Does anyone have a protocol for emergency transfusion for neonates they would be willing to share? We are not a neonatal facility but are being asked to put together a policy for emergencies. This would be a very rare event for us. Thanks

I am unable to share the exact protocol, but here is the generic idea:

---O neg CMV neg, irradiated as fresh as possible

---depending of amount requested ( issue either entire unit, aliquot in syringe or satellite bag)

--- label with either downtime labels or do computer prep ( downtime is preffered since this could be made ready in anticipation, especially if its a rare event)

----you may be able to get path approval to give non-irradiated depending on your situation (iraditor on site or not)

O negative, leuko-reduced (we use 100% leuko-reduced), irradiated, freshest available. We sterile dock on a syringe or pedi-pak to give the volume requested. Or you could keep an O neg unit with satellite bags attached from your blood supplier for possible use. It is always tricky when you don't work at a facility that routinely transfuses infants.

Does anyone have a protocol for emergency transfusion for neonates they would be willing to share? We are not a neonatal facility but are being asked to put together a policy for emergencies. This would be a very rare event for us. Thanks

Who is performing the transfusion? Is it your nursing staff or staff from another facility who will transport the baby? I feel your pain. I 'm sure that neither the blood bank or nursing staffs are comfortable with transfusing an infant. Normally at our facility, the NICU team from a hospital 1 hour away take over the responsibility for the transfusion. That happened this weekend with an infant born at 25 weeks. We did not have CMV negative blood on hand and do not irradiate our own products. Unfortunately, we had to go with what we had. He weighed one pound and chances of survival are slim. In this case after the nursery obtained the uncrossmatched blood, we performed a crossmatch against the maternal sample. I am in the process of revising our policy as a result.

Make sure that you maintain an open line of communication with the people who are performing the transfusion. Good luck.

:confuse:

For you larger institutions it is probably relatively common to provide the products you describe to neonates . . . for us small/smaller places the "emergency" availability of CMV=, irradiated products is non-existent unless we happen to have such a product on our shelf (for someone else). We do not transfuse infancts - our policy is to provide O=rbcs over the MDs signature for emergency release (AB plasma if that is ordered). Xms are done after the fact.

We have a small NICU and we do not use CMVneg or irradiated for our neonates- we use the freshest AS-3 unit on our shelf. Our sickest babies get transferred out but while they are here, they get CMV safe (leukocyte reducted) products not CMV tested. Irradiation Guidelines in the Technical Manual states that irradiation should be done for premature infants weighing less than 1200 grams at birth so for preemies larger than that, irradiation is not required.

If you will be shipping any baby you transfuse then it won't matter if you aliquot. The rest of the unit will probably go to waste either way. Some babies hemorrhage at birth but are otherwise normal so don't get shipped. They may sometimes need a top-off transfusion within a day or so, but these are the ones that start out as really super stats so taking time to aliquot when you are unaccustomed to doing it can be tough. Worst case scenario is baby gets exposed to a second donor because you either gave out the whole first unit or aliquoted in an open system and they decided to give more blood after 24 hours and 3 min. These days the infectious disease risk is low enough that that is probably not as big a deal as it was back in the 80's. As for fresh blood, don't worry about it too much (unless you are giving near exchange volumes in an almost total exsanguination). Still reasonable to choose the freshest O neg LR unit that you have, but don't stress if it isn't terribly fresh.