RESOURCES Calgary Lab Services website - Lab Services - Transfusion Medicine guide : Ontario Regional Blood Coordinating Network (ORBCN) “Bloody Easy” Resources at ORBCN website – Bloody Easy 3 manual – Bloody Easy Online Course Canadian Blood Services Website : Canadian Blood Services – Clinical Guide to Transfusion

Dr. Steele’s responses to resident questions (page 1 of 2) 1.Neonatal Transfusion- CMV negative, irradiated blood. According to transfusion guidelines normal newborns do not need to receive CMV negative, irradiated blood. However it is recommended by some authorities that premature babies and those who are considered immunocompromised do receive CMV negative and irradiated blood. In fact different countries have different recommendations regarding healthy neonates and non- immunocompromised preemies. Considering that in the hospital system the majority of neonates receiving blood products would fall into those categories it is the current policy in Calgary that all newborns under the age of 4 months receive CMV negative blood and irradiated blood to avoid the possibility of clerical error causing administration of the wrong product. 2.Neonatal Transfusion- blood type transfused. Although neonates do have their blood type (ABO and Rh) tested they do not routinely get a screen as antibodies in serum will be of maternal origin until baby develops his/her own isohemagglutinins. Therefore babies under 4 months routinely receive O type blood so as to avoid the need for giving blood that will not be destroyed by maternal ab. 3.Risk of hyperkalemia- There always seems to be questions about neonatal transfusion and risk of hyperkalemia and other metabolic disturbances. In general “older” (> 5 days) blood has a greater potassium content but this is still negligible unless a patient is getting a massive transfusion which would be greater than 20 cc/kg at a time AND is given very rapidly. According to the CBS guide for transfusions there has been a number of studies demonstrating the safety of transfusing neonates with “older” blood (usually > than 5 days) if infused at regular rate (3-4 hours).

Dr. Steele’s responses to resident questions (page 2 of 2) 4.Risk of hypocalcemia due to citrate in blood.There were questions regarding the implications of citrate anticoagulant and the storage solutions in blood and the effect on neonates. The CBS guide is not specific about this but again suggests no special precautions need to be taken for neonates receiving usual transfusion that are transfused at the usual rate. For a massive transfusion (likely 20 to 40cc/kg) that is give rapidly to a neonate it would be best to communicate this with the blood bank-if possible and time allows the blood bank could give blood that has been collected into a different storage solution and/OR washed and resuspended in normal saline. Significant metabolic disturbances are likely very rare in neonatal transfusions and probably occur in emergent situation.