Hi,

Supposing you have a quad pack where one piece was taken off for a baby but the rest of the unit is intact and has not been entered (hence the original unit outdate can be maintained), would you give the remainder of the unit to another (adult) patient once the unit is too old to give to an infant? Are there any standards governing this?

Thanks!

I wouldn't, on the grounds that the volume of blood (red cells) being given to the adult would not be the volume expected by the doctor requesting the unit, and so the expected rise in Hb and hct would not be reached (which is the point of giving the blood in the first place), and it may well worry the doctor and, possibly, the patient.  The doctor may even suspect a delayed haemolytic transfusion reaction, and then request a work-up, which would cost everyone time and, I believe, as far as the USA is concerned, money.

Just my opinion, of course.

I agree with you 100% Malcolm and we ended up trashing the remainder of the unit but I was curious as to what others would have done.

I should imagine the wards wouldn't be happy about having to rehang part units too

I would discuss how much can be removed and still be considered a whole unit with your medical director.   It seems a shame to waste a unit if just 25 mls were removed.  

14 hours ago, R1R2 said:

I would discuss how much can be removed and still be considered a whole unit with your medical director.   It seems a shame to waste a unit if just 25 mls were removed.  

In the UK a paediatric unit is 45ml and we do a 6 unit split pack. If you are only doing a 4 unit split pack, then wouldn't the volume lost be more than that? (275ish/4 = 70ml ish)

1 hour ago, Auntie-D said:

In the UK a paediatric unit is 45ml and we do a 6 unit split pack. If you are only doing a 4 unit split pack, then wouldn't the volume lost be more than that? (275ish/4 = 70ml ish)

Not always the case in US.   Volumes can vary depending on amount requested by MD.  

Another thought would be if you have an active pediatric unit that could possibly use a reduced volume unit on one of their kids.  It would be a shame to discard perfectly good blood but I do agree that it would be unacceptable to issue it to an adult.  It never hurts to consult with the patient's physician and let them make the final decision on if a reduced volume unit would be acceptable.  

As a side note, we sterile docked syringes to our Neonate units and provided the exact amount the physician requested plus 5 additional mls to fill the tubing.  It was not unusual for a patient to either go home or go to a higher acuity facility leaving a unit short by less then 25 mls.  I don't recall doing anything with these units except throwing them away or setting them up on another neonate if they still met the criteria. 

We weigh each one of our units before issue (for the RNs input/output numbers) and our ADULT units range from 270 ml to 420 mls - a huge range to begin with.  The small ones are the pheresed units.  So - we base our decision to issue the remaining amount of a pedi-pak unit on the weight of the unit.  If it still exceeds 270 ml and has been handled correctly, we will give it to an adult.  After all, it is no smaller than some of the ADULT units our distributor sends to us to begin with..... 

 

Edited January 1, 20169 yr by carolyn swickard

On January 1, 2016 at 10:13 AM, cswickard said:

We weigh each one of our units before issue (for the RNs input/output numbers) and our ADULT units range from 270 ml to 420 mls - a huge range to begin with.  The small ones are the pheresed units.  So - we base our decision to issue the remaining amount of a pedi-pak unit on the weight of the unit.  If it still exceeds 270 ml and has been handled correctly, we will give it to an adult.  After all, it is no smaller than some of the ADULT units our distributor sends to us to begin with..... 

 

Very good point.  Just as not all RBC units are created equal, neither are all "adult" patients.  The lab MD should be able to help draft a policy for issuing partial units based on the size of the patient.

Good to see you back Heather!

 

On 12/31/2015 at 7:39 PM, John C. Staley said:

Another thought would be if you have an active pediatric unit that could possibly use a reduced volume unit on one of their kids.  It would be a shame to discard perfectly good blood but I do agree that it would be unacceptable to issue it to an adult.  

But it would be more of a shame to give a child an antibody due to unnecessary increased donor exposures. I'm not sure about in the US, but in the UK we allocate all 6 units to one baby so they are only exposed once. If the medics suspect only one unit is needed, then we will give the excess units from other babies if that makes any sense?

Auntie-D, it is common practice in the US to allocate a unit to an infant/child patient (or a few patients depending on anticipated need) to reduce donor exposure, but in some cases the patient(s) may receive only a very small volume of red cells prior to dismissal or transfer. In that circumstance it's a shame to waste the remainder of a unit of perfectly good red cells.

20 hours ago, AMcCord said:

Auntie-D, it is common practice in the US to allocate a unit to an infant/child patient (or a few patients depending on anticipated need) to reduce donor exposure, but in some cases the patient(s) may receive only a very small volume of red cells prior to dismissal or transfer. In that circumstance it's a shame to waste the remainder of a unit of perfectly good red cells.

We wouldn't waste them - we would use them on a low need baby. We also transfer packs between the main, and satellite hospitals, to make sure they don't get wasted. We wouldn't use one on an adult though.

We release partial units to general inventory for adults if they are above 180 mL.  We took the minimum volume of a whole blood that would be produced by our blood supplier and multiplied it by the minimum allowable Hct for donation.  The logic being that we could receive a "full" unit of RBCs made from a 474 mL (minimum from blood supplier) whole blood donation from a donor with a 38% Hct.

At what age do you start giving type specific red cells?  We have a 1 year old (12 months exactly) in house.

It depends upon the circumstances and the underlying pathology, but we usually do so at four months.

Agree with Malcolm but can be at any age.   Additional testing may need to be done for some babies receiving type specific.  It is outlined in CAP and AABB checklists.