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incompatible blood type platelets for neonates.


Antrita

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We are getting ready for a NICU in our hospital. I talked to my blood distributor about only giving type specific or type compatible platelets. They told me the other hospitals are giving any type to neonates but I can't find anything that backs this up. The technical manual transfusing ABO incompatible plasma should be avoided. Does anyone out there transfuse any blood type platelets to neonates? They also told me they don't wash or plasma reduce.

Thanks

Antrita:confused:

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We are a blood supplier in the UK, although I do not work on the donor side of things (strictly patients, and strictly red cells), but I know that we would never condone giving platelets in ABO incompatible plasma, unless it was proved to be ABO antibody high titre negative, and only then in extremis (say the baby had neonatal alloimmune thrombocytopenia with an ongoing intracranial haemorrhage, and the platelet antibody causing it was directed against a very high frequency platelet antigen and no ABO plasma compatible platelets were available).

:eek:

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From the AABB Technical Manual, 16th edition, p 650: "Transfusion of ABO-incompatible plasma (in platelet units) should be avoided in pediatric patients and especially in infants because of their small blood and plasma volumes. If it becomes necessary to administer ABO-incompatible platelets to an infant, plasma may be removed either by volume reduction or washing. The platelets may then be resuspended in saline or compatible plasma."

We don't have a NICU yet, but will in a couple years, so I will be interested to see what others with NICU units do for platelet transfusions.

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The current CAP (College of American Pathologists) Transfusion Medicine Inspection Checklist addresses this in Checklist Question # TRM.40740:

"Is there a policy to prevent of limit the administration of ABO-incompatible donor plasma in platelets given to infants? NOTE: 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. In necessary, the plasma volume in platelet units can be reduced shortly before transfusion by removing plasma from the platelet unit and resuspending the platelets in saline of albumin solution."

Sounds like it's time to tell your blood supplier "This is considered to be 'best practice' and this is what we need."

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Thank you everyone, I talked to other hospital in my area and their procedures are really old. After reading her the technical manual she is changing her procedure to mine. I talked to my blood provider again and was told when we are up and running they will try to keep us a nonreturnable AB platelet. So, one less thing to worry about.

Antrita

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I supervise the Transfusion Service at a Children's Hospital so we give lots of platelets to lots of neonates and small kids. We use plasma compatible platelets for everyone up to 45 kilos. If we cannot get plasma compatible (our donor center supplies only leukoreduced-plateletpheresis), our policy is to volume reduce and remove the incompatible plasma. We also aliquot and irradiate almost everything, so we spend a lot of "quality time" with our products. :juggle:

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Presumably people will centrifuge the platelet unit, then remove some plasma, and resuspend the platelets. Is this how it`s done? I was always told this may activate the platelets and lead to a reduction in viable platelets, so this was not recommended where I used to work. Is this reasoning correct? The maternity hospital I am now at will try its best to give group-specific platelets. If they are not available, we would give other groups only if absolutely necessary - except we would NOT give group O platelets to a non-group O recipient.

Whilst on this topic, would you give Rh Pos platelets to a Rh neg female baby (assuming no Rh Neg platelets are available)?

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Yep, we spin them in a temperature controlled centrifuge at:

Speed in RCF = 2000 RCF

Temperature = 22 C

Time = 10 minutes

Then we express off all the plasma except about 50 mL.

Leave the bag at 20-24 C, without agitation, for 1 hour.

At the end of this "rest" period, resuspend the platelets by either:

A. Gentle manual massage for 5 to 10 minutes until the platelets are evenly suspended.

B. Rotating the bag on a standard platelet rotator/agitator for 1 hour.

We tried to avoid spinning if at all possible.

We also avoid giving Rh positive platelets to any of our Rh negative patients (male or female, birth through 21 yr). When we must, we always recommend that the MD give a mini-dose of RhIG.

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