irradiated blood for NICU babies?

[suhu]

Looking for what is standard practice? Is there a certain birthweight below which a baby should receive irradiated rbc/plts?  Once a unit is irradiated for a neonate, how long do you use it?  thanks.

[tbostock]

AABB recommends irradiated for neonates weighing <1200 g at birth, any neonate with a known cellular immune deficiency, or any patient getting directed donations from a blood relative.

 

We use a fresh irradiated unit for the first transfusion, and we keep the baby in that same unit for additional transfusions.  Our policy is that our neonatologist decides how many days that he wants us to stay in the same unit; he/she has the balance the effect of the irradiation on K levels vs. the exposure of the neonate to multiple donors.

Edited April 3, 2014 by tbostock

[fenwayman]

Are you using a sterile dock device? If so, it should be good to expiration

[fenwayman]

Of course, K+ does increase as the unit sits on the shelf. I worked at a facility where one of our cardio-thoracic surgeon ALWAYS asked for fresh, less than or equal to 7 day old blood. We nicknamed him Dr. Fresh!

[tbostock]

Of course, K+ does increase as the unit sits on the shelf. I worked at a facility where one of our cardio-thoracic surgeon ALWAYS asked for fresh, less than or equal to 7 day old blood. We nicknamed him Dr. Fresh!

That's funny.  We have a Dr. Cry Wolf here. 

[DeeMc]

It can be difficult to identify those infants who fall into the categories AABB lists as those that require irradiated products. One of the immune deficiencies encountered in infants is DeGeorge syndrome (an immunodeficiency that often occurs with cardiac anomalies). That diagnosis is not identified immediately upon admission to a NICU or CVICU. My institution has a 98 bed NICU and a 28 bed pediatric CVICU. For patient safety, we irradiate all products for infants in NICU or CVICU regardless of their birthweight. Yes, we do have our own irradiator. We also limit donor exposure by designating a specific unit for a baby and use until its expiration for small volume transfusions. If a large volume transfusion is needed (for OR) a fresh, irradiated unit is selected. And we do give fresh, < 5 day old blood to all cardiac surgery patients < 2 years of age.

[suhu]

DeeMc

  Do you use those irradiated units up to 28 days for the really tiny babies?  The K+ leak isnt a concern?  Sometimes they only transfuse less than 10cc. should I be concerned about the K+?    I'm stuck in that old mindset when we were required to wash units if more than 24 hours after irradiation, .

...do you use reserve only a certain type anticoagulant?  thanks

[Abdulhameed Al-Attas]

Our policy is that our neonatologist is the one who determines which neonate receives irradiated PRBC's,But ususlly Pre-terms are the ones.

Once a unit is irradiated for a neonate,it must be used with in 24 hours.

[Eagle Eye]

All our neonates gets irradiated rbc and platelets

[Liz0316]

same here, all neonates get irradiated RBCs and platelets. Once a unit is allocated to a baby, it's theirs. Each baby gets their own unit. It's very rare that the neonatologist want syringes made from the unit after the first few days, but the unit is set aside for the baby anyway to prevent additional donor exposure. Same with platelet, we sterile weld the syringes in case more than one dose is needed.

[suhu]

for rbcs, are you irradiating the syringe aliquot or do you irradiate the parent unit? If  you irradiate the parent unit, how long do you use it? ...the whole 28 days? we sterile dock, but interested in knowing if the shelf life of an irradiated rbc should be shortened for the NICU babies...thanks

[Kathy]

I am in a pediatric hospital and we give irradiated to all NICU patients and DiGeorge syndrome patients. We don't have our own irradiator and we do sterile connect. We will assign one unit to a few patients and use it for those patients until it is gone or it expires, whichever comes first. Blood for surgeries or exchange transfusions for babies has to be less than 5 days old.

[carolyn swickard]

for rbcs, are you irradiating the syringe aliquot or do you irradiate the parent unit? If  you irradiate the parent unit, how long do you use it? ...the whole 28 days? we sterile dock, but interested in knowing if the shelf life of an irradiated rbc should be shortened for the NICU babies...thanks

 

We receive a unit with pedi-paks attached that we use for our babies.  We learned the hard way to irradiate each pedipak as we make it - not the whole unit.  Yes - the K+ will build up and may cause problems with a newborn if given several days later, after irradiation of the whole unit.  If you can wash all of the units, that might be OK, I really don't know about that.  I would think in any case that 28 days would be way too long for the unit.  We try to keep our baby unit no more than 14 days. 

[DeeMc]

Practice does vary from NICU to NICU. There are multiple studies that have shown that small volume transfusions (10-20mL/kg) given over 2-3 hours cause no change in K+ levels. Larger volume transfusions, however, are a different story.

 

Strauss R. Controversies in the management of the anemia of prematurity using single-donor red blood cell transfuions and/or recombinant human erythropoietin. Transfusion Medicine Review. 2006;20:34-44

[goodchild]

Agreed. We provide irradiated products to all NICU patients. The primary bag is irradiated by the supplier. We assign the primary bag to one neonate and provide aliquots until transfusions are no longer needed or the bag is depleted. In times of great demand we'll share primary bags between multiple neonates. We haven't had to wash a unit for years.