Reconstituting blood for exchange transfusion in neonates, redux

On December 15th 2008, a colleague asked the following question as part of the e-Network Discussion entitled: Reconstituting blood for exchange transfusion in neonates “A medical technologist who works at a small (less than 200 beds) hospital in a rural area of Texas reports that for patients in their Neonatal ICU an exchange transfusion happens rarely, but RBC transfusions for preemie and term newborns happen frequently. Until recently, their hospital blood bank has been able to maintain an inventory of CPD-A1 RBC units for neonatal transfusions. However, their blood product provider no longer manufactures CPD-A1 RBC units and the inquiring colleague's hospital now has to special order CPD-A1 RBC from another supplier, but it takes up to two weeks to fill each special order. The inquiring colleague has read with interest the e-Network Forum comments on the subject of using (or not using) AS-RBC products for neonatal transfusion, but she cannot see that there is a clear consensus. She believes that ADSOL-reduced or washed cells are recommended for exchange transfusions but that approach is not a viable option for her hospital. Her hospital is two hours away from their supplier (there are none closer) and their neonatologist feels that is too long to wait for their supplier to manipulate an RBC unit for them. Usually, it takes from 3-4 hours to get a STAT order filled. They don't have the equipment to wash or even reduce the anticoagulant. Her question is: Since they only keep one or two units for these babies (a mix of term and preemies) should the blood they keep on hand be irradiated and what anticoagulant is the best choice in relation to mannitol, potassium and other constituents that may be harmful to these babies.”

At the inquiring colleague’s hospital it has become necessary to write a definitive procedure for their technologists to follow when an exchange transfusion is ordered. The inquiring colleague is hoping for some ‘up to date’ guidance, because currently no one at her hospital can agree on whether or not to use irradiated blood.

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