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Neonatal Transfusion Practice


martha

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Sadly there is no global standard of practice for Neonate transfusion. Both of the practices you mention are in wide spread use. The main driver will be where your Neonatologists and Blood Bank Medical Director place their priorities and concerns.

We would assign on unit to a baby and it was their unit as long as it lasted. The exception was twins and triplets. They were all put on the same unit. Our docs did not want to expose the "family" to more donors than they had to. Others I've talked with feel this practice is appalling. They don't want to expose the "family" to the same dangers.

If you put multiple babies on the sme unit you run the risk of running out of blood and having to assign them to another unit thereby increasing their donor exposure. On the other side of the coin, by assinging one baby per unit you end up wasting a lot of blood.

Let the docs decide where their greatest concerns are and go from there.

:crazy::faint:

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We assign two babies per unit unless we know that a baby is going to use more than half a unit. We only assign twins and triplets to the same unit if the unit is directed for them. This seems to be a pretty good balance between donor exposure and wastage of blood. Most babies we have that require many transfusions would have gone to a second and third unit even if we gave them the first unit by themselves. Once a baby goes through the first unit, we will usually hold the second unit for them alone until we are sure they will not use all of it.

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  • 1 month later...

We reserve one unit per patient to reduce donor exposure. If the unit is close to expiring, and we can use the unit for another patient, we will release the product from the neonate and set the unit up for another patient so that we do not loose the unit.

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  • 3 weeks later...

I am from a small community hospital with no neonatologists. I have worked here for 13 years and have never given out blood for a baby, however we do have a policy to give o negative (freshest available) out if needed. My question is how do we issue this blood? Do we just give the whole unit to the ambulance staff? If we had a baby in distress here at this hospital, we would be shipping it immediately. There is 99.9% chance this scenario would never happen, but it is the 0.1% chance that scares me to death. Could anyone give me some direction on this subject? Thanks a bunch!

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We assign two babies per unit unless we know that a baby is going to use more than half a unit. We only assign twins and triplets to the same unit if the unit is directed for them. This seems to be a pretty good balance between donor exposure and wastage of blood. Most babies we have that require many transfusions would have gone to a second and third unit even if we gave them the first unit by themselves. Once a baby goes through the first unit, we will usually hold the second unit for them alone until we are sure they will not use all of it.

What are your thoughts about the extrcellular K+ and the function of the RBCs as the unit ages ?

Thanks

Liz

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At the beginning of the year, at the instigation of our neonatologists, we started reserving specific units for neonates to reduce donor exposure. This was limited to all neonates with a birth weight of less than 1000g as they were the ones expected to have most transfusions. Exceptions could be made if necessary. All the literature I have read states that the minimal doses of K+ in the top-up units are of no consequence.

Do people use blood in additive solution for neonatal top-ups, or blood collected in CPDA-1 or CPD?

Also, do people give specifically CMV negative blood, or is leucodepleted blood considered equivalent to CMV Neg? Is it okay to give CMV Pos, leucodepleted blood to Extreme Low Birth Weight neonates?

Edited by BoroCliff
forgot about the CMV bit
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Liz, I'm confused. At what point are you centrifuging to remove the aliquot?? We always used the blood directly out of a packed unit of RBCs without any additional packing. We did stop using ADSOL units and one of the reasons was with the additive solution the Hct was lower than the neonatologists wanted. If memory serves (and it seldom does lately) they wanted a Hct in the high 70s to the mid 80s and the ADSOL units seemed to run in the mid to low 70s. Again, every Neonatologist seems to want their own thing.

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What are your thoughts about the extrcellular K+ and the function of the RBCs as the unit ages ?

Thanks

Liz

Same as adiescast. We start with the freshest unit available, usually two days old. It gets used rather quickly by the same baby or the baby only needs one dose and then we start another baby on the unit to use it up.

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I am from a small community hospital with no neonatologists. I have worked here for 13 years and have never given out blood for a baby, however we do have a policy to give o negative (freshest available) out if needed. My question is how do we issue this blood? Do we just give the whole unit to the ambulance staff? If we had a baby in distress here at this hospital, we would be shipping it immediately. There is 99.9% chance this scenario would never happen, but it is the 0.1% chance that scares me to death. Could anyone give me some direction on this subject? Thanks a bunch!

We would just give them the whole unit. Splitting the unit has labeling requirements - barcode labeling requirements - that are not practical for a 'once in a blue moon' situation.

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Liz, I'm confused. At what point are you centrifuging to remove the aliquot?? We always used the blood directly out of a packed unit of RBCs without any additional packing. We did stop using ADSOL units and one of the reasons was with the additive solution the Hct was lower than the neonatologists wanted. If memory serves (and it seldom does lately) they wanted a Hct in the high 70s to the mid 80s and the ADSOL units seemed to run in the mid to low 70s. Again, every Neonatologist seems to want their own thing.

