Neonatal RBC Transfusions

[vilma_mt]

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.

I think it's more a "techs don't have to think" approach to neonatal transfusion. A lot of facilities provide type "O Neg" units instead of type specific even if neonates do not have passive Anti-A/B./D antibodies. Which is not bad in some cases....nowadays all techs (willing or not) have to rotate through blood bank and this is a good way to avoid transfusion errors on our most "precious" patients.

[vilma_mt]

I think it's more a "techs don't have to think" approach to neonatal transfusion. A lot of facilities provide type "O Neg" units instead of type specific even if neonates do not have passive Anti-A/B./D antibodies. Which is not bad in some cases....nowadays all techs (willing or not) have to rotate through blood bank and this is a good way to avoid transfusion errors on our most "precious" patients.

I would like to add this simplifies handling your inventory... most small facilities always keep fresh units for neonatal transfusion. Lekoreduced (and/or CMV Neg), Irradiated O neg Packed red cells.

[jcdayaz]

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.

When I worked in the Blood Bank of a Pediatric Hospital we were able to sterile dock our own aliquots as needed. We would give type specific, cmv-, irradiated blood each and every time. We don't have a sterile docking unit at my current facility. You have to work with what you have. Our blood supplier is ONLY sending us O Neg baby units. We have typically two baby units on our shelf at a time. If we have not had a baby that needed to be transfused from a particular unit within 7 days, we disconnect the pedi-packs and put it in our general irradiated inventory. We do not have a large neonatal blood need. It is only occasional.

[jcdayaz]

I think it's more a "techs don't have to think" approach to neonatal transfusion. A lot of facilities provide type "O Neg" units instead of type specific even if neonates do not have passive Anti-A/B./D antibodies. Which is not bad in some cases....nowadays all techs (willing or not) have to rotate through blood bank and this is a good way to avoid transfusion errors on our most "precious" patients.

You are off base here with this response. The reasoning is not "Techs don't have to think"...the reasoning is that's what our blood supplier will provide us with on a weekly basis! We only get O Pos and O Neg regular(no pedi-packs attached)irradiated, cmv- units. EVER! We get one Pedi unit each week. When a fresher one comes in if we haven't used any of the previous one for an infant we put it in our general irradiated inventory.

[profbaud]

No we don't wash our neonatal pediatric red cell products unless it is for an exchange transfusion. We transfuse O Neg CMV=, LRPC AS1 units less than 30 days old and we irradiate the pedi pack aliquot just prior to transfusion.

[jcdayaz]

Washing is out here. There is no capability to wash anything..even at our local reference lab! Anything needing to be washed goes to their main reference lab in California. We have not had any IgA deficient patients needing transfusing since I've been here. That's the only time that I'm aware of washing is still indicated.

Someone feel free to correct me if I'm wrong!

[PAWHITTECAR]

I work at a large pediatric facility (75+ NICU babies) We do not wash units unless the K+ is extremely high or the patient is waiting for an ABO incompatible heart exchange then we do wash in-house. We give ABO and Rh compatible units that are leukoreduced and Irradiated. We irradiate in-house as well. We also use a unit until its expiration or its empty.

[jcdayaz]

No we don't wash our neonatal pediatric red cell products unless it is for an exchange transfusion. We transfuse O Neg CMV=, LRPC AS1 units less than 30 days old and we irradiate the pedi pack aliquot just prior to transfusion.

Check on the AS-1 anticoagulant use in neonatal transfusion. We won't use AS-1 units for a baby...to my knowledge, it can lead to renal failure in a preemie and/or multiply transfused neonate.

[sandy]

We do NOT use washed red cells as a standard of care. We use aliquots from leukoreduced red cells that are inadvertantly spun. We do not routinely use CMV- and/or irradiated.

[DOGLOVER]

We have a 50 bed NICU supply leuko-reduced, irradiated red cells routinely. We only wash for kids weighing less than 5 kg in open heart surgery. anesthesia worries about the potassium in these tiny babies with such large volumes being given. We don't worry about CMV status because everything is leuko-reduced. How would you handle washing for aliquots, the unit would outdate in 24 hours and the rest would be wasted? Our policy is that we don't share units between babies, and we try to limit donor exposure as much as possibel for neonates so once a kid starts a unit, they own it until outdate.

[techchief]

We wash for the following reasons; Neonate has increased K - when fresh bood (<6 days old) required for certain protocols is not available.

