A 3-day old A negative newborn required blood last night, his Ab screen was positive and Ab Id revealed anti-Jka. He phenotyped Jka negative, I typed his mom, also Jka negative. These are her Abs that crossed and his titer (dilution ) was 8. The major-crossmatches with Jka positive donors were compatible; still I do not transfuse except with Ag negative units, and "fresh" for newborns. So, we performed a call in the Medical Center and to Red Cross volunteers and finally found an A negative donor with Jka negative blood. All went well.

My question is, given this situation, how would the 3-day old Jka negative's immune system react to seeing the antigen Jka?

Moreover, I plan to keep this unit for him, according to the latest literature and practice it is preferable to use the same unit up to expiry; do you only wash the small aliquots each time to remove the excess K? Anything else required? How are the 42- day old RBCs in terms of function?

Thank you,

Liz :writersbl

Bottom line regarding how the infant's immune system would react to seeing Jka Positive donor red cells.....I wouldn't want to find out. The fact that the maternal Anti-Jka is circulating in the infant's system would totally rule out even considering transfusing Jka Pos donor red cells in my book.

Can you say why the infant is being transfused? (Is it just to compensate for blood loss due to multiple specimen collections/testing?)

Bottom line regarding how the infant's immune system would react to seeing Jka Positive donor red cells.....I wouldn't want to find out. The fact that the maternal Anti-Jka is circulating in the infant's system would totally rule out even considering transfusing Jka Pos donor red cells in my book.

Can you say why the infant is being transfused? (Is it just to compensate for blood loss due to multiple specimen collections/testing?)

I agree entirely, and the only time I have seen newborns with a positive DAT that was complement, as well as IgG was with maternal Kidd antibodies (although most of these were anti-Jk().

:eek::eek:

Liz,

When transfusing PC's one should always think in terms of 120 days post transfusion; if you transfused Jka positive RBC's they would surely not last 120 days and the increased degredation products maybe of insult to the infant's system therefore adding further complications. No, the infant is not capable of developing an alloantibody but that is why the maternal antibody is present. As far as the length of use of the unit; I practice similarly but I will say that I have always had concerns of potential hyperkalimia when transfusing PC's to the infant that are perhaps to within one week of expiration. The reason we assigned the unit of PC's the each baby is to limit the donor exposure.

I agree completely with the other posters as far as transfusing antigen negative. As long as the blood is being used for replacement volume only, and not for surgery or any potential massive use, we transfuse neonates up to unit expiration with no adverse effect, and do not wash the aliquot (AS-1 units).

Bottom line regarding how the infant's immune system would react to seeing Jka Positive donor red cells.....I wouldn't want to find out. The fact that the maternal Anti-Jka is circulating in the infant's system would totally rule out even considering transfusing Jka Pos donor red cells in my book.

Can you say why the infant is being transfused? (Is it just to compensate for blood loss due to multiple specimen collections/testing?)

Yes it was for anemia.

Thanks,

Liz

I agree, we always use antigen negative units in this situation. Our policy is that all neonates get the same unit until expiration or until gone, whichever comes first. Also all our neonates receive irradiated products because we were not always getting information on tiny infants less thatn 1 kg so we decided to just give them all irradiated. The only time we wash basically is for open heart surgery on a kid under 5 kg. Between 5 and 10 kg we givce additive free for open heart. Regular NICU babies get ADSOL blood most of the time.

Yes, absolutely, we do that; but I was wondering about the Adsol free: you spin upside down, rather than wash, right? Dr. Strauss talked about that at a meeting.

Liz:)

We keep a supply of ADSOL free units on hand for out open heart and ECMO babies. Our blood supplier draws some that way for us because we are the major children's facility in the area.

That is a good idea. We have our Hospital-based donor Center , so I will consider that. Thanks.

Liz