Hello John,

We still use Adsol for all our bags. I usually take the aliquot directly out of the packed RBCs. But I understood from a talk by Dr Strauss at an AABB meeting and by a post at this thread that the K+ goes to the supernatant plasma, I assumed that the packed RBCs are being centrifuged again to remove an aliquot without a high concentration of K+ and Mannitol.

What would you advise?

Thank you.

Liz

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I work in a pediatric hospital with an NICU that routinely has 75+ babies so putting one baby per unit isn't very practical. We try to limit it to 2-3 babies per unit babies that weigh <1 kg at birth generally bet their own unit. We give CPDA-1 units that are leukoreduced, irradiated and sickle cell negative. We always start with a fresh unit and then give out of it until it expires. Occasionally if they are having a baby that's K+ is getting really high we will start them on a fresh unit or (rarely) wash an aliquot for them.

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We assign one unit per baby. Twins, etc do no share a unit unless the family makes a big issue out of it and convinces the medical director to make an exception. They all get group O Rh matched, irradiated, leuko-reduced units with ADSOL. The K+ has not been a problem. If a kid weighing less than 5 kg is having open heart surgery they get washed units. Between 5 and 10 kg we use additive free in the cardiac OR.

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Liz,

Our process is this: We get a fresh unit of whole blood collected in CPDA-1 anticoagulant straight from our small donation center. We then centrifuge the unit so it is hard-packed. It is then stored like this. When it is required for a neonate top-up we then remove most of the plasma to make the packed cell with a HCT between 70 and 80%. We then take the required volume necessary from the packed cells and reserve the rest of the unit for that particular neonate (if the birth weight is < 1Kg). All our top-ups are leucoreduced, sickle cell negative and G6PD normal. They are not irradiated -at present.

I actually want to change this process and use units collected in additive solution (in my case SAG-M). The packed cells would be made as normal for a RBC unit and then when a top-up is required an aliquot would simply be taken from the unit. There would be no more centrifugation involved. Fresh blood would be used initially and then the unit reserved for the neonate throughout the shelf-life of the unit. For various reasons this would make my life a lot easier in my Blood Bank. I have discussed this with my neonatologists and they seem okay with this. I told them that the HCT of the units would be only 60-70% if I did this method, but they would adjust their volume requirements accordingly.

My concern was the extra mannitol and potassium I would be giving with these units. But every bit of literature I have read (British, American, BCSH, AABB) concerning neonatal top-ups with SAG-M units says this is not a problem. The amounts involved in top-up transfusions are too small to be a cause for concern.

So is my current method acceptable? Is my proposed use of SAG-M units acceptable? Are they both okay?

Thanks to everyone for the interest in this topic!

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We assign one unit per baby. Twins, etc do no share a unit unless the family makes a big issue out of it and convinces the medical director to make an exception. They all get group O Rh matched, irradiated, leuko-reduced units with ADSOL. The K+ has not been a problem. If a kid weighing less than 5 kg is having open heart surgery they get washed units. Between 5 and 10 kg we use additive free in the cardiac OR.

When you say additive free you mean you spin it once more and top up?

Liz

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Hello John,

We still use Adsol for all our bags. I usually take the aliquot directly out of the packed RBCs. But I understood from a talk by Dr Strauss at an AABB meeting and by a post at this thread that the K+ goes to the supernatant plasma, I assumed that the packed RBCs are being centrifuged again to remove an aliquot without a high concentration of K+ and Mannitol.

What would you advise?

Thank you.

Liz

Liz,

We would take the blood directly from the bag and into the syringe. The syringe came attached to tubing with a filter in line. It would be attached to the RBCs with a SCD to maintain the original outdate. At no time did we ever consider centrifuging the unit. The reason we stopped using ADSOL bags was because the Hct was lower than the Neonatologists wanted and they did not want to increase the dose to compensate. K+ was not a consideration even when we switched to CPDA-1 PRBCs. We started with a unit less than 2 weeks old and once assigned to a baby it stayed with them until it either expired, was used up or the baby went home.

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We would just give them the whole unit. Splitting the unit has labeling requirements - barcode labeling requirements - that are not practical for a 'once in a blue moon' situation.

We have 3 smaller hospitals in our system which transfer babies to our NICU. "once in a blue moon" a baby needs to be transfused while in the ambulance or helicopter and we just tell them to use a whole unit and the neonatal transport team can use what they need out of it.

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  • 3 weeks later...
We would just give them the whole unit. Splitting the unit has labeling requirements - barcode labeling requirements - that are not practical for a 'once in a blue moon' situation.

Thank you AMcCord. Do you have a policy or procedure that you are willing to share that deals with this scenario or something close? Thank you all for your help!

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  • 8 years later...

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