Neonatal RBC Transfusions

[tlorme]

Can anyone tell me if their standard practice for neonatal RBC transfusions is to provide WASHED PRBC's (in addition to CMV (-) and irradiated product), and if so, do you wash the cells in-house or does your local Blood Center provide the washed units?

[tjohnk1]

In the institution I used to work at there was a 40 bed NICU and we only gave irradiated, leukoreduced group O.

[Malcolm Needs ☆]

I can't see any reason to wash such units unless the mother has an IgG anti-IgA that may be in the neonate's circulation or, under certain circumstances, if the neonate is T activated.

[Likewine99]

I did pediatric blood banking for 5.5 years and we did not wash, only irradiated. All inventory was leukodepleted so we moved away from CMV neg.

[YorkshireExile]

We have a 50 bed NICU unit and we give only leucoreduced group O blood. No washing, no CMV- units (we wouldn`t be able to find any anyway) and even irradiation is optional for top-up transfusions according to British Guidelines.

[SusanM]

We also only use Leukoreduced O neg RBC. They are only washed & irradiated for exchange transfusions.

[Malcolm Needs ☆]

We also only use Leukoreduced O neg RBC. They are only washed & irradiated for exchange transfusions.

Why are they washed for an exchange transfusion?

:confused::confused:

[Ellen Zeigler]

One of our hospitals washes but only for limited situations. The typical product infused is CPD/CPDA-1, group O, leukoreduced, CMV neg, irradiated. For exchange transfusions or if blood less than 14 days old is not available, cells are washed. The intent is to remove K+ and metabolytes

[bbbiker]

Can anyone tell me if their standard practice for neonatal RBC transfusions is to provide WASHED PRBC's (in addition to CMV (-) and irradiated product), and if so, do you wash the cells in-house or does your local Blood Center provide the washed units?

We do not wash the RBCs. We do use CMV negative and irradiated units. One of the main reasons for washing RBCs would be to decrease the amount of potassium in the unit. We ensure the potassium is low by using the freshest unit available (always less than 7 days, usually 2-4 days).

[Malcolm Needs ☆]

We do not wash the RBCs. We do use CMV negative and irradiated units. One of the main reasons for washing RBCs would be to decrease the amount of potassium in the unit. We ensure the potassium is low by using the freshest unit available (always less than 7 days, usually 2-4 days).

Well, yes, I do know about the K+, but if fresh blood is used, there is no need to wash,

:)

[tlorme]

Many thanks to all who have responded. We had a situation recently which prompted my medical director to call upon a "blood bank expert" (his words, not mine) in the US. That individual indicated that it is standard practice to wash PRBC's for neonatal transfusion. I disagreed, and wanted to hear what my peers had to say....so thank you all for confirming my suspicions that washing is not standard practice!

[YorkshireExile]

We do not wash the RBCs. We do use CMV negative and irradiated units. One of the main reasons for washing RBCs would be to decrease the amount of potassium in the unit. We ensure the potassium is low by using the freshest unit available (always less than 7 days, usually 2-4 days).

Are you talking exchange transfusions or top-ups here? Do all your top-ups receive blood that is less than 7 days old? We assign a unit for a baby as much as possible to reduce donor exposure, so we may get four or five aliquots out of one unit for a baby. The fifth aliquot may well be up to 35 days old by the time it is used as a top-up - we still don`t bother washing.

[martha]

Can anyone tell me if their standard practice for neonatal RBC transfusions is to provide WASHED PRBC's (in addition to CMV (-) and irradiated product), and if so, do you wash the cells in-house or does your local Blood Center provide the washed units?

Our standard practice for neonates is leukodepleted and irradiated products. We do not wash RBC for neonatal transfusion. We only wash RBC for our ECMO patients and we do it inhouse.

[vilma_mt]

Can anyone tell me if their standard practice for neonatal RBC transfusions is to provide WASHED PRBC's (in addition to CMV (-) and irradiated product), and if so, do you wash the cells in-house or does your local Blood Center provide the washed units?

yes, i've heard some hospitals and some doctors do order washed units for neonates for same reasons and also reduce wbc,leukoagglutinins etc mainly removing the plasma, wbc and platelet that could be harmful to the patient....nowadays this practice is almost non-existent in most cases or indication there are alternative method or prophylaxis (which is more cost effective) to achieve the same goal.

[adiescast]

We do not wash red cells for a standard neonatal transfusion. We use leukoreduced products. We only irradiate for babies of low birth weight.

[Abdulhameed Al-Attas]

Our standard practice for neonatesTransfusion is to dedicate a fresh group O Rh specific,leukodepleted and centrifuged top-ups. Irradiation is only for Pre-Terms and We do not wash RBC for neonatal transfusion.

