in the HIV risk era) where they had twins sharing a unit and it turned out the unit was infected and both twins got HIV or Hep C or whatever it was. Some places have a policy against twins sharing a unit so the same family won't lose them both. Since NAT I would think the only real concern would be the next emerging disease.