[YorkshireExile]

Check on the AS-1 anticoagulant use in neonatal transfusion. We won't use AS-1 units for a baby...to my knowledge, it can lead to renal failure in a preemie and/or multiply transfused neonate.

As far as I know, for routine top-ups it is okay to use blood which has been collected with an additive solution (be it AS-1, SAG-M or Adsol). Multiply transfused - no problem whatsoever. Very premature - no problem except for ones with known renal problems.

[mdcbk]

We've been using AS-1 units for years (as is, no centrifugation or washing) for simple transfusions of neonates of all weights and gestation. We also use AS-1 units for cardiac surgery for neonates. We have had no problems related to the use of AS-1. Potassium is an issue with neonates who may receive large volumes of blood in surgery, so we provide blood < 10 days for surgery patients, and blood < 2-3 days for cardiac surgery.

I think its imortant to realize that different facilities may have different but acceptable practices, dependent on how many neonates are transfused, available equipment, available blood supply, and how conservative the blood bank director and clinicians are. We are a large >100 nicu bed facility, and our practices are certainly different than a hospital that transfuses 1-2 babies/week. If a facility wants to know the current standard of care, it's usually best to ask several large "premier" institutions what their practice is, and then adapt to meet your needs. We do just that whenever a question arises regarding best practice for a particular procedure.

[Malcolm Needs ☆]

Check on the AS-1 anticoagulant use in neonatal transfusion. We won't use AS-1 units for a baby...to my knowledge, it can lead to renal failure in a preemie and/or multiply transfused neonate.

It can, but on occasions there is no alternative, and it can be successful.

Win N, Amess P, Needs M (whomsoever he may be), Hewitt PE. Use of red cells preserved in extended storage media for exchange transfusion in anti-k haemolytic disease of the newborn. Transfusion Medicine 2005; 15: 157-160.

:redface::redface:

[NANCY AUGENSTEIN]

Is sickle cell testing required for an exchange?

[Malcolm Needs ☆]

Is sickle cell testing required for an exchange?

It certainly is in the UK, and if it isn't elsewhere, it should be!

:):)

[adiescast]

Yes, it is required in the U.S. also.

[KPayne]

We also assign one unit per infant until unit is used up or outdates. Would like to know how you bill for this.

[Malcolm Needs ☆]

We also assign one unit per infant until unit is used up or outdates. Would like to know how you bill for this.

I know nothing about the bill for this, but I do know a good reason why it should be done, apart from exposing a baby to many donors.

If, by any chance, the unit has been infected somewhere along the way, and is split into several neonatal units, it is better, in the worst imaginable scenario, for one baby to die because of bacterial septicemia, than several babies to die of bacterial septicemia, if the same split unit were given to a lot of babies.

It's not a very nice thing to think about, but it could (and, somewhere in the back of my mind, I seem to remember it did) happen.

:eek::eek:

[L106]

Malcolm - That's a very good point. Thanks for presenting that slant on it. ...................Donna

[jcdayaz]

It can, but on occasions there is no alternative, and it can be successful.

Win N, Amess P, Needs M (whomsoever he may be), Hewitt PE. Use of red cells preserved in extended storage media for exchange transfusion in anti-k haemolytic disease of the newborn. Transfusion Medicine 2005; 15: 157-160.

:redface::redface:

Malcolm, You're killing me here. I know that there could be certain cases that As-1 has to be used for a neonate. Having an Anti-k would certainly be one (I'm guessing) of those circumstances.

If I EVER get a neonate with an anti-k..that might be the day I just up and walk out of the blood bank!:D

[Malcolm Needs ☆]

Malcolm, You're killing me here. I know that there could be certain cases that As-1 has to be used for a neonate. Having an Anti-k would certainly be one (I'm guessing) of those circumstances.

If I EVER get a neonate with an anti-k..that might be the day I just up and walk out of the blood bank!:D

Sorry!

:D:D

[adiescast]

We also assign one unit per infant until unit is used up or outdates. Would like to know how you bill for this.

We figured out an average of how many aliquots we usually did per unit and divided the unit price by that number to get a price per aliquot. Then we set the price from there.

[Giemsa]

Is sickle cell testing required for an exchange?

I'm a blood banker in small hospital in small Canadian city (~35,000 pop). If anyone out there is doing sickle cell trait testing of their units in their blood banks, what method are you using (solubility, metabisulfite, other)?

[profbaud]

Yes that is the test we do [actually Hematology does it for us] for exchange transfusion.:cool: