A blood banker in Louisiana reports that the use of irradiated RBCs for transfusion to neonates is being debated at her institution, in which is a Level III NICU. Her hospital currently uses group O Rh negative, CMV sero-negative, sickle hemoglobin negative, leuko-reduced red cells for their routine 'maintenance' transfusions of neonates. Using a sterile connecting device they dedicate a unit to no more than 4 babies, and assign a 28 day expiration. The aforementioned protocol has been employed for many years. She is aware that many facilities have adopted the use of irradiated RBCs for neonates, but she is concerned about the resulting potassium leakage and accumulation in the supernate of RBCs after prolonged storage. With this in mind, she wonders if those who have opted to use irradiated RBCs have a policy to limit the storage of the RBCs after they have been irradiated.

She has reviewed the earlier discussions on this forum:

• Policies for storage of previously irradiated red cell units intended for transfusion to neonates
• Should cellular blood products for exchange transfusion in neonates be routinely irradiated?

At least one institution limits the storage of irradiated RBCs for neonates to 21 days. She wonders how long other facilities limit storage of these red cell products.

The following responses have been received.

ADDENDA Oct. 7, 2004

1. A Transfusion Service Supervisor at a hospital in Utah reports that his hospital has a very active NICU with 32 beds, most of which are usually full. He points out that they are unable to irradiate blood products 'on demand' so they must get irradiated products from their blood supplier; their supplier is more than two hours away. This being said, their routine is to provide RBCs for their babies that are type-specific, leukoreduced and irradiated. They also keep a unit of irradiated group O Rh neg and group A Rh neg ready at all times for emergency situations. Once a unit is assigned to a baby, the baby gets aliquots of red cells from the irradiated unit for the shelf life of the product, up to a maximum of 28 days. They use a sterile connecting device to make the aliquots. Finally, he reports that since following the above protocol over the last 5 years, they have administered about 2500 irradiated RBC transfusions without any 'known' problems attributable to elevated potassium in the units.

ADDENDA Oct. 19, 2004

2. A colleague in Wisconsin reports that at his hospital they irradiate red cell aliquots on-site, and keep the aliquot bag in the refrigerator for up to 24 hours, using it for any baby in their NICU who might need it. They do not dedicate an RBC unit to a certain baby routinely for patients in their NICU. If their irradiator is not working, they obtain blood that has been irradiated from their supplier, in which case they "revert back to their old ways of doing things" and keep the product up to 7 days post-irradiation for NICU babies.

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