[tcoyle]

We use O, irradiated, fresh (<14 day old), hemoglobin S negative products for our neonates. All of our red cell inventory is leukoreduced.

[jcdayaz]

No washing in our Blood Bank either. We get every week fresh "baby units" from our donor facility--it is a standing order. "Baby units" for us are CMV-, irradiated, leukodepleted O Negs with sterile docked pedi-packs attached. When we receive a fresher one, we move the current "Baby unit" to our general irradiated inventory if we haven't transfused a neonate with it. We try to use the same unit if we have transfused a neonate to reduce exposure to whatever.

[YorkshireExile]

No washing in our Blood Bank either. We get every week fresh "baby units" from our donor facility--it is a standing order. "Baby units" for us are CMV-, irradiated, leukodepleted O Negs with sterile docked pedi-packs attached. When we receive a fresher one, we move the current "Baby unit" to our general irradiated inventory if we haven't transfused a neonate with it. We try to use the same unit if we have transfused a neonate to reduce exposure to whatever.

Do all your babies get O neg blood irrespective of the Rh group of the baby? If so, why?

[Eagle Eye]

we use O Neg, <7 days, LR, CMV-, Irrdiated unit(up to 3 days post irradiation)...one unit being used for all babies...

NO we do not wash RBC.

I thought if you wash RBCs, it's consider manufacturing and will need FDA registration???? Same thing when you volume reduce platelets for neonates?? and combining RBC and FFP for exchange transfusion for neonates...

And I do not think it's worth to get FDA registration for few of those procedure..

[vilma_mt]

we use O Neg, <7 days, LR, CMV-, Irrdiated unit(up to 3 days post irradiation)...one unit being used for all babies...

NO we do not wash RBC.

I thought if you wash RBCs, it's consider manufacturing and will need FDA registration???? Same thing when you volume reduce platelets for neonates?? and combining RBC and FFP for exchange transfusion for neonates...

And I do not think it's worth to get FDA registration for few of those procedure..

i agree!!! washing and combining RBC and FFP are considered manufacturing and needs FDA registration. Although sometimes it's welcoming to have different pairs of eyes to review the facilities' process...depends on the knowledge and experience of inspector of course.

Edited May 27, 2010 by vilma_mt

[mdcbk]

We provide leukocyte reduced (not CMV neg) AS-1 irradiated blood products for all simple transfusions of neonates. We set them up on fresh (less than 7 days) units and continue to provide that unit if needed until expiration. We give group specific blood, but we transfuse a large number of neonates, and are able to efficiently use all the unit. As I understand it, the only reason to use O blood is to share the unit so as to limit wastage. We either wash or pack to remove Adsol for neo exchanges.

[jcdayaz]

Do all your babies get O neg blood irrespective of the Rh group of the baby? If so, why?

Yes, all our "baby units" are O neg, CMV-, irradiated, CPDA-1, with sterile pedi-packs attached. It would be impossible for us to keep inventory of a baby unit in every blood type. O neg is universal, as you well know, it is safe for any baby to get. It works for us!

Also all of our normal irradiated stock is only O Pos and O Neg. We have an outpatient chemo/cancer transfusion service and several times a week irradiated units are requested. We use our irradiated O Pos or O negs in this case--regardless of the patient's blood type.

[Abdulhameed Al-Attas]

we use O Neg, <7 days, LR, CMV-, Irrdiated unit(up to 3 days post irradiation)...one unit being used for all babies...

NO we do not wash RBC.

I thought if you wash RBCs, it's consider manufacturing and will need FDA registration???? Same thing when you volume reduce platelets for neonates?? and combining RBC and FFP for exchange transfusion for neonates...

And I do not think it's worth to get FDA registration for few of those procedure..

Could you please give us your reasons for using O Rh Negative for all your Neonatal Transfusions and Why one unit is being used for all Neonates?

Thanks in advance.

[YorkshireExile]

Yes, all our "baby units" are O neg, CMV-, irradiated, CPDA-1, with sterile pedi-packs attached. It would be impossible for us to keep inventory of a baby unit in every blood type. O neg is universal, as you well know, it is safe for any baby to get. It works for us!

Also all of our normal irradiated stock is only O Pos and O Neg. We have an outpatient chemo/cancer transfusion service and several times a week irradiated units are requested. We use our irradiated O Pos or O negs in this case--regardless of the patient's blood type.

I still don`t get why only O Neg is used for all babies. What if the baby is Rh Pos (with no maternal anti-D problems). We would use Rh pos for all our Rh Pos babies, and save the O negs for the people and babies who really need it - the ones who actually are Rh neg.