blood , plasma and platete transfusion

  1. hi, every body...............
    I wonder what is blood volume in neonatal, how many cc we should extracted from the baby and how many cc we should transfused of PRBS?
    and when should we transfused FFP?
    Thank you very much?
    •  
  2. 12 Comments

  3. by   dawngloves
    Bood volume depends on the weight of the baby.
    Extracting blood for what? Labs? Depends on the what lab you are sending are how bad your lab is. Mine donesn't seem to understand that the baby I'm sending blood on weighs 540 grams and can't spare 2 mls of blood!
    PRBCs are generally 10 mls per kilo. I have found different mindsets in transfusing platlets. Some wait until they are >90, some >50. Or if there is a trend down that you know will only end up being less than 90.
  4. by   Gompers
    These questions really should be answered by your unit's doctors since they're the ones ordering it - plus each hospital has their own guidelines as to when and how much they transfuse.

    This is what we do, though...

    For most blood products (PRBC's, FFP, cryo) we transfuse 10-15 cc/kg - running at a rate of 5cc/kg/hr. For platelets, we also tranfuse 10-15 cc/kg but over only 15-30 minutes.

    We'll give PRBC's depending on how the kid is doing and what their hematocrit is (we don't go by hemoglobin). If it's a sick baby on a vent, we'll transfuse for anything under 40. If it's an intermediate baby we'll do it for anything under 35. If the baby is a grower-feeder, we'll do it for anything under 30. And even if the baby is asymptomatic, we'll do it for under 25. Sometimes it depends though - these aren't hard and fast rules, just guidelines we tend to follow. There are things that will impact whether or not we'll give blood - if the baby is having bradys, up on the oxygen, going to surgery, etc. then we are more likely to give blood even with a borderline hematocrit. Likewise, if the baby is getting ready for discharge we might add in a reticulocyte count - and if it's high (meaning their body is working hard to produce more blood) then we'll let them go without a transfusion because we don't want to knock out the bone marrow's drive when it's in high gear.

    For platelets, we transfuse for under 50,000 usually. If the baby has chronically low platelets, we'll lower the threshold to 25,000 unless there is active bleeding or the baby is going to surgery.

    We'll give cryo and FFP depending on the coags - if the fibrinogen is very low we'll give these products.

    We used to keep a "blood deficit" where we recorded how much blood we were drawing from a baby for labs, and when it hit 10cc/kg we'd transfuse that much PRBC's. They stopped doing this a few years ago. I wish we'd start it up again, or at least check hematocrits on babies once a week just to monitor them even if they're feeder-growers. I've seen too many babies that were white as sheets but asymptomatic...until the hematocrit dropped below 20 and suddenly we had a sick little kid on our hands!
  5. by   mawjood
    we have one baby for OR we should extracted PT &PTT ,so night nurse extracted them with CBC , RFT , Ca,PO4, Mg , ABG & blood culture , our tube for PT &PTT are the same for adult it mean 2cc for every one so she extracted almost 7 cc and baby weight 1520 gm when the result came his Hg already 8.1 , HCT 27.3 and Plt 40 ,the total 24 hour blood extracteion I think it was almost 9cc I feel its too much for baby from his blood volume I think blood volume 82\kg.
    we transfused 20cc PRBC over 3 h, and 20cc Plt over 2h.
    and I am asking if this blood enough to replaced and to maintaince I realy dont know may be gus you will say this stupid lady , sorry about that.
    Thank you .............................
  6. by   SteveNNP
    wow..... this baby's total blood volume is around 122 ml's TOTAL. You basically took about 8% of his total blood volume in 24 hours just for tests.

    At my NICU, we generally transfuse PRBC's if either the hct is <30 AND symptomatic, or about <27 if asymptomatic. We'll also usually draw a retic ct on the bigger babies and make sure they're getting either polyvisol or some other supplementation. Our MD's usually hold off on the platelets until they are <40, unless the kid's bleeding or has been requiring multiple transfusions per shift. Their rationale is that the septic babies who get repeated plt transfusions develop an autoimmunity to them, and can destroy the new plts as fast as we can give them. We generally use 10-15ml/kg over 2 hours of plts/prbc/albumin (I've only given cryo and FFP once)
  7. by   Gompers
    We also have to take about 2cc of blood to check coags, but everything else is in a capillary tube, tiny blood gas syringe, or microcontainer. For pre-op labs, 7cc is a ton of blood. The only time we ever take that much is when the baby is being worked up for chromosomal problems.

    Are we the only unit that transfuses platelets so quickly? I was taught in school and by our hospital's blood bank that unless they are constantly in motion, platelets will stick together so when you're doing a transfusion it needs to be over less than 30 minutes. In the blood bank, the platelets are usually kept on some sort of machine that keeps them in constant motion to prevent clotting.
  8. by   SteveNNP
    Well,

    we do it over 1-2hours usually..never have had a problem with clotting... How do you keep from blowing your peripheral IV sites when giving platelets that fast, especially with larger volumes, and without a double lumen UVC/Cooke/Broviac in place?
  9. by   Gompers
    Quote from SteveRN21
    Well,

    we do it over 1-2hours usually..never have had a problem with clotting... How do you keep from blowing your peripheral IV sites when giving platelets that fast, especially with larger volumes, and without a double lumen UVC/Cooke/Broviac in place?
    That is why we dread giving platelets!!!

    The problem wasn't so much with them clotting the lines off, but the actual platelets themselves apparently can clot together and become useless. That's at least what blood bank explained to me. Also something about studies showing the shorter the infusion time for platelets, the higher the platelet count rises because less cells are damaged.

    I can't be the only one!?!?
  10. by   dawngloves
    We give platelets over an hour and I haven't blown an IV, yet. Have you blown peripherials when you are giving fluid boluses in a code situation? You wouldn't want a NSS bolus to go in over 1-2 hours.
  11. by   RainDreamer
    Quote from dawngloves
    We give platelets over an hour and I haven't blown an IV, yet. Have you blown peripherials when you are giving fluid boluses in a code situation? You wouldn't want a NSS bolus to go in over 1-2 hours.
    An hour is different than the 15-30 minutes that was described. We run platelets over about an hour, I've never seen them run over 15-30 minutes.
  12. by   dawngloves
    Quote from RainDreamer
    An hour is different than the 15-30 minutes that was described. We run platelets over about an hour, I've never seen them run over 15-30 minutes.
    Yeah, but we give boluses over half an hour.
  13. by   RainDreamer
    Quote from dawngloves
    Yeah, but we give boluses over half an hour.
    Oh I know what you mean. It's just that you said you run platelets over an hour and haven't blown any IVs yet, but I think Steve meant he would be worried about blowing IVs if he were to run platelets over 15-30 minutes.

    Yeah we do run NSS boluses over 30 minutes. And I can't remember a time where it blew my IV. But 15 minutes seems like so little time to infuse all that volume. But who knows, it's an interesting theory .......
  14. by   Zippedodah
    We run plts 30-60 minutes, depends on the kid. Boluses and FFP usually over 30 minutes...you want to get the volume in and the BP up.

    On our tiny ones, we keep blood out and transfuse automatically when we hit 10%/kg. Most of our kids are on Epo now, so we are more tolerant of lower hcts as long as they are reticing. The only way they get transfused is if they are Aing and Bing and Ding all over the place and have a high high rate.

    For pre-op labs, we have new coag containers that only need 1ml! Yippee! Then the CBC/BMP/PLT is another 1ml. Chromosomes and metabolics are 3-5 mls.
    Last edit by Zippedodah on Nov 21, '06 : Reason: hit enter too fast

close