Current Status: Active
PolicyStat ID: 3583443
Origination:
Last Approved:
Last Revised:
Next Review:
Owner:
Policy Area:
References:
11/15/2000
12/1/2016
12/1/2016
12/1/2018
Janette Oneill: VCMC - Lab
Blood Bank
L.BB.41 Neonatal Transfusions
POLICY/PROCEDURE:
Replacement transfusions:
A. Initial pre-transfusion workup:
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1. Check Blood Bank historical records for an HDN workup on the neonate for the current admission.
Testing performed should include an ABO-Rh typing and a Direct Antiglobulin Test (DAT).
a. If testing has not been performed and the neonate was born at VCMC, check for a cord blood
specimen. If a cord blood specimen is located, request an HDN order and perform testing on the
retrieved cord blood.
b. If testing has not been performed and the neonate does not have a cord blood specimen,
request an HDN order and submit the Laboratory request label to a phlebotomist to collect one
(1) EDTA pediatric tube and (2) yellow top pediatric tubes. Collect each tube to the maximum fill
line indicated on the tubes. Label each tube with a Laboratory label or if the NICU collects the
sample an addressograph label can be used.
c. If this is a new admission, request an HDN order and submit the Laboratory request label to a
phlebotomist to collect one (1) EDTA pediatric tube and two (2) yellow top pediatric tubes.
Collect each tube to the maximum fill line indicated on the tubes. Label each tube with a
Laboratory label or if the NICU collects the sample, an addressograph label can be used.
2. Check Blood Bank historical records for the mother's antibody screen. The mother's screen
performed within 3 days of delivery, on this admission, is acceptable.
3. If an antibody screen has not been performed on the mother's specimen:
a. Check for an extra Blood Bank specimen submitted within 3 days of delivery. If a specimen is
located request a type and screen order and perform testing.
b. If the mother is unavailable and there is no specimen, perform an antibody screen on the
neonate's specimen and perform compatibility testing for the requested red blood cells.
B. Subsequent pre-transfusion testing (for this admission) may be omitted during the first four (4) months of
age if:
1. The original antibody screen is negative.
2. All red cells transfused during this period are Group O or ABO-identical or ABO-compatible and
L.BB.41 Neonatal Transfusions. Retrieved 02/13/2019. Official copy at http://vcmc.policystat.com/policy/3583443/. Copyright
© 2019 Ventura County Medical Center
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either D negative or the same D type as the neonate. Before giving any non-group-O red cells, the
neonate's serum must be checked for passively acquired maternal anti-A and/or anti-B, including the
anti-globulin phase of testing.
3. Testing for Anti-A and/or Anti-B in the baby's serum/plasma:
a. Label two 12x75 mm tubes for A1 cells and B cells.
b. Add 2 drops of the baby's serum to each tube.
c. Add 1 drop of A1 and B cells to the appropriately labeled tubes.
d. Incubate the tubes at 37°C for 15 minutes.
e. Wash the tubes 4 times with saline and then add 2 drops of anti-IgG to each tube.
f. Spin at 3500 RPMs for 15 seconds.
g. Read macroscopically and microscopically.
h. Add check cells to all negative reactions.
i. If the antibody is present ABO-compatible red cells lacking the corresponding A or B antigen
must be used.
C. If the initial antibody screen (mother or neonate) demonstrates a clinically significant antibody/antibodies,
transfuse units negative for the corresponding antigen(s). These units must be crossmatched with the
mother's serum/plasma (or the baby's serum if the mom's serum/plasma is unavailable).
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D. Record the pre-transfusion testing results on the Blood Bank worksheet. Enter the results in the
computer. Refer to Laboratory Blood Bank policy L.BB.43, Aliquoting of Red Blood Cells for Neonatal
Transfusions, for preparing small aliquots of RBCs.
E. If an infant is discharged and re-admitted, an ABO-Rh typing and antibody screen must be performed,
even if the infant is less than four months of age.
F. Red Blood Cells and Plateletpheresis components for neonates must be CMV negative and Irradiated.
Red Blood cells should be 10 days old or less at the time the first aliquot is made. If only older blood is
available from United Blood Services contact the Pathologist.
G. Components containing unexpected or ABO-incompatible antibodies must not be transfused.
H. Normally one donor unit will be assigned to each neonate who requires transfusion for the full life span of
the unit or until the unit expires earlier for some other reason. Donor units may be used for more than one
infant when there are insufficient units to meet the need.
I. If thawed plasma is required, group AB negative components will be used. Pediatric AB negative units are
provided by United Blood Services. These pediatric units come as 4 divided units with the same donor
number. The CMV status of pediatric plasma is unknown and not required.
J. Platelets must be CMV negative and Irradiated. Try for ABO/Rh compatible Product. Refer to Laboratory
Blood Bank policy L.BB.44, Platelet Components, for more information. (Contact a Pathologist if ABO-Rh
compatible product is not available.)
1. When ordering platelet pheresis units for a baby, please order the unit sterile docked with extra bags.
If the platelet pheresis is to be aliquoted refer to Laboratory Blood Bank policy L.BB.43, Preparation
of RBC and Platelet Aliquots.
2. Reduced Volume Platelets will only be issued in cases in which the transfused product contains
incompatible plasma. These platelets will be ordered and issued only with the approval of a
L.BB.41 Neonatal Transfusions. Retrieved 02/13/2019. Official copy at http://vcmc.policystat.com/policy/3583443/. Copyright
© 2019 Ventura County Medical Center
Page 2 of 3
Pathologist. If a reduced volume product ( less volume) is required, the outdate of the platelet
pheresis will be decreased to four hours, one hour of which is used to rest the unit and a second
hour is used to rotate the unit. This leaves only 2 hours to infuse the unit. Make sure that the doctor
involved in ordering this product is aware of the narrow infusion window he/she is dealing with. This
procedure will be done by United Blood Services.
Exchange transfusion:
A. Steps A through D above apply.
B. Group O positive/negative RBCs and AB fresh frozen plasma will be used. The cells used must be less
than 5 days old (if cells less than 5 days old are not available have the freshest available unit less than 10
days old washed by United Blood Services), CMV negative, Irradiated, and Hgb S negative.
C. If FFP and RBC's are used, the Blood Bank will pool the two components to arrive at the desired
hematocrit (see Laboratory Blood Bank policy L.BB.42, Reconstituting Blood for Exchange Transfusion).
WASHED CELLS:
A. Place a request with United Blood Services to wash a CMV negative, Leukodepleted, Irradiated red blood
cell which is 10 days or less old.
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B. When the washed unit arrives, transfer the contents to a 600 mL transfer pack. The expiration date is the
same as that which is on the washed unit.
C. If the washed unit is to be used for aliquots proceed as you would with any pediatric unit.
If the unit is to be used for an exchange transfusion, follow the instructions in Laboratory Blood Bank policy
L.BB.42, Reconstituting Blood for Exchange Transfusion.
REFERENCES:
1. Standards for Blood Banks and Transfusion Services. Bethesda, MD: American Association of Blood
Banks, 2015. 30th Edition.
2. Funk, Mark K. Technical Manual. Bethesda, MD: American Association of Blood Banks, 2014. 18th
Edition.
All revision dates:
12/1/2016, 12/1/2013, 2/1/2012, 1/1/2007
Attachments:
No Attachments
L.BB.41 Neonatal Transfusions. Retrieved 02/13/2019. Official copy at http://vcmc.policystat.com/policy/3583443/. Copyright
© 2019 Ventura County Medical Center
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