Managing neonatal transfusions with a syringe based delivery system

A Supervisor of a Transfusion Service in Northern California reports that at her facility, they have "Pedibags" provided by their blood supplier. They do not transfuse very many babies (only about 1 per month) but anticipate more in the future as their facility has requested approval for a higher level NICU. When they get a request for a 'micro volume' transfusion, based on the order, they aliquot red cells into the pedibag an amount sufficient to cover the day's transfusion. Immediately preceding the transfusion they use the Hemo-Nate® filter set and enter the aliquot bag, filter and cap off the syringe. The syringe is assigned a 4 hour outdate - the aliquot bag 24 hours. Additional transfusions for that 24 hours period would be drawn from the same pedibag. Based on the aforementioned practice, their concern is that there is limited exposure to room air when capping off the syringe. They are not sure how to address this issue. Their Lab Manager suggested that perform the transfer of red cells under a hood, possibly in the pharmacy or Bacti lab. They do not have a sterile docking device at this time, but are considering getting one. She asks for feedback from the community. How are others managing this situation at their facility?

Editors' Note: Colleagues may also find the discussion, Dispensing blood products for neonates in a syringe and compliance with ISBT labeling requirement, to be germane to the question posed above.

The following comments have been submitted in response.

ADDENDA August 25, 2009

1. A hospital transfusion service supervisor in a sunbelt state comments that she has reviewed the current AABB Technical Manual and found a statement that "cellular components stored in syringes have an expiration of 4 hours, but if stored in an FDA-approved transfer bag, the expiration remains the same as that of the mother unit". Thus, it seems reasonable that RBC aliquots that are prepared using a sterile connecting device and then transferred into a syringe should have an expiration of four hours. She found no statement requiring that the transfer of the aliquot into the syringe take place under a hood.

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