A colleague at a hospital in Georgia reports that their transfusion committee is re-evaluating their neonatal transfusion practice pertaining to the use of CMV antibody negative blood components. The hospital's current policy is for all neonates to receive CMV antibody negative blood components that are no older than 14 days. They would like to know what other institutions are doing about the following issues:

• Use of CPDA-1 versus ADSOL anticoagulant preservatives
• choice of product for minimizing risk of CMV transmission
  • CMV antibody negative products OR
  • leukocyte-reduced products OR
  • BOTH of the above
• Maximum age of blood used for transfusion
• Use of irradiated products
  

Several earlier discussions on this forum (1, 2, 3) address the question of equivalency of CMV antibody screening vs leukocyte reduction for preventing CMV. Another discussion addresses the related questions.

The following responses have been received.

ADDENDA Nov. 27, 2004

1. A colleague in Rochester, New York reports that for neonatal transfusions his hospital has no preference for CPDA-1 versus ADSOL anticoagulant. In his opinion, there are no real data to support the safety or efficacy of one of these systems over the other. They use small volume, aliquoted washed group O Rh negative red cells for ALL premature newborns. They do NOT routinely wash platelets for newborns. As for the use of CMV antibody negative products versus the use of leukocyte reduced products, they have used only leukoreduced components for more than a decade. They do not use CMV testing for any patient in the hospital. They believe the data demonstrating the equivalence of these two approaches is convincing. As for the maximum age of blood used for transfusion of neonates, they use blood that is less than 14 days old at the request of the neonatologists. He suspects, given the degradation of oxygen releasing capacity and red cell deformability, this would probably be an ideal practice for all critically ill patients, but it is only practical for these small volume transfusions. Finally, as for the use of irradiated products, they irradiate all cellular components for all patients in the hospital at this point for logistic reasons, but would irradiate all cellular components for newborns in any case. He cautions that it is virtually impossible to diagnose immunodeficiency syndromes in the first few months of life in many cases.

ADDENDA Nov. 30, 2004

2. An Arizona colleague reports that at a 350-bed children's hospital where she works they routinely use leukocyte-reduced rather than CMV antibody negative blood products for neonatal transfusion therapy. The regional blood supplier prepares the leukocyte-reduced products. When a neonate is scheduled for surgery or exchange transfusion they set up fresh (< 5 days old) unit of CPD RBC for transfusion. When a neonate needs small volume transfusions, they assign a fresh (< 7 days old) AS-1 RBC unit from which they issue aliquots until the unit is used up or it outdates at 42 days. Most of their infants (except for those of extremely low birth weight - between 500-1000 g) need only one donor exposure, using the aforementioned approach. Extremely low birth weight babies account for approximately 10% of their neonatal population and almost never get by with only a single donor exposure, because these babies have more complications, more surgery, and need more transfusions of all products. At the current time their 'Neonatal Patient Care Committee' has approved irradiation of blood products for specific indications, such as exchange transfusion, congenital immunodeficiency, intra-uterine transfusion, etc. However, there is concern that not all patients who should receive irradiated products are recognized as needing these products, prior to their initial transfusion. Thus, there is a proposal that all blood products given to neonates should be irradiated. Since they have an irradiator, they could irradiate each aliquot immediately prior to use.

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