Neonate workup and product choice

Summary

In this Blood Talk video, the focus is on blood testing and transfusions for neonate patients. The speaker explains how neonates differ from adults in terms of antibody production and blood work, emphasizing the importance of specific tests like DAT and crossmatching. Key points include blood type determination, antigen testing, and the use of compatible blood products. The video also discusses the challenges posed by blood supply shortages, particularly CPDA1 bags, and the need for specialized blood components like irradiated or CMV-negative products. Overall, it provides a comprehensive guide for healthcare professionals dealing with neonatal transfusions.

Takeaways

• 😀 Adult patients are considered those aged 18 years and older in daily life, but in blood banks, neonate patients are treated as adults once they reach 4 months old.
• 😀 Neonates cannot produce their own antibodies before 4 months, so they may have transient antibodies from their mother that will disappear over time.
• 😀 The common test performed in blood banks for both adults and neonates is the 'type and screen' test, which determines the blood type and checks for antibodies.
• 😀 For neonate blood typing, only the forward typing is performed because neonates cannot generate antibodies.
• 😀 Antigen testing (such as Rh antigen) in neonates is done the same way as in adults, although the antigen expression might differ in neonates.
• 😀 The Direct Antiglobulin Test (DAT) for neonates is used to check if the baby’s red blood cells are coated with antibodies, often due to ABO incompatibility.
• 😀 ABO incompatibility can cause hemolytic anemia in neonates, but this is treatable using light therapy to manage bilirubin levels.
• 😀 Crossmatching is performed for neonates only if their mother has antibodies. The test ensures that the transfused blood does not react with the baby’s blood.
• 😀 Blood products for neonates are carefully selected, with specific requirements such as CMV-negative and irradiated RBCs, depending on the hospital and patient needs.
• 😀 CPDA1 is the preferred blood collection method for neonates to avoid additives that could harm their calcium levels, though alternatives may be used in cases of shortages.

Q & A

Why are patients under four months old treated differently in blood banks?

Patients under four months old are treated differently because they cannot produce their own antibodies yet. They may have transient antibodies from their mother that disappear after a few months. This affects how blood types and antibody screenings are performed for neonates.

What is the main blood bank test performed for adults and how is it conducted?

The main blood bank test performed for adults is the 'Type and Screen.' This test determines the patient's blood type (A, B, AB, O) and checks for any antibodies present in the patient's blood. The test is done by performing both forward and reverse blood typing, which must agree before assigning a blood type.

Why don't neonate patients undergo reverse blood typing?

Neonate patients don't undergo reverse blood typing because they cannot produce their own antibodies. The reverse blood typing involves testing the patient's antibodies, which neonates don't have the ability to make at such a young age.

What does the Rh antigen test (arch test) detect for neonate patients?

The Rh antigen test (arch test) detects the presence of Rh antigens on the patient's red blood cells. It helps to identify whether the neonate's red blood cells express the same antigens as an adult, and if there are any antigen mismatches between the neonate and their mother.

What is the purpose of the Direct Antiglobulin Test (DAT) for neonate patients?

The DAT is used to detect whether the neonate's red blood cells are coated with antibodies. A positive result suggests that the baby's red blood cells have been affected by antibodies, potentially leading to hemolysis and jaundice. It is commonly seen in ABO incompatibility between the baby and the mother.

How do you determine the need for crossmatching in neonate blood transfusions?

Crossmatching is only performed for neonate patients whose mothers have antibodies. In such cases, antigen-negative red blood cells are crossmatched with the baby's blood sample to ensure compatibility and avoid any adverse reactions during transfusion.

What type of blood products are typically given to neonate patients?

For neonate patients, group O negative red blood cells (RBCs) are typically used. Additionally, products like plasma, platelets, and cryoprecipitate may be used, depending on the patient's needs, with special consideration given to factors like irradiation, CMV status, and blood type compatibility.

Why is CPDA1 preferred for neonate blood transfusions, and what is the limitation?

CPDA1 (citrate-phosphate-dextrose-adenine) is preferred because it avoids additive cells, which are harder for neonates to process and can deplete calcium levels, causing cramps. The limitation arises from shortages in CPDA1 collection bags, which may require using alternative blood products or washing red blood cells in some cases.

What special considerations are there when selecting RBC products for neonate transfusions?

For neonates, the RBC products selected are typically fresh (less than 10 days old), CPDA1, and group O negative to reduce the risk of adverse reactions. Additionally, the RBCs must be free from additives and may require irradiation and CMV testing based on the patient's condition and hospital policies.

How does a light bath help treat jaundice in neonate patients with hemolysis?

A light bath helps treat jaundice in neonates by using phototherapy to break down the excess bilirubin produced from the destruction of red blood cells. This helps prevent complications like brain damage and seizures due to high bilirubin levels in the blood.