Transfusion in surgery pediatric cardiac

[mpmiola]

Hello guys,

I need your help with transfusion of packed red blood cells in pediatric cardiac surgery. Our surgeon requests washed and irradiated red blood cells. Did we ask why? However, he could not answer.
Someone knows what's best, red blood cells washed or not washed?

It is important to say that we provide red blood cells of 5 to 7 days of storage and identical ABO.

Thanks for any input,

[John C. Staley]

Is this request specific for a certain patient or by a specific physician?  Is this a "universal" order for all pediatric cardiac surgeries?

[mpmiola]

John C. Staley, he asks for all children up to three months old and for children over three, only if it is the second procedure.
When we asked for a referral for this conduct, he did not provide it!
I believe it has no significant benefits. Some studies say that washing minimizes the risk of inflammation, but it is not a consensus.
Other risks seem to me to be more worrying than the benefits pointed out, such as:
Risk of contamination - our service does not have automation for the washing of red blood cells;
Loss of yield - in addition to the loss of cells that occurs during the procedure, mechanical trauma can accelerate the process of hemolysis of more fragile cells;
Anyway, I would like to know your opinion on this subject and what is the practice adopted by your service?

[John C. Staley]

You may want to post this under Transfusion Service.  I think more people will see it there.  I'm afraid I won't be able to help you.  We did not do pediatric cardiac surgery at either of the hospitals I was in.  There was a large pediatric hospital nearby that took care of that.  Prior to my retirement washing red cells had gone out of vogue and most places had gotten rid of their IBM 2991 cell washers but I've read recently that it might be coming back.  It's a shame the surgeon would not try to educate by explaining himself but not surprising.  

 

[Cliff]

Irradiating red cells releases potassium, it's likely they want that potassium removed prior to transfusion.  We will only issue units to our NICU that are 3 days or less post irradiation.  We do not do surgery on babies here.

[mpmiola]

 

7 hours ago, John C. Staley said:

You may want to post this under Transfusion Service.

Thank you, I'll do it.

[mpmiola]

6 hours ago, Cliff said:

Irradiating red cells releases potassium, it's likely they want that potassium removed prior to transfusion.  We will only issue units to our NICU that are 3 days or less post irradiation.  We do not do surgery on babies here.

 We only issue units that are 3-5 days post irradiation.

Thanks a lot

[slsmith]

For patient's less than 4 months old we give either O= or O+ red cells that are irradiated, hbg s neg and less than 5 days old. We also split the red cell as quite often the team only use 1/2 the unit at a time.

Patient's 4 months-10 years we give type specific, hbg s neg  and split. The unit is fresh by that I mean it isn't expiring in the next week or so.