neonatal exchange transfusions

[Robert1015]

just a quick question: i've been getting different opinions on the kind of product used for neonatal exchange transfusions.

some of the people i've spoken with, are using O neg whole blood for such procedures (leuko, irradiated, CMV neg, and Hgb S neg).

Is this an acceptable product????

[Malcolm Needs ☆]

just a quick question: i've been getting different opinions on the kind of product used for neonatal exchange transfusions.

some of the people i've spoken with, are using O neg whole blood for such procedures (leuko, irradiated, CMV neg, and Hgb S neg).

Is this an acceptable product????

Group O is fine, as is leukodepleted, irradiated, CMV-, HbS-, but a) whole blood and D Negative blood I'm not so sure about, and the blood would have to be negative for high titre ABO antibodies, particularly if the reason for exchange is ABO HDN, and we would also choose K- (unless, of course, the maternal antibody was anti-k).

Many of the paediatricians in our area like to "order" a particular haematocrit, i.e. have semi-packed red cells, rather than whole blood.

The reason I question D Negative blood is purely that there will be occasions that the exchange will be because of maternal anti-c, in which case R1R1 would be better (in all but very rare cases - we had an r'r' mum once who made both anti-D+c - that was fun!).

The blood would, of course, have to be negative for any other antigen against which the mother had made antibodies, even if the neonate was negative for that particular antigen him or herself.

The blood would also have to be less than 5 days from draw.

:):)

Edited April 7, 2010 by Malcolm Needs
I wrote a load of rubbish the first time - probably did this time too!!!!!!!!!!!

[adiescast]

We use O packed cells, Rh matched to the infant (Rh negative if the Rh is unknown), leukoreduced, Hgb S neg, matching antigen negative for known maternal antibodies and reconstituted with AB plasma. I would think that giving O plasma to a small infant who is not type O would be a bad idea.

[YorkshireExile]

We also do exactly what adiescast does.

[vilma_mt]

The products chosen for 'exhange transfusion' should be based on your: 'crossmatching and tranfusion protocols' (neonatal or adult), criteria for CMV neg or leukoreduced productrs, criteria for Irrad. products, Hgb S etc.....Exchange transfusion is just a treatment for several conditions.....patient's blood removed and replaced. The information blood bank need are 'desired hematocrit' and 'total volume'.

Edited April 10, 2010 by vilma_mt

[dmpollock]

Also, the anticoagulant of the RBC is important for exchange transfusion to infants. Should be CPD or CPD-A1 (not AS-5 or other additive).

We combine FFP with RBC that are irradiated, leukoreduced, CPD, CMV-neg, and sickle screen negative.

We use O Neg RBC and AB FFP.

[dcubed]

Type O red cells,AS1 preservative solution, leukoreduced, HgbS neg, CMV neg, irradiated, 5 days old or less and antigen negative for maternal antibody capable of causing HDN. Cells are spun, and suppernant removed. AB plamsa added back to red cells to give a HCT of 50%. Sterile connecting device used for access to products.