Neonate transfusion Flashcards
Concerns for transfusion of baby-immune
immunocompromised- no immune system TA-GVHD, must irradiate blood units
Concerns for transfusion of baby- Volume
very low blood volume, concern of large volume transfusion can cause acidosis and hypocalcemia due to inability to metabolize citrate
AS
additive solution AS1 AS3 AS5 AS7 SAGM. Association with renal toxicity- should be used cautiously when large volumes are considered.
SAGM
saline adenine glucose mannitol
What is one adverse effect of irradiation
causes potassium leakage from surface of red cells- may need to wash of excess potassium if unit has been sitting for an extended period (days) after irradiation
Issue with transfusion old red cells in babies
decreased amount of 2.3 DPG, babies cannot replace this deficit in RBCs that are older- need to use acidic pH or increase PCO2 in order to shift oxygen curve back to the right
AABB what needs to be done before issuing non O RBCs to a baby
Check the maternal plasma/serum for anti-A or anti-B to ensure that whatever antibodies int he plasma are not going to hemolyse the unit- must include the AHG phase
Symptoms of anemia in a newborn
tacchycardia, tachypnea, poor feeding
Common morbidities of prematurity
ICH, IVH (intraventricular hemorrhage) Necrotizing entercolitis, bronchopulmonary dysplasia
Effect of transfuion RBCs in neonate
10mL/KG of RBCs with hct >80 will: increase hgb by 3mg/Dl per unit
How do you make an RBC unit with high hct
hang it and allow sedimentation by gravity undisturbed, aliquot ports in the bottom of the bag.
How different components alter babies numbers after transfusion
65%hct rbc= 2g/dL hgb increase. FFP- 15-20% increase in factor levels, plts=50,000uL rise in platelet count. Cryo (1-2units) 60-100mg/Dl fibrinogen increase
What is the most common indication for exchange transfusion
Hyperbilirubinemia (also inborne error of metabolism)
Why does Kernicterus occur
due to immature liver cannot conjugate bilirubin effectively and incompletely developed blood-brain barrier
What is the phototherapy treatment
light 460-490 nm converts unconjugated bilirubin into water-soluble isomer
at what level do you get kernicterus
> 25 mg/Dl normally but in VLBW infants bilirubin as low as 8-12mg/Dl can cause kernicterus
What does an exchange tranfusion in neonates do to the different levels
removes 70-90 percent of circulating red cells (if mothers antibody is directed against baby red cells- removal of these is key) removes 50% of bilirubin, however bilirubin can pool from the tissues after this removal to get blood equilibrium and anther exchange transfusion is necessary
Two different systems of exchange transfusion
Isovolumetric -2 catheters of identical size provide vascular access, simultaneous withdrawl and transfusion. Manual Push pull is second method with singular vascular access portal with 3 way stop cock- standard filter and in line blood warmer recommended- much more time consuming.
Coagulation factors in neonates
Longer aPTT, PT, Thrombin Time, bleeding time. low levels of Vitamin K dependent factors- 2,7,9 and 10. plus contact factors XI XII Prekallikrein and HMWKinongen. Protein C and S also decreased in neonates.
Why do aliquots need to be transfused within 4 hours?
Rapid drop in pH in the aliquot once it’s been separated from the parent unit.
If coagulation factors are decreased why don’t we see more bleeding or thrombosis?
it’s rare because the procoag and anticoag systems are still balanced.
AABB expiration time during aliquot creation
If aliquot prepared using sterile connecting device is used then this is considered a closed system and outdate of aliquot is the same as parent unit.
Hemorrhagic disease of newborn
due to vitamin K deficiency
What type of platelet due you provided for neonate and why
Type specific, any excess of anti-A or anti-B in platelet that may react with the newborn can be detrimental due to small blood volume of the neonate.
Polycythemia in babies
> 65% hct or 22% hgb within first week of birth, hyperviscosity of the blood leads to congestive heart failure in neonateds due to limited capability to increase cardiac output. Treatment is partial exchange to remove RBCs and replace with saline.
Granulocytes in babies
need evidence proof for viral or bacterial septicemia. Granulocytes cannot be leukoreduced so CMV negative must be considered for the baby. Could also be transfused due to Leukocyte adhesion deficiency.
Volume of replacement fluid calculation
(BV)x(currect hct-desired hct) /current hct
