A colleague in New Mexico reports that her facility is contemplating providing aliquots of syringed RBCs to their neonatal intensive care unit patients. Their thought is to aliquot the RBCs into a syringe, and then to irradiate the product (blood plus syringe) immediately before issuance for transfusion. The syringes fit in their irradiator if the volume is < 25 mL. Currently they provide small aliquots of RBCs in component bags and irradiate the RBC aliquots immediately prior to issuing. The New Mexican colleague wonders if others have studied the effect of irradiation on aliquots of blood in syringes. If so, what validation protocols were used?

ADDENDA Sept. 20, 2003

The following responses were received.

1. A colleague in San Antonio, Texas reports that for their newborn intensive care unit at their facility they issue red blood cells for neonates in a syringe. The blood has been previously irradiated before it is transferred to a syringe.

ADDENDA Sept. 22, 2003

2. A colleague in Texas reports that they obtain irradiated aliquots of RBCs from their blood supplier. These aliquots are CPDA-1 group O Rh negative packed cells that are CMV seronegative and leukocyte-reduced. The blood supplier prepares 8 separate aliquots from a single donation and distributes the aliquots as sets of four or eight upon request. Each individual aliquot is labeled with the same unit number and a terminal letter (A through H) corresponding to each respective aliquot. The aliquots are irradiated (four at a time), immediately before they are delivered to the hospital. The Texan's hospital usually orders 4 aliquots at a time. Since a neonate may remain in their NICU for an extended period of time, they designate each set of four aliquots to a particular baby in order to reduce donor exposures. If necessary the aliquots may be transfused up to their expiration date. The Texan does not have in-house data on the potassium levels of the irradiated red cell aliquots that have been stored up to the expiration date, but is of the opinion that this should not be a clinically important issue. Before transferring an RBC aliquot from a component bag to a syringe the individual aliquot is rechecked to verify the ABO/Rh. The laboratory policy is to draw up into the syringe the volume requested plus an additional three (3) to five (5) mls for priming the infusion pump tubing. They pre-filter the blood through a 150 micron filter with a distal Luer adapter into a syringe. Once the syringe is prepared it is dispensed promptly.

Please submit comments to the e-Network Forum.

Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator