Neonatal & Pediatric Transfusion Practice

[martha]

Is anyone washing RBC for neontes /pediatric patients with a High Potassium level? What is the transfusion protocol for neonates with high Potassium level? I am trying to stop washing cells and I will like to know what everyone else is doing.

Thanks,

Martha:)

[Malcolm Needs ☆]

We don't do this in the UK except under special circumstances.

These circumstances include certain cases of, but not all cases of T activation (which, actually, has nothing to do with potassium ion levels), but, if the baby required extremely rare blood (say pp) and no fresh blood was available, we would either use thawed cryopreserved blood (which would be washed during the thawing process) or, in extremis, if there was an "old, wet" unit available, this may be washed and transfused, but may require a clinical deviation (deviation isn't the word, but I just can't think of the exact word at present - age is catching up - well galloping up if I were honest).

In cases where there is no blood readily available, we may take blood from the mum, wash it and irradiate it and give the baby that (assuming all the bacterial and viral tests were negative).

There was a case in a Journal a few years back (?Transfusion, ?Vox Sanguinis - I'm not sure) where blood from the mother was washed, irradiated and successfully transfused in a case of a rare Rh antibody, that was ABO incompatible with the baby. I'll try to get the details of the paper later in the week.

[Yanxia]

I remember if the patients have high level of potassium, the transfused RBC need to wash, is there something new to change this practice? Help is appreciated.

[Malcolm Needs ☆]

I remember if the patients have high level of potassium, the transfused RBC need to wash, is there something new to change this practice? Help is appreciated.

Hi shily,

It is not that the patient has a high level of potassium, so much as the unit having a high level of potassium through membrane leakage, which accelerates with the age of the unit after storage (i.e. it is a storage lession). This high level of potassium can be toxic to the heart, and this is why you need to wash the units prior to transfusion, particularly if the neonate is premature or of small stature for age.

[Yanxia]

Thank you, Malcolm.

I have another question : why not wash the RBC be transfused to neonatal and pediatric?

[Malcolm Needs ☆]

Tests have been performed that show that the potassium leakage in fresh units (up to about a week) is minimal, and so there is no need to wash.

After that time the leakage starts to accelerate, and the potassium level eventually rises to a concentration that could be dangerous. It is, therefore, not a great idea to give neonates older blood, but, if needs must (if you will excuse the pun on my name), then washing the red cells is one way to reduce the potassium concentration to an acceptable level.

Of course, at the same time, you will be washing away other electrolytes and clotting factors. This must be taken into account, and the neonate may require FFP or the red cells may be resuspended in group AB FFP.

[RR1]

I presume we are discussing washing blood for neonatel exchange transfusions and not top-ups?

The volume being transfused and therefore the amount of potassium within the unit is the critical factor. In the UK blood for neonatel top-up transfusions can be up to 35 days old.

[Malcolm Needs ☆]

I presume we are discussing washing blood for neonatel exchange transfusions and not top-ups?

The volume being transfused and therefore the amount of potassium within the unit is the critical factor. In the UK blood for neonatel top-up transfusions can be up to 35 days old.

Well, put it this way Rashmi, that's what I have been talking about!

Maybe I've got the wrong end of the stick.

Youare quite correct about "top-up" blood being safe for the full 35 days.

:confused:

Is that what others have been talking about??????????????

[martha]

Currently we are washing Red blood cells for neonates with high potassium levels but we use a cobe 2999 which needs to be replace soon and I was hoping that proving fresh RBC to neonate was equivalent to wash cells.

[RR1]

Currently we are washing Red blood cells for neonates with high potassium levels but we use a cobe 2999 which needs to be replace soon and I was hoping that proving fresh RBC to neonate was equivalent to wash cells.

Hi Martha,

Sorry - but i'm a bit confused. Are you saying that if your neonate has a high potassium level then if they need a blood transfusion-you have to wash the red cells ?

If this the case, are you providing the blood to correct anaemia or for exchange transfusion?

Thanks