Neonate transfusion

Question 1

Concerns for transfusion of baby-immune

Answer 1

immunocompromised- no immune system TA-GVHD, must irradiate blood units

Question 2

Concerns for transfusion of baby- Volume

Answer 2

very low blood volume, concern of large volume transfusion can cause acidosis and hypocalcemia due to inability to metabolize citrate

Question 3

AS

Answer 3

additive solution AS1 AS3 AS5 AS7 SAGM. Association with renal toxicity- should be used cautiously when large volumes are considered.

Question 4

SAGM

Answer 4

saline adenine glucose mannitol

Question 5

What is one adverse effect of irradiation

Answer 5

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

Question 6

Issue with transfusion old red cells in babies

Answer 6

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

Question 7

AABB what needs to be done before issuing non O RBCs to a baby

Answer 7

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

Question 8

Symptoms of anemia in a newborn

Answer 8

tacchycardia, tachypnea, poor feeding

Question 9

Common morbidities of prematurity

Answer 9

ICH, IVH (intraventricular hemorrhage) Necrotizing entercolitis, bronchopulmonary dysplasia

Question 10

Effect of transfuion RBCs in neonate

Answer 10

10mL/KG of RBCs with hct >80 will: increase hgb by 3mg/Dl per unit

Question 11

How do you make an RBC unit with high hct

Answer 11

hang it and allow sedimentation by gravity undisturbed, aliquot ports in the bottom of the bag.

Question 12

How different components alter babies numbers after transfusion

Answer 12

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

Question 13

What is the most common indication for exchange transfusion

Answer 13

Hyperbilirubinemia (also inborne error of metabolism)

Question 14

Why does Kernicterus occur

Answer 14

due to immature liver cannot conjugate bilirubin effectively and incompletely developed blood-brain barrier

Question 15

What is the phototherapy treatment

Answer 15

light 460-490 nm converts unconjugated bilirubin into water-soluble isomer

Question 16

at what level do you get kernicterus

Answer 16

> 25 mg/Dl normally but in VLBW infants bilirubin as low as 8-12mg/Dl can cause kernicterus

Question 17

What does an exchange tranfusion in neonates do to the different levels

Answer 17

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

Question 18

Two different systems of exchange transfusion

Answer 18

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.

Question 19

Coagulation factors in neonates

Answer 19

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.

Question 20

Why do aliquots need to be transfused within 4 hours?

Answer 20

Rapid drop in pH in the aliquot once it’s been separated from the parent unit.

Question 21

If coagulation factors are decreased why don’t we see more bleeding or thrombosis?

Answer 21

it’s rare because the procoag and anticoag systems are still balanced.

Question 22

AABB expiration time during aliquot creation

Answer 22

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.

Question 23

Hemorrhagic disease of newborn

Answer 23

due to vitamin K deficiency

Question 24

What type of platelet due you provided for neonate and why

Answer 24

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.

Question 25

Polycythemia in babies

Answer 25

> 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.

Question 26

Granulocytes in babies

Answer 26

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.

Question 27

Volume of replacement fluid calculation

Answer 27

(BV)x(currect hct-desired hct) /current hct