SDP Aliquots for Neonates??

[rravkin@aol.com]

As the title suggests; I wanted to know if anyone is utilizing SDP aliquots for neonates. If so can you explain your practice and procedure? If not, can you explain?

[Eagle Eye]

we prepare aliquots from Apheresis platelets and issue required amount.

[Malcolm Needs ☆]

In the UK, we use SDP FFP for all patients under a certain age (I think it's 16, but I honestly can't remember without looking it up), al inported from other countries (i.e. the USA) becuse we have vCJD in our donor pool, and because it gets rid of enveloped viruses.

[rravkin@aol.com]

Aakupaku and Malcolm,

Thank you for your responses. Aakupaku, what happens to the original SDP unit after aliquoting a volume for neonatal transfusion? Is there any bacterial testing performed on either or both units before transfusion? Is there any effect on the experation date of the original SDP? Are you using a sterile docking device? Is the SDP irradiated and CMV negative?

Malcolm, what is the anticipated time frame for allowing the vCJD to disipate from your donor pool if any? Are decreased platelet counts in neonates treated with imported plasma only? What is the concept behind this practice?

Am I asking enough questions???

[Eagle Eye]

Aakupaku and Malcolm,

Thank you for your responses.

Aakupaku, what happens to the original SDP unit after aliquoting a volume for neonatal transfusion? If the volume is >250 mL(most cases it is <250 mL)and there is an emergent need, it can be given out to other patient with MD approval.

Is there any bacterial testing performed on either or both units before transfusion?

All SDPs are tested by supplier.

Is there any effect on the experation date of the original SDP?

No. (unless it's double bag and if you pool into one bag then you have to follow supplier recommendation).

Are you using a sterile docking device?

Yes. Aliquot in a syringe.

Is the SDP irradiated and CMV negative?

Irradiated. CMV safe(in other words Leukoreduced)

Other option is volume reduction but there are too many steps involved and you need to get FDA registration and :cries: FDA inspection...not worth it for us. We do not have large ped. population.

Am I asking enough questions??? Not really. I was kind of ready for the questions.:tongue::tongue::)

[kharbert]

Do I remember correctly concerns about SDP plasma because the process destroyed factor C (or was it S, or both?), and recipients therefore were at risk for blood clots?

[rravkin@aol.com]

Aakupaku,

Thank you for your response. I was wondering what the fate of the mother SDP was in the abscence of MD approval to tranfuse another patient. Additionally, when you use a syring are you tapping the mother SDP or are you tapping an aliquot of that SDP? Also, do you have a procedure for your practice that you can share?

[Malcolm Needs ☆]

Malcolm, what is the anticipated time frame for allowing the vCJD to disipate from your donor pool if any? Are decreased platelet counts in neonates treated with imported plasma only? What is the concept behind this practice?

I am not ignoring your question.

I am still trying to find out the definitive answer.

:redface::redface:

[Elizabeth Pailloz]

Pediatric facility here who utlizes only SDPs for all patients. We dose by volume in the tiny, tiny patients getting less than 55ccs. SPlit off the parent unit into either bags or syringes via a Sterile docker. For kids getting over 55 cc, splits go into aliqout bags and are dosed by 1/4 unit , half unit, or full unit based upon volume tolerated for child and size of orignal unit. Once we split a SDP we try to utilize it as best we can and have much more opportunity to give to other small volume patients. We try our best NOT give the remaining parent as a FULL unit dose unless the need is urgent.

Ie 275 cc parent with 50 cc taken out is now 200cc "piece": not really a full or a half, but could be further split into other pieces.

[sgoertzen]

I also supervise the Transfusion Service at a pediatric hospital and our procedure is very similar to Elizabeth's. Our donor center quit collecting whole blood derived platelets over 10 years ago and so we use only leukoreduced irradiated plateletpheresis units and aliquot them using sterile connecting devices just like we do PRBCs and Thawed Plasma. We rarely end up throwing away any left over "pieces" of a plateletpheresis. Our oncology doctors would much rather approve giving 3/4 or 1/2 unit to their patient than have us throw it away, and since we have all sizes of patients, it usually works out.

[adiescast]

We also aliquot from a pheresis platelet. We use a sterile docker and aliquot on request. Many of our "mother" bags then are wasted because we often do not get further requests. We do not give a partially depleted unit out to other patients unless they also need a lower volume. We used to do volume reduction, but it wasn't worth the trouble, so we don't do that much any more. We match the blood type for all infant platelet transfusions (and most adult transfusions) as I have mentioned in other posts.

[Townsend]

Coming from another Children's Hospital.... we handle single donor plateletpheresis similar to Elizabeth/sgoertzen/adiescast. However, we refer to a standard dose as 5ml/kg for any patient under 40kg. A patient (including an adult patient) above 40 kg would just get an entire plateletpheresis. We only rarely use random platelet concentrates when no plt pheresis of a specific type are available, so the bacterial testing is done at the blood center by culture. No further bacterial testing on the plateletpheresis is done by us (at least for now). We use the sterile connection device to aliquot the required dose into either a syringe or a bag, so the outdate of the parent plt pheresis is not effected.

The only time we would volume reduce a platelet product is after Medical Director approval and for one of the following reasons:

-extreme volume restrictions, which does NOT happen often

-multiple transfusions of ABO plasma-incompatible platelets (we allow one dose in a 24 hour period without volume reduction). Lately this has been in a few situations when we had to give IgA deficient products or HPA-1a neg platelets which were ABO incompatible. What fun!

Stephanie Townsend, MT(ASCP)SBB

[Brenda K Hutson]

As the title suggests; I wanted to know if anyone is utilizing SDP aliquots for neonates. If so can you explain your practice and procedure? If not, can you explain?

