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I. Principle:

Infants less than 4 months of age, or neonates, have different transfusion requirements than adult or pediatric patients. This procedure defines the testing required for neonates to receive any blood product.

II. Clinical Significance:

Infants less than 4 months of age have small blood volumes and immature immune systems. This necessitates special approaches to component therapy.

III. Specimen:

Infant specimen, EDTA preferred.

IV. Materials:

Refer to the “ABO Group and Rh Type, Patient; MTS Monoclonal Grouping Cards”, “Antibody Detection & Identification; MTS Gel Card” and “Crossmatch; MTS Gel Card” procedures.

V. Reagents:

Refer to the ““ABO Group and Rh Type, Patient; MTS Monoclonal Grouping Cards”, “Antibody Detection & Identification; MTS Gel Card” and “Crossmatch; MTS Gel Card” procedures.

VI. Standardization: N.A.

VII. Procedure:

    1. RBCs

      A. Tests that must be completed for an infant less than 4 months old:

        a. ABO Group (forward type)
        Note: Neonates typically have not developed Anti-A or Anti-B, so back typing is not required.

        b. Rh Type

        c. Antibody screen
        Note: If the antibody screen is positive an antibody identification must be performed.

        d. AHG Compatibility testing (IgG)
        Note: Immediate spin is not required for infants receiving O Negative blood.

        e. All units must be antigen typed for any antibodies found.

      B. Donor Selection:

        a. Replacement transfusion:

        1. Stat
           Verify if a special need is required (e.g. irradiated, Hgb S Negative)
           Select the freshest O Negative RBC that meets any requested special need.
           Following compatibility testing the whole unit is issued.

        2. Expedite or Routine
           Call the RN and explain aliquotted RBCs will be ordered but if the transfusion is emergent, a regular O Negative RBC can be used.
           If not emergent, call MVRBC and request an O Negative RBC that meets any requested special need, to be aliquotted into 3 pedi-paks ASAP (aliquots cannot be ordered Stat).
           Upon receipt, each aliquot has a unique identifier and is handled like a regular RBC unit.

        3. If whole blood is requested, consult a pathologist.

        b. Exchange transfusion:

        1. Select the freshest O Negative RBC for compatibility testing

        2. Thaw an AB Plasma for product selection.

        3. Issue each product separately.
        Note: If the pediatrician requests that the products be combined, use the plasma transfer tubing and aseptic technique to add the AB Plasma to the O Negative RBC. Both products are issued and both product bags with all identifying tags and labels are released to the nurse or designee.

        c. Request for group-specific RBC:

        1. Consult with a pathologist.

        2. Additional testing required to give a non-O RBC to a neonate:
           Test the infant’s plasma with A1 and B cells (back type) through the AHG phase using the tube method.
           Perform an ABO/Rh on the mother with appropriate tests ordered and mother identified.
           Select the freshest group-specific RBC that is compatible with the infant and these additional tests.
           Perform an Immediate Spin Crossmatch in addition to IgG Crossmatch.

    2. Platelets

      A. Perform ABO/Rh forward testing.

      B. Select platelets that are ABO compatible (and Rh compatible if the platelet has visible RBC contamination).

    3. Plasma

      A. Perform ABO/Rh forward testing.

      B. Select AB Plasma.

    4. Cryoprecipitate

      A. Perform ABO/Rh forward testing.

      B. Select Cryo that is ABO compatible.

VIII. Results Derivation:

Refer to the “ABO Group and Rh Type, Patient; MTS Monoclonal Grouping Cards”, “Antibody Detection & Identification; MTS Gel Card” and “Crossmatch; MTS Gel Card” procedures.

IX. Expected Result(s) and/or Critical Values:

Refer to the “ABO Group and Rh Type, Patient; MTS Monoclonal Grouping Cards”, “Antibody Detection & Identification; MTS Gel Card” and “Crossmatch; MTS Gel Card” procedures.

X. Quality Control:

Refer to the “ABO Group and Rh Type, Patient; MTS Monoclonal Grouping Cards”, “Antibody Detection & Identification; MTS Gel Card” and “Crossmatch; MTS Gel Card” procedures.

XI. References:

    1. AABB Technical Manual, Bethesda, MD., current edition.

    2. AABB Standards for Blood Banks and Transfusion Services, Bethesda, MD, current edition.

 

 

Comprehensive Review:

    Pathologist:

    Technical Director:

 

Interim Review: September 2009 S. Hosch (no changes)

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