Neonate transfusion dose?
Blood: 10-15 mL/kg
FFP: 10-15 mL/kg
Plt: 5-10 mL/kg
Cryo: 1-10 U/10kg
Do neonates need 5-7 day old RBCs?
Worry of mannitol?
Are units leukoreduced, radiation needed?
Concern for >20 mL/kg it effects cerebral blood blow
Yes leukoreduced; Rads for preemies and immunocompromised
What causes HDFN?
Mom's IgG antibodies that attack RBCs of neonate (Paternal molecules)
Anemia; indirect hyperbilirubinemia; and DAT+
ABO most common: mon O, and Anti-A,B (IgG) crosses placenta; mild hemolysis
Rh: Rare, D- mom, D+ baby; Bilirubin below 20 mg/dL; Phototherapy/echange
D- female @ 28 wks
D- female within 72 hrs of D+ delivery
D- with pregnancy complications
Contra: D- female WITH Anti-D (rule out previous RhIg administration last 6 months)
D+ females (weak D)
RhIg Full dose 300 ug protects against how much D+ whole blood?
Mini-dose 50 mL protects against?
30 mL D+ whole blood or 15 mL RBCs
Mini: 5 mL D+ whole blood; 1st trimester Abs
Fetal Rosette test?
Mom's blood look for D+ test: Add Anti-D and add indicator D cells and form Rosette's
Kleihauer-Betke: Fetal hemoglobin is resistant to acid treatment; Maternal cells are ghosts, fetal cells pink. Count 2000 cells
RhIg dose; round up or down?
<0.5 round up; if >0.5 or 0.5 round up one and again!
(%KB positive cells *5)/3
How to calculate %compatible units?
Estimate number needed to be screened?
Multiple %negative for each unit
Needed to crossmatch= # units needed/Chance of combination
What is corrected count incriment?
How to calculate?
Successful vs unsuccessful?
CCI= (Plt increase *BSA)/ Plt transfused
<5000 on 2 or more refractory
What is needed to dose Cryoprecipitate for Dosing?
BV, PV, mg Fibrinogen required (150 assumed)
BV: Body weghtx 70 mL/Kg
PV= BV * (1 -HCT)
Mg fibrinogen needed: PV * (desired level - current)/150
Contrainers of cryo: Mg fibrinogen nedded/150
Factor 8 calculation requires?
Body weight, HCT, F8 level and target
50% for hemarthrosis and 100% for surgery or major bleed
Units= PV (desired- current level)
Cryoprecipitate needed: Units needed/80 IU/unit
Antibody indification check first?
Typical cold antibodies (Frigid five)?
Autocontrol for auto antibodies!!
LeA, LeB, M, N, P: do not react at body temp; clinically insignificant most of the time
What is autoadsorption?
If autoantibody detected add Patient's cells to remove to reveal underlying antibodies
Lewis a- b- more common in blacks or whites?
S- s- U-?
Fy a- b-?
Le a-b-: Black 22%, 6% White
S- s- U-: <1% blacks, NEVER IN WHITES
Fy a- b-: 68% blacks, rare whites; protects against P. Vivax
K antigen: 2% black, 9% white
Rule of B's, exception?
Big 4 R/r white vs black?
B antigen more common unless Kidd