Our Donor Center sterile docks aliquot bags to the SDP and we give those until the unit expires. I don't know how many Donor Facilities make Platelet Concentrates anymore so it doesn't leave us with a lot of options (other than possibly wasting a lot of SDP if the baby needs more than 1 transfusion).

Brenda Hutson, CLS(ASCP)SBB

[mawomack]

We split off SDPs only (no pooled platelets) based on Technical Manual 5-10 ml/ kg body weight. We use sterile docker and syringes. If original unit has not been depleted more than 10% then we issue out remainder. Because these units are still in excessive of the 3.0 x 10(11) platelets.

[Brenda K Hutson]

Just curious; do we have 2 different conversataions going on here or am I missing something?

I think some people are translating SDP to mean "Single Donor Platelets" (as I did) and others are

translating it to be Solvent Detergent Plasma (or some type of FFP)??

So, which are we discussing (or am I just confused; which is certainly possible)?

Brenda Hutson, CLS(ASCP)SBB

[Malcolm Needs ☆]

I think you are right Brenda, because I thought it was Solvent Detergent!

I have also been very remiss, because I have not yet found out what I promised to find out (and I'm off tomorrow "creating a masterpiece" - well, writing a lecture - so it will still be a couple of days before I can keep my promise).

:o:o:o:o

[Eagle Eye]

I sent private e-mail to poster and his question is refering to Single Donor Platelet.

[Brenda K Hutson]

By the way, Sorry for the incorrect spelling in some of my posts (as I look back now); I am usually writing very quickly because I don't have as much time to be on this site as I would like. I will try to proof read in the future.

Brenda

[rravkin@aol.com]

Thank you all again for your valuable posts. I am speaking about Single Donor Platlets as Aakupaku has said. I wanted to know if you utilized the SDP for only that neonate for which the initial aloquot was made or is the SDP utilized for other neonates or other patients as well? The reason I am asking is because many hospital blood banks that regularly transfuse neonates packed cells utilize the PC specifically for only that neonate for which the first aliquot was made in order to reduce the number of exposures to different donrs.

Also, I would like to ask if you give ABO/Rh specific SDP's. THe reason I am asking this question is because I know that for adult transfusions of platelets ABO/Rh specificity is not always practiced and I also know that it is a rae occurence that some "O" type platelets contain abnormally elevated concentrations of anti A and B, and this has cause some noted complications.

Lastly, I wonder when, where, and how we are going to start checking for bacterial growth in this product weather utilized whole or in aliquots. he biggest proble with platelets, as you know, is the fact that it being a room temp product makes it the most like candidate for bacterial contamination and this has been shown. The bartial testing perormed at the donor center has a sensitivity level even though some centers may use genetic detection sytems for thier testing. Basically, the bacteria that slips under these detection systems can still growth and at the third or forth day of shelf life may contain enough bacteria to cause a problem especially in a neonate. Do any of you know of any literature that addresses the concerns I have mentioned here?

Thank you all once again, and I am sorry for the lengthy post.

[heathervaught]

The device you are looking for is http://www.veraxbiomedical.com/products/platelet-pgd-test.asp. It is designed for platelet testing at the transfusion service supplemental to any sterility testing that is performed at the donor center.

[Brenda K Hutson]

Thank you all again for your valuable posts. I am speaking about Single Donor Platlets as Aakupaku has said. I wanted to know if you utilized the SDP for only that neonate for which the initial aloquot was made or is the SDP utilized for other neonates or other patients as well? The reason I am asking is because many hospital blood banks that regularly transfuse neonates packed cells utilize the PC specifically for only that neonate for which the first aliquot was made in order to reduce the number of exposures to different donrs.

Also, I would like to ask if you give ABO/Rh specific SDP's. THe reason I am asking this question is because I know that for adult transfusions of platelets ABO/Rh specificity is not always practiced and I also know that it is a rae occurence that some "O" type platelets contain abnormally elevated concentrations of anti A and B, and this has cause some noted complications.

Lastly, I wonder when, where, and how we are going to start checking for bacterial growth in this product weather utilized whole or in aliquots. he biggest proble with platelets, as you know, is the fact that it being a room temp product makes it the most like candidate for bacterial contamination and this has been shown. The bartial testing perormed at the donor center has a sensitivity level even though some centers may use genetic detection sytems for thier testing. Basically, the bacteria that slips under these detection systems can still growth and at the third or forth day of shelf life may contain enough bacteria to cause a problem especially in a neonate. Do any of you know of any literature that addresses the concerns I have mentioned here?

Thank you all once again, and I am sorry for the lengthy post.

1. Since the Platelet Apheresis only has a 5 day shelf life, the chances are rare that we would have another baby in

NICU also in need of platelets at that time. Since it is no longer a complete unit once an aliquot is removed, we do

not transfuse the rest to an adult. We leave it assigned to the baby who may use more aliquots before the unit

expires (depending of course on what is going on with the baby). But we always end up throwing at least some

amount of the product away.

2. We do give ABO compatible plasma products (though our Donor Center always ends up sending ABO Type

Specific. And actually, I just had to look up the exact wording in the patient's special requirements in that it is

infrequent; it states ABO compatible. However, I am not particularly comfortable with that; I may change it to ABO

Type Specific.

3. The only bacterial testing is that which is now routinely performed by the Donor Centers. Since the bags are sterile

connected, we consider it a closes system like any other.

Brenda Hutson

[Eagle Eye]

1. We use same SDP for more than one neonates.

2. ABO & RH type specific.

3. DO not do any additional bacterial testing.