Platelets for neonates

[PHYLLIS]

Does anyone have a procedure for transfusing platelets to neonates? I'm familiar with the type selection but how do you take them off of the original unit and how much?

[dmpollock]

When dealing with random platelets we issue the whole unit and don't worry about splitting. If you are talking about pulling from an apheresis bag it depends on how you issue it. Other factors are whether you are using a sterile docking device, or whether you need leukoreduced product.

With a syringe (which we won't make for plateletets) I would issue the amount required for transfusion plus 8-10 mL. Check with nursing staff to see what they need for dead space, if any, in their tubing.

If given through a Y set we add 25 mL for the tubing.

Watch for the volume ordered. Anything more than 15 mL/Kilo, or less than 10 mL/Kilo, might warrant double-checking. I once saw an order for 2000 mL for a premie!

[JWCHB'HAM]

If you are dealing with a plt apheresis then you must use a sterile docking device of the remaining amount in the mother unit will expire in 4 hrs. Your blood supplier may be able to dock aliquot bags to the mother unit for you (for a fee). The aliquot will expire 4 hrs from the time that the aliquot is made. It does not matter if it is in a syringe or a bag. If you need additional info you can call me at (205) 558-2347. James at Children's Hospital. Hope this helps.

[heathervaught]

I have seen it done this way: the doctor orders a dose for the infant, the Blood Bank takes the actual product yield (the blood supplier documented it on each apheresis platelet bag), calculates the volume required to obtain the desired dose, then uses a sterile method to remove the desired volume. A sticker on the bag tracks the number of aliquots that have been removed.

Word of caution: As JWCHB'HAM mentioned, the aliquot expires in 4 hours. The original storage bag also has storage requirements as well, regarding the minimum volume required to maintain happy platelets at a pH of 6.2 or greater. I can't speak for all bag manufacturers, but the Caridian (formerly Gambro) bags must contain at least 100 mL. If the product contains less than 100 mL, then you must transfuse within 24 hours or discard the product.

[BenchTech]

When I worked at a place that transfused to neonates, the docs would order in MLs and we would sterilely aliquot type AB plts only in to a syringe.

[GilTphoto]

I can't see wasting a Pheresis for a neonate. The average volume transfused is about 10 mLs. We only order a single donor Platelet which is only 50 mLs. There is a BIG cost difference. Our Pheresis costs $590, while a single platelet is only $40. We issue the complete unit and the nurse pulls off however many mLs they need, then discards the remainer of the unit.

[BenchTech]

That's a great point GilTphoto, but often times we would have a neonate receive multiple plt transfusions over the course of a couple days. We would try and keep them on one single plt as long as we could to decrease the donor exposure. We were lucky and had the luxury of ordering one AB plt to have on hand for just neonate use.

[GilTphoto]

Our experience with neonatal platelet transfusion is rare. The couple of times I've seen, the order was a one time transfusion (maybe they transferred the baby to a REAL hospital) <g>