Directed Donors for Neonatal Transfusions

[tlorme]

Hi gang: another question for you all regarding neonatal transfusions: Can you tell me if you accept type-specific directed donors OR do you only accept group O, Rh compatible directed donors for neonatal transfusion.

Thanks!

[Malcolm Needs ☆]

Hi gang: another question for you all regarding neonatal transfusions: Can you tell me if you accept type-specific directed donors OR do you only accept group O, Rh compatible directed donors for neonatal transfusion.

Thanks!

It would depend very much upon why the neonate was being transfused.

If it were for straight-forward neonatal anaemia, or even for HDN caused by a maternal antibody diercted against an antigen that is commonly negative in the general population, then the answer would be no, we would not use type-specific directed donors, as the donors we use to produce such blood are known donors who have donated several times (known as in known to previously have been negative for all tests, such as CMV - although, of course, they are tested each time they donate).

In certain rare circumstances, however, such as severe HDN caused by a maternal antibody directed against a high-incidence antigen, we may have no alternative than to use a typed-specific directed donor.

:)

[tlorme]

Thanks Malcolm. I should have clarified: this would be for simple neonatal transfusions to replace iatrogenic blood loss: no maternal antibody or special circumstances involved.

[Malcolm Needs ☆]

Thanks Malcolm. I should have clarified: this would be for simple neonatal transfusions to replace iatrogenic blood loss: no maternal antibody or special circumstances involved.

Sorry for the misunderstanding; in that case no.

:)

[vilma_mt]

Hi gang: another question for you all regarding neonatal transfusions: Can you tell me if you accept type-specific directed donors OR do you only accept group O, Rh compatible directed donors for neonatal transfusion.

Thanks!

I would say yes....provided you still follow your neonatal transfusion protocol. Perform initial type and screen, antigen typing of the unit. Other facilities perform a second typing before giving type specific unit. Irradiate the unit if low birth rate or if the donor is a blood relative. The unit still has to pass your screening process as if it was a random unit.

[JOANBALONE]

We will accept type specific units. However, our procedure states that before non group O units can be issued, testing of the infant's plasma is required to detect passively acquired maternal anti-A or B and it must include the antiglobulin phase. This is an AABB requirement.

[vilma_mt]

We will accept type specific units. However, our procedure states that before non group O units can be issued, testing of the infant's plasma is required to detect passively acquired maternal anti-A or B and it must include the antiglobulin phase. This is an AABB requirement.

yes... performing antibody screen including detection of passive ABO antibody is included in the initial testing. If neonate has passive antibody, units need to be negative for that antigen whether it's Direct donor or random unit.

[mjshepherd]

I prefer to use O neg, Irradiated, CMV neg for all neonate transfusions as long as there are no antibodies involved. We will accept type specific donors, however, we discourage the donation of blood relatives due to the possibility of GVHD in neonates and immune compromised patients.

[mdcbk]

There is no reason that type specific directed donor blood can't be used, as long as the patient's plasma is first screened for passively acquired maternal anti-A or B at the antiglobulin phase. The unit should also be negative for any other antigens to which the baby has passive antibodies. As long as the directed unit meets all donor requirements, the unit is no different from a random unit pulled off the shelf. If the unit is from an immediate family member, it should be irradiated to prevent graft vs. host.

[Marilyn Plett]

In my opinion, directed donations should be discouraged. They are no safer than random units. I think that the recipient's family gets a false sense of security. The only exception would be for serological problems for which a family member is the only donor.

[adiescast]

We accept directed donors, although we discourage them. When we get type specific, we test the patient for anti-A and anti-B to the antiglobulin phase and irradiate the blood. It's always fun when you get one unit to split between twins or triplets.

[mdcbk]

We would love to discourage directed units, but we have several services and doctors that encourage them, usually just from family members. Yes, it can give the parents a false sense of security, expecially when the units are coming from outside the immediate family. On the up side, it gives the parents a way to feel like they're helping, it means one less unit taken from the usual donor population, and perhaps the donor will be inspired to become a regular blood donor.

[Mary**]

:eyepoppinAnd the cost is nearly double!!

[Cliff]

In my opinion, directed donations should be discouraged. They are no safer than random units. I think that the recipient's family gets a false sense of security. The only exception would be for serological problems for which a family member is the only donor.

For non-neonatal donors, I could not agree more. Many / most of our directed NICU donors are dads. I don't think you can underestimate the positive psychological effect this has on families who feel so helpless.

[vilma_mt]

We can discourage patients from using Directed Donors but we can not refuse, it's the patients choice/right. We just need to remember to Irradiate Directed Donor units from a blood relative. Having a child myself, I would put us her parents first as possible donors. When we're pulling a unit off the shelf we don't know if the donor just walked in that day or if he's hundred gallon donor. There is no such thing as "Risk Free Transfusion".

[Malcolm Needs ☆]

We can discourage patients from using Directed Donors but we can not refuse, it's the patients choice/right. We just need to remember to Irradiate Directed Donor units from a blood relative. Having a child myself, I would put us her parents first as possible donors. When we're pulling a unit off the shelf we don't know if the donor just walked in that day or if he's hundred gallon donor. There is no such thing as "Risk Free Transfusion".

Whilst I would agree that there is no such thing as a "Risk Free Transfusion" (the safest transfusion is that which is never given)), within the UK we certainly do know if the donor is as established donor or not, and specific units are manufactured for neonatal transfusions by the NHSBT.

:):)

[profbaud]

We accept ABO/Rh compatible units as long as they are CMV= or the doctor has to waive CMV= status if a parent is donating.

[KAllen]

We accept non-group O directed donors, but we perform a full crossmatch. We actually require a full crossmatch on group O directed donors too because of any antibody to a low frequency antigen the Mother may have made to the newborns red cells (new Dads frequently want to donate for their newborns and would pose an increased risk). The problems of parent donations are listed in many places in the publication on Pediatric Transfusions by the AABB. Mothers donating for their kids (if enough time has elapsed since delivery) pose an increased TRALI risk. But we do allow it if the MD and parents insist.

[donnalander]

Where I worked previously, a donor must have donated 3 units before they were considered for neonatal use (O Neg, CMV neg donors only).

I've always had issues with directed donations in that donors (who are approved by patient/family) may not be as forthcoming with their donor histories as a non-directed donor; who wants to tell Aunt Sally that you could not donate for Uncle John because you were deferred for possible HIV or Hep exposure. I'm not saying that this is the case for all directed donors, but it is more likely to happen due to familial pressure.