Pediatric male trauma patients

[tms8313]

Just wondering what other hospitals do....

We are a Level 1 Trauma Center. We give one set of O= (consisting of 6 units) to all Level 1 trauma patients. If another set is requested, we switch all male patients and females over the age of 50 to O+ in order to conserve the O= inventory.

Now we will be treating pediatric trauma patients which we haven't routinely done in the past.

When you are switching types on pediatric male patients, does anyone have a lower age limit to switch these boys over to O+? If the pedi male is 3 years old, would you still switch him to O+ without confirming his type first? What if he is confirmed to be Rh=, would you switch him to Rh+ at any point?

Please respond, we are actively discussing our options.

[tbostock]

Our massive transfusion protocol includes children along with women of child bearing years in the O Neg category. I would not want to expose a 3 year old male to Rh Pos if not confirmed; they would take a lower volume of red cells anyway, so the issue of "wasting" too many O Neg units is not as prevalent as in an adult.

[tms8313]

this was my thought also. thanks!

[L106]

My thought also.

[Malcolm Needs ☆]

As a self-confessed fan of giving group O, D positive to older male patients, I also agree with these sentiments about young males group O, D negative blood.

[Yanxia]

Why give young male D neg cells?

[Malcolm Needs ☆]

Why give young male D neg cells?

I think that one of the reasons is that D- individuals are far more common in the West, than they are in China (indeed, in the Far East as a whole). Depending where you are, as the figures vary quite a lot (about 15% in the UK, approximately 25% in the Basque Region of Spain), D- blood is much more available than it is in China.

The D antigen is probably the most immunogenic antigen (after the A, B and H antigens) in human blood, probably because it is a fair size polypeptide of some 416 amino acid residues, which is completely "missing" in D- individual. Therefore, there is a very high chance that an immunological challenge with D+ red cells in the circulation of a D- individual will result in the production of anti-D.

Obviously, a young male has the rest of his life to live, with a chance that, at some time during his life, he may require further transfusions, and with a slimmer chance that he may require emergency blood at some point, in which case he may then be given D+ blood. If he has made an anti-D early in his life, this, obviously, may result in a diasterous transfusion reaction.

In the case of trauma (which is really what this thread is driving at, I think) there is a higher risk of the boy needing further transfusions during his life as a result of the initial injuries (e.g. reconstructive surgery, plastic surgery, joint replacement, etc), and so it is a reasonable idea to try to avoid him making an anti-D early in life, if he happens to be one of the 15% of the population that are capable of so doing.

These are my thoughts, but others may disagree, or cite other reasons that are better than mine.

(By the way, I haven't forgotten that I have to look out those papers on ABO for you. I am off sick at the moment - again!)

:):)

[martha]

Our massive transfusion protocol includes children along with women of child bearing years in the O Neg category. I would not want to expose a 3 year old male to Rh Pos if not confirmed; they would take a lower volume of red cells anyway, so the issue of "wasting" too many O Neg units is not as prevalent as in an adult.

I agree with you on not wanting to expose a 3 year old male to Rh positive. We are in the process of creating a massive transfusion protocol for pediatrics. Would you be so kind to share yours?

Martha.delgado@MCH.com.

Thanks

[AMcCord]

We stick to Rh neg for young males (until type specific can be issued) until 18 yrs. We don't have many pediatric trauma cases, so it's not a problem for us to do this.

[Yanxia]

Thank you, Malcolm. Best wish for you. In Chinese is " zhu fu ni":):)

If my memory do not deceit me some paper mentioned infant younger than 4 month no need to do atypical antibody screen other than his or her mother's because they can't produce his own atypical antiby. Will this apply to the D neg patients?

[Yanxia]

http://www.bcshguidelines.com/pdf/neonates_124_4_2004.pdf

[Malcolm Needs ☆]

Thank you, Malcolm. Best wish for you. In Chinese is " zhu fu ni":):)

If my memory do not deceit me some paper mentioned infant younger than 4 month no need to do atypical antibody screen other than his or her mother's because they can't produce his own atypical antiby. Will this apply to the D neg patients?

Thank you for your kind words shily.

Yes, indeed, your memory does not deceive you concerning infants up to four months, and there is some slight evidence that such infants' immune systems become tolerant to "foreign" antigens and may never produce antibodies against certain antigens. In fact, studies have shown that even approximately 15 to 20% of D- adults will never produce anti-D after several immunological challenges with D+ red cells.

On the other hand, however, the same studies showed that an equal number of D- individuals have what can be loosely described as a "hyperactive" immune system, and will produce anti-D after a very small initial immunological challenge of D+ red cells (sort of "super producers" of anti-D).

I think, therefore, that I would rather be "safe than sorry" in the case of paediactric male trauma patients, and give them D- red cells in an emergency, if they are available.

:):)

[jcdayaz]

We transfuse ONLY Type O Rh neg, CMV neg, Irradiated blood to our neonates. My current hospital doesn't treat children in the 3 yr old age range(typically). I do remember, however from the Children's Hospital I worked in previously to this one, that we would have NEVER switched a child to Rh pos.

As in previous posts...they have a life time ahead of them to live. What happens X-number of years down the road when they might have some sort of trauma situation and your blood bank is running low on O negs????? Not something I would want to take the risk on....

That being said..I would not allow a patient to die in any circumstance. If you have a child who needs blood (true need) and you have no O neg stock then obviously you have to go to O pos.

[sun]

the most strange case I had seen is a newborne with neonatal jaundice > He was Rh negative. His mother was Rh positive CDe/CDe and developed anti c antibodies that ended with anti c hemolytic disease of newborne. It took time to convince the pediatrician to transfuse Rh positive blood o Rh negative newborne however at end ,they agreed and every went alright.

[Malcolm Needs ☆]

the most strange case I had seen is a newborne with neonatal jaundice > He was Rh negative. His mother was Rh positive CDe/CDe and developed anti c antibodies that ended with anti c hemolytic disease of newborne. It took time to convince the pediatrician to transfuse Rh positive blood o Rh negative newborne however at end ,they agreed and every went alright.

Yes, I would imagine that HDN due to anti-c is much, much more common than HDN due to anti-D in your area of the world, if, as I suspect, you live in Far East Asia.

:confused::confused:

[SMW]

the most strange case I had seen is a newborne with neonatal jaundice > He was Rh negative. His mother was Rh positive CDe/CDe and developed anti c antibodies that ended with anti c hemolytic disease of newborne. It took time to convince the pediatrician to transfuse Rh positive blood o Rh negative newborne however at end ,they agreed and every went alright.

If the mother was indeed CDe/CDe, would the neonate not have been Rh-(D) positive??

[Malcolm Needs ☆]

If the mother was indeed CDe/CDe, would the neonate not have been Rh-(D) positive??

Not necessarily!

This would have been the mother's probable Rh type. In fact, she could have been CDe/Cde, and the baby Cde/cde.

:)

[sun]

In fact malcolm you are absolutely right because the baby was cde/cde . the mother was D+, C+,E+ and e + so she is most probably CDe/Cde .Sorry it was typing mistake.

[Mabel Adams]

Since adolescent males are sometimes repeat traumas (mostly due to the nature of adolescent males), it could be justified to use Rh neg as universal donor until the age of 26 when the adolescent brain is supposed to mature enough so that thrill-seeking, risk-taking behaviors drop off to the adult level. We could probably use the auto insurance industry's age cut-offs for a reasonable guideline. Should we give them the "good student discount"? Just joking.

[Malcolm Needs ☆]

Since adolescent males are sometimes repeat traumas (mostly due to the nature of adolescent males), it could be justified to use Rh neg as universal donor until the age of 26 when the adolescent brain is supposed to mature enough so that thrill-seeking, risk-taking behaviors drop off to the adult level. We could probably use the auto insurance industry's age cut-offs for a reasonable guideline. Should we give them the "good student discount"? Just joking.

I know some that are well into their eighties who still have adolescent brains (and certainly one fifty-five-year old)!!!!!!!!!

:rolleyes::rolleyes: