Neonatal syringes

[Laura Mc]

We are a large tertiary care center with a Neonatal intensive care unit. We assign an infant to a unit of blood until the unit is used up, expired, patient has gone home or expired. We currently keep the parent bag and draw off aliquots as needed using a sterile connecting device and a syringe set from CharterMed. In the codabar world I have made this work but making up our own codabar syringe codes. However in the ISBT world I will not be able to do this. How do you assign the product code when the parent bag still exists and you want to keep making aliquots? I cannot do A and B then Aa and Ab as this only works twice. I have made up to 20 syringes off one unit of blood. If your facility is doing this and have implemented ISBT or you know the answer I would love to hear from you.

[heathervaught]

Laura,

This is the way I understand it...

You can divide each part into 26 divisions (A through Z). If you take your original bag, then draw off one syringe-worth, then that aliquot is A0. If you draw the next aliquot off of your original bag, then that aliquot is B0. Then draw your next aliquot off of your original bag, then it is C0. Then draw your next aliquot off your original bag, then it is D0. You can do that until your original bag is used up.

OR

You can divide your original bag into two aliquots, A0 and B0. Then further divide each aliquot into Aa, Ab, Ac, Ad....through Az and Ba, Bb, Bc, Bd....through Bz.

Just remember, these activities require registration with ICCBBA. This will also give you access to the Registered Users Area of the iccbba.org website.

[Cathy]

Just when I thought I knew how we were going to handle these, another thought crops up in my head. In the previous example, where we might call the first aliquot A0, the second B0, etc.... Don't we need to change the original bag? How can we put the bag away labelled 00 with these aliquots removed?

My next thought is to change the original bag to A0 when removing the first aliquot, since it will no longer be an undivided unit. The first aliquot would then be Aa, the second Ab, etc.

[Pat Distler]

The first time you make an alilquot, you can designate the parent unit as A0, and the first aliquot as B0. Thereafter, the parent unit remains A0 and subsequent aliquots are named Aa, Ab, Ac, etc. There is no requirement that the aliquots be removed at the same time, or that the be of equal size.

[Cathy]

Thank you Pat. Now I am wondering about product codes. I think E0339 (AS-1 added, supernatant removed) is the code I would want for our neonatal syringes. We spin the unit upside down so we can attach a syringe and removed packed red cells. My problem is E0339 does not specify leukocytes reduced, do I need a code that specifies leukoreduced? What about irradiated, I cannot find a code for AS-1, supernatant removed, leukoreduced, irradiated.

Thanks.

[David]

The first time you make an alilquot, you can designate the parent unit as A0, and the first aliquot as B0. Thereafter, the parent unit remains A0 and subsequent aliquots are named Aa, Ab, Ac, etc. There is no requirement that the aliquots be removed at the same time, or that the be of equal size.

Flummoxed again! I thought the mother bag stayed '00', the first satellite became 'A0', the second satellite would be 'B0', and the first syringe from each would be 'Aa' and 'Ba' respectively. But it sounds like each subsequent removal gets the next letter combination irregardless of the kind of container it goes in, syringe or satellite bag?

Are we glad Pat monitors this site or what :-))

[Pat Distler]

Yes, David, sounds like you've got it. You need to show the parent unit is no longer a "full" unit so it must get a division code (letter in the 7th position). Thereafter, you'll need to use the 8th position a,b,c, etc. codes to identify the products that are created from this divided unit. And it is independent of the type of container it goes in.

The goal here is to ensure you can track every aliquot. There's some flexibility in exactly how you achieve that, but it's best to decide up-front what is best for you, then be consistent.

Sorry I missed your question, Cathy. Is this from 450 or 500 mL of whole blood? For 450 mL, E5546 would seem appropriate; for 500 mL (E5537 for irradiated version); for 500 mL E5547 (and E5077 for irradiated).

[Eagle Eye]

I have my split set up correctly. Parent unit is always 00. 1st aliquot is A0, 2nd is B0, third is C0.

Incase your 1st aliquot is 100 mL and you decide to split that then that split product will become Aa, Ab, Ac so on. In my computer I will not have an option to do that because that is one more validation!!:cries:

[Eagle Eye]

I am sorry. I take it back. I had it wrong.....because the way my computer is set up.

So 1st time we modify the product parent becomes A0, 1st aliquot is BO and subsequent aliqout from parent/A0 becomes Aa, Ab, Ac...etc.

Again I apologize for posting incorrect information.

[GilTphoto]

We are a large tertiary care center with a neonatal intensive care unit. We assign an infant to a unit of blood until the unit is used up, expired, patient has gone home or expired.

How are you using a single unit until expiration? It's my understanding that red cells for newborns must be less than 7 days old because of the red cell leakage of potassium. After 7 days, the potassium level is too high for newborns to handle and could cause cardiac problems.

Are you washing these aliquots before transfusion?

Gil

[Lcsmrz]

It's a trade-off between a slightly higher potassium in the unit and an additional donor exposure. We start aliquotting units when they're less than 7 days old, but will use them for one infant until expiration.

The amount of extra potassium is small in comparison to the total potassium in a premie.

[Pailloz]

WHile we would love to keep to a less than 7 ot 10 day old protocol. It is just not possible with the inventory.

Generally the NICU kids and Docs with keep the Dedicated donor after the 7th /10 day....no washing

The Cardiac docs evaluate it on a case by case basis. Sone tinys can tolerate the K ...others can not. MD decides.

With teh tiny SIcklers/Dialysis/Leukemias/ transplants etc. you can see why we couldnt keep the 7 day inventory rule.

As for ISBT, alliquots are quite a challenge. and I agree with the posts clarifying that the parent bag ceases to exist and alliqouts can not be made after the 2nd generation (Aa or Ba) level, but must proceed to CO or DO...etc.

Lastly, has any PEDS site addresses the complications of double product units like Single Donor Plats or Double Red cells that have the same ID #, going into the 1st or 2nd generation?

Meaning have you define each alliqout AO BO Aa Ba etc for each antigoaculant and its particular "E" code.

[heathervaught]

Pailloz, each component has a different product code. So in the event of an apheresis platelet, Bag 1 product code is E3087, Bag 2 product code is E0388, and Bag 3 product code is E3089, with each component able to be divided into A0, B0, C0, (those are the number zero and no the letter "oh") Aa, Ba, Ca, etc. Same applies to apheresis RBCs. The receiving facility needs to identify components by the actual component code and not generic "red cells", "platelets", etc.

[Mabel Adams]

Fresh blood for neonates is a bigger concern for exchange transfusions than for small volume transfusions, right?

[pdavenport]

Ronald Strauss has published several papers on this topic. It boils down to "do the math." While the potassium on a unit of blood at 42 days may appear to be extremely high, it's mEq/L of plasma. When you calculate the K level in a small volume aliquot, it turns out to be significantly less than the infant's maintenance dose of K. The benefit of using a single unit until it outdates is decreased donor exposure. The majority of neonates who are "feeders & growers" get all their transfusions during the first month, if you assign them to a fresh AS-1 unit for the first transfusion, you can get them through the entire stay in the NICU with only one donor exposure.

[vdvictory]

Sorry, I meant to start a new thread not reply to this one.

Edited February 27, 2009 by vdvictory
Sorry I meant to start a new thread

[Christie Loe]

Hi Gil,

You may want to refer to the most recent version of AABB's Handbook for Pediatric Transfusion Therapy for recommendations as to washing for pediatric aliquots and maintenance volume transfusions.