Whole blood in pediatric cardiovascular surgery

[Michelle44]

Are there any transfusions services providing whole blood for pediatric cardiovascular surgeries? If so, how is this affecting wastage? Are there any studies to prove this is better than components?

Edited September 16, 2011 by Michelle44
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[Kathy]

I worked in a pediatric hospital where we provided whole blood for cardiovascular surgery. I seem to remember that my boss would express the plasma of whole blood units that were not used and make them packed cells. I am currently working in a larger pediatric hospital with a very active cardiovascular surgery program but whole blood units are not used.

[Yanxia]

We use packed cells.

[Auntie-D]

I worked in a pediatric hospital where we provided whole blood for cardiovascular surgery. I seem to remember that my boss would express the plasma of whole blood units that were not used and make them packed cells. I am currently working in a larger pediatric hospital with a very active cardiovascular surgery program but whole blood units are not used.

In the UK this would not be allowed. It would take away our unique traceability and also indrodces the risk of bacterial contamination.

[David Saikin]

Not if the units retain an integral bag or the sterile connection device is utilized.

[Malcolm Needs ☆]

'Fraid so in the UK David.

It's almost got to the stage where, if you take a sample from the line for the cross-match, you become a blood producer, and have to have a licence so to do. Then, you have to be inspected by the MHRA, an iniquitous bunch of...............well, I'll stop there.

[DOGLOVER]

We use packed cells. If the child is under 5kg we wash irradiated units. Between 5 and 10 kg they get additive free units(less than a week old) or washed if additive free are not available. Over 10kg they get regular packed cells. Past the neonatal period irradiation depends on if the immune status.

We also use washed for babies going on ECMO or when the ECMO lines are beiong changed.

[Townsend]

We also used whole blood about 8 years ago at the request of a particular cardiothoracic surgeon. It was a nightmare to coordinate with the blood center (fresh, possible directed donors, antibody/maternal antibody, etc). We also spun the whole blood down and created a packed cell unit if it wasn't used in surgery. This required a sterile connection device and FDA registration, both of which we already had.

Now, we just give CPD units for patients under 4 years, adsol units for all others. All open heart surgeries also get fresh rbc, preferrably less than 5 days old. Platelets and plasma are ordered on a case-by-case basis, sometimes when the patient is being warmed and coming off of the circuit.

Stephanie Townsend, MT(ASCP)SBB

[sgoertzen]

I'm at a pediatric hospital and our CT surgeons would love it if we could supply them with whole blood but they want it "fresh" - like less than 3 days old. Our donor center does not collect or prepare whole blood unless it is a specially pre-ordered (very similar to directed donation, prepaid, additional fees, etc.). So... we've told the surgeons that they can have it, but they have to do all of the ordering, pre-testing of the patient (for ABO/Rh/Screen), and pre-arranging with the donor center and the patient family. This is apparently too much hassle for them so they routinely opt to use fresh packed cells and thawed plasma.