blood , plasma and platete transfusion

dawngloves, BSN, RN · Nov 16, 2006

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.

Gompers, BSN, RN · Nov 16, 2006

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!

mawjood · Nov 17, 2006

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 .............................

SteveNNP, MSN, NP · Nov 17, 2006

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

Gompers, BSN, RN · Nov 17, 2006

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.

SteveNNP, MSN, NP · Nov 17, 2006

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?

Gompers, BSN, RN · Nov 17, 2006

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!?!?

dawngloves, BSN, RN · Nov 17, 2006

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.

RainDreamer, BSN, RN · Nov 18, 2006

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.

dawngloves, BSN, RN · Nov 18, 2006

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.

:chair: Yeah, but we give boluses over half an hour.

RainDreamer, BSN, RN · Nov 18, 2006

:chair: 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 .......