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
Component ChoicesComponent Choices
• 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
Component ConsiderationsComponent Considerations
• 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
Sterile ConnectionSterile Connection
Sterile ConnectionSterile Connection
Sterile ConnectionSterile Connection
Sterile ConnectionSterile Connection
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
Component ConsiderationsComponent Considerations
Neonatal Aliquots Neonatal Aliquots
Transfusion ConsiderationsTransfusion Considerations
Component ChoicesComponent Choices
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