Jump to content

Reconstituted whole blood alternatives


maybe

Recommended Posts

My hospital is currently is the process of discontinuing making reconstituted whole blood in house due to multiple factors (competency, FDA license/inspection, equipment, etc...). Due to some restructuring of our blood supplier we now have access to ordering this product through them (yay!) with a turn-around-time of about 6ish hours.

Our neonatologists have been understanding of the reasons and the move to the new process, however, they do want to set up an alternative option for emergency situations (extreme bad weather that would significantly delay the TAT). I've heard of some hospitals that are using alternating      aliquots of red cells and FFP in place of the reconstituted whole blood which seems like it would be fine, but I can't find any good procedures/guidelines outlining this process or any evidence-based journal articles.

Has anyone else come across this before or have access to any guidelines/articles about this? Or how does your hospital handle neonatal exchange transfusion without whole blood?

Thanks in advance!

Link to comment
Share on other sites

Shipping the baby out is really not an option unfortunately.

Strangely enough the neonatologists here do not seem concerned at all about the mannitol in the ADSOL units. It's what they've been using for neonate transfusions for years before I came, which was a change as my previous hospital was very anti-ADSOL for babies. With the blood supplier restructure we have been starting to get in the CPDA-1 units for the other babies , but for the exchanges the docs want the ADSOL units.

 

6 hours ago, CarrieM said:

We use CPDA O neg packed cell units and AB plasma.  It is a rare occurrence, and usually involves middle-of-the-night phone calls when it comes up! 

Carrie- does your facility have an SOP on how to do the aliquots specifically for exchanges or are you providing normal aliquots and they do all the fun calculations on the NICU side?

 

Link to comment
Share on other sites

Unless a physician requests otherwise, we reconstitute to a 50-55% HCT.  The average crit of our CPDA units is ~75%, and the approximate volume is ~270mL.  By sterile welding about 100 mL of plasma, we get the desired HCT.  All packed cell units used are LR, HGB-S neg, <7 days old, and irradiated.  They would also be negative for offending antigen in cases of HDN.  If a physician requests a different HCT, we use the formula:. x= DTV X DH/ OH

x= mL packed cells

DTV= desired total volume

DH= desired % HCT

OH= original HCT

The plasma needed would= total volume desired - x

I'm sure the Technical Manual can fill-in some of the blanks.  Our LIS does all of the labeling and tracking work for us.

Link to comment
Share on other sites

  • 3 weeks later...
On 8/26/2016 at 9:16 PM, CarrieM said:

They are for exchanges, and the NICU tells us the desired volume.  We reconstitute to a standard HCT, and issue in a transfer bag.  We use SoftBank, and it basically allows us to create a pooled product so all the components are included on the label.

Could you share your policy and procedure? We have a policy but it's not very good. We haven't performed one in years but we have been transfusing a lot of babies lately and I'm thinking there might come a time very soon where we might have to. Thanks!

Link to comment
Share on other sites

We use Adsol for small volume transfusions but I understood that the mannitol was a bigger problem for exchanges than for small transfusions.  For our exchange procedure (which we have not done in 15 years) we got permission from our neonatologists to just remove the Adsol and replace it with FFP.  They get a higher Hct than is standard but it is simpler to do without having to measure Hct of unit before or after. It does mean if you have a good-sized term baby, you might require 2 units for the total volume they would want. They feel this is okay partly because they expect any baby that we exchange to be anemic.  We do have calculations for doing a different Hct but are hoping that the one we may be facing in the next few weeks will be able to use the more simple process.

Link to comment
Share on other sites

  • 2 weeks later...
On ‎8‎/‎26‎/‎2016 at 1:49 PM, maybe said:

Shipping the baby out is really not an option unfortunately.

Strangely enough the neonatologists here do not seem concerned at all about the mannitol in the ADSOL units. It's what they've been using for neonate transfusions for years before I came, which was a change as my previous hospital was very anti-ADSOL for babies. With the blood supplier restructure we have been starting to get in the CPDA-1 units for the other babies , but for the exchanges the docs want the ADSOL units.

 

Carrie- does your facility have an SOP on how to do the aliquots specifically for exchanges or are you providing normal aliquots and they do all the fun calculations on the NICU side?

 

We have discovered with ADSOL units that we can add very little (7-10 mls) of FFP in order to stay close to a 50-55% HCT., something I have tried again and again to inform them of, but they don't seem to understand what it might mean for the coag factors for the baby in a full exchange transfusion.  Our blood center is eliminating CPDA-1 units as much as possible, and that seems to be OK for small volume transfusions, but it bothers me for exchange transfusions.  Do your neonatologists have a "reason" for wanting ADSOL units for exchange transfusion?  Could you share it?  And based on your calculation formulas - is 7-10 mls about as much FFP as you can get into an ADSOl unit too?

Link to comment
Share on other sites

On ‎9‎/‎17‎/‎2016 at 3:24 PM, Mabel Adams said:

We use Adsol for small volume transfusions but I understood that the mannitol was a bigger problem for exchanges than for small transfusions.  For our exchange procedure (which we have not done in 15 years) we got permission from our neonatologists to just remove the Adsol and replace it with FFP.  They get a higher Hct than is standard but it is simpler to do without having to measure Hct of unit before or after. It does mean if you have a good-sized term baby, you might require 2 units for the total volume they would want. They feel this is okay partly because they expect any baby that we exchange to be anemic.  We do have calculations for doing a different Hct but are hoping that the one we may be facing in the next few weeks will be able to use the more simple process.

Hi  - can you describe how you "remove the ADSOL and replace it with FFP"  - does it involve a refrigerated, validated, etc centrifuge for RBC units?

And absolutely - keeping a whole team "trained" and competent on this procedure is a nightmare!  Especially when they call and get us all excited and trying to get everything ready and then they do one more T. Bili and the baby is going to be OK, from all of the hydrating and Bili lights they have been using, without the transfusion.  Don't get me wrong - I would much rather skip the whole thing, but the work just getting ready for an exchange transfusion, before you even touch the units, is extensive and either involves a lot of phone calls or a trip in.  And they are still doing it too rarely to maintain competency.

 

Link to comment
Share on other sites

  • 2 weeks later...
On ‎10‎/‎6‎/‎2016 at 9:45 AM, cswickard said:

Hi  - can you describe how you "remove the ADSOL and replace it with FFP"  - does it involve a refrigerated, validated, etc centrifuge for RBC units?

Yes, we use a refrigerated centrifuge and spin down the unit.  We insert an injection site into a unit port and use 60 cc syringe(s) to remove the Adsol.  As I recall, we use the same injection site and more syringes to add an equal volume of plasma.  Or we would if we had ever had to do the procedure. :)

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
  • Advertisement

×
×
  • Create New...

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.