Best Practices in Neonatal Transfusions

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BEST PRACTICES IN NEONATALTRANSFUSIONSBEST PRACTICES IN NEONATALTRANSFUSIONS

Jacque Tagliere, MT(ASCP)SBB

Neonatal TransfusionNeonatal Transfusion

Component ConsiderationsComponent Considerations

Neonatal Aliquots Neonatal Aliquots

Transfusion ConsiderationsTransfusion Considerations

Component ChoicesComponent Choices

• Red Blood Cells• Fresh Frozen Plasma• Platelets


• Iatrogenic transfusion– 35 days – 42 days

• CPDA-1 • Additives

– AS-1 and AS-5 Have Mannitol– AS-3 Lacks Mannitol

• Potassium – Surgery or exchanges– Irradiation

Red Blood CellsRed Blood Cells

• ALL ROUTINE TESTING REQUIRED• ADDITIONAL TESTING

– CLINICALLY SIGNIFICANT ANTIBODY, USE ANTIGEN NEGATIVE UNITS

– HEMOGLOBIN S NEGATIVE• EXCHANGE OR MASSIVE TRANSFUSION

OF HYPOXIC OR ACIDOTIC INFANTS

• IRRADIATION


• PROVIDE SMALL VOLUMES• CONSERVE BLOOD PRODUCTS• ⇑ LEVELS OF 2,3 DPG• ⇓ MULTIPLE DONOR EXPOSURE• ⇓ CMV EXPOSURE• ⇓ COST

Red Blood CellsRed Blood Cells

• QUAD PACKS/MULTIPORTION -closed– ASSIGNED UNIT INVENTORY– DECREASED DONOR EXPOSURE

• MULTIPORTION - open system– INCREASED DONOR EXPOSURE

• HALF UNIT/ FREQUENT DONATION– DECREASED DONOR EXPOSURE– DONOR COMMITMENT

SMALL RBC ALIQUOTSSMALL RBC ALIQUOTS

Neonatal Dedicated UnitsNeonatal Dedicated Units

Quad Pack SystemQuad Pack System

Pediatric Blood FiltersPediatric Blood Filters

Neonatal/Pediatric Syringe with filterSterile Connecting Device

Advances in AliquotingAdvances in Aliquoting

Neonatal Syringe with FilterNeonatal Syringe with Filter

Neonatal Syringe & BagNeonatal Syringe & Bag

CODABAR LABELCODABAR LABEL

Sterile Connecting DeviceSterile Connecting Device

Sterile ConnectionSterile Connection






CODABAR SYRINGE LABELCODABAR SYRINGE LABEL

ISBT LABELISBT LABEL

W141606000555 E0226V00

W141606000555 E0226VA0 W141606000555 E0226VB0

W141606000555

E0226VA0

W141606000555

E0226VAa

Dividing ISBT Product CodesDividing ISBT Product Codes

W141606000555

E0226VA0

W141606000555

E0226VAb

2nd Bag

3rd Bag

Parent

Parent

1st BagParent

ISBT SplitsISBT Splits

Zebra Printer Zebra Printer

ISBT Labels on DemandISBT Labels on Demand

Neonatal Syringe & BagNeonatal Syringe & Bag

ISBT Syringe LabelISBT Syringe Label

Component Label VerifyComponent Label Verify

Transfusion RecordTransfusion Record

• Decisions ISBT or both codabar and ISBT– ISBT Modifications

– Dividing: ISBT divide suffix V00 VA0, VAa etc…– Pooling: Generate a new ISBT pooled number– Regular modifications: Irradiation, thawing, washing,

freezing, deglycing

– Frozen products – Suppliers ISBT

ISBT and Codabar?ISBT and Codabar?

• Modifying Units– Pre-printed 2x2’s– Stand alone software

• Hema-Trax.LPS™ ISBT-128 : Microsoft Windows-95/98/NT 4.0/2000/XP operating system platforms.

DowntimeDowntime

Tracking SuppliesTracking Supplies

--

• PLATELETS from WB– Not available in So Cal

• PHERESIS– Aliquot as needed– Volume reduced - 4 hr expiration

PLATELETSPLATELETS

• ABO COMPATIBLE • THAW

– ISSUE– ALIQUOT AND ISSUE

• FREEZE IN SMALL ALIQUOTS

FRESH FROZEN PLASMAFRESH FROZEN PLASMA

Pediatric Blood PumpsPediatric Blood Pumps

Pediatric Blood PumpsPediatric Blood Pumps

Neonatal TransfusionNeonatal Transfusion


Neonatal Aliquots Neonatal Aliquots

Transfusion ConsiderationsTransfusion Considerations


ReferencesReferences

• Standards for Blood Banks and Transfusion Services 24th Edition

• http://www.iccbba.org• http://www.aabb.org/Documents/Members

_Area/Labeling/ISBT_128/isbt128plan0906.pdf

http://www.iccbba.org/

http://www.aabb.org/Documents/Members_Area/Labeling/ISBT_128/isbt128plan0906.pdf



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Best Practices in Neonatal Transfusions