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Guidelines for selection of blood
components for ABO-Incompatible Heart Transplants: patients less than
1 year old.
University of Michigan Hospitals & Health Centers
· Blood Bank & Transfusion Service
HEART, LUNG, HEART-LUNG TRANSPLANTS
AND HEART ASSIST DEVICES
General Information
ABO-incompatible transplants are performed on infants as their ABO
isohemagglutinins are not well developed.
Supplies
In addition to testing materials, the following items are needed:
Nomograms for 50% Hematocrit
Sample Site Coupler
These items are stored on the counter in the pooling area.
Potential ABO-Incompatible Heart Transplant
When an infant is identified as a potential ABO-incompatible
heart transplant candidate, enter a PTC comment: "Potential Heart
Transplant, issue Leukocyte-reduced Red Blood Cells and Platelets.
Do not volume reduce RBC for isohemagglutinin removal
for pre-operative bedside requests.
To prepare a volume reduced partial unit
| Step |
Action |
| 1. |
Obtain a group O LPRCA |
| 2. |
Divide the unit equally into . Modify the unit to
Leukocyte-reduced RBC Part (LRRP) and reserve the LRRP for the infant. |
| 3. |
Centrifuge the reserved unit for the time and speed
indicated on the centrifuge |
| 4. |
Carefully remove the unit from the centrifuge without
disturbing the plasma-cell interface. |
| 5. |
Place the unit in the plasma extractor, attach a transfer
pack and express all the plasma/supernatant into a transfer pack |
| 6. |
Use a heat sealer to seal the connecting tubing and
separate at the seal. Discard the plasma/supernatant into a biohazard
bucket. |
| 7. |
Weigh the volume reduced red blood cell unit and record
the weight on the label. |
| 8. |
Label the unit and attach the Instructions for Reconstituting
a Volume Reduced RBC with Saline, a transfusion record form, and
a sample site coupler to the unit. |
| 9. |
Notify the nursing unit when the product is available. |
Transplant Notification
When notified of a transplant, obtain the ABO of the donor heart. If
the transplant is ABO incompatible, enter the phrase HTXPABO in PTC.
Information entered should provide guidelines during and after the transplant.
If the transplant is cancelled, remove the HTXPABO comment.
Blood Selection
ABO of Heart Recipient |
ABO of Donor Heart |
Select for Transfusion |
|
|
Plasma |
Red Cells |
Platelets |
O |
AB |
AB |
O |
AB |
O |
B |
AB or B |
O |
AB or B |
O |
A |
AB or A |
O |
AB or A |
B |
AB |
AB |
O or B |
AB |
B |
A |
AB |
O or B |
AB |
A |
AB |
AB |
O or A |
AB |
A |
B |
AB |
O or A |
AB |
Provide Volume reduced Leukocyte-reduced cellular components only
·
Freshest available ·
Irradiation not required unless specified in PTC. ·
SKL testing is NOT required ·
Do not prepare resuspended whole blood ·
If AB prestorage leukocyte-reduced platelets are not available, wash
a pool of 2 of the appropriate platelet ABO
Initial Set up
Patient Weight (kg) |
Volume reduced LPRCA |
FFP |
Platelets |
3 |
4 units |
600 mL |
2 reserved unpooled |
5 |
5 units |
800 mL |
4 reserved unpooled |
7 |
6 units |
1000 mL |
5 reserved unpooled |
10 |
7 units |
1600 mL |
5 reserved unpooled |
Post Transplant
Volume reduce RBC components for post-operative requests.
Titers
Isohemaglgutinin titers will be performed periodically to determine
the level of antibody incompatible with the transplanted heart. Call
intraoperative titer results to the OR Room. The following titers are
recommended:
Pretransplant
After the 3 volume exchange (If the titer following the exchange
is > 1:2, an additional single volume exchange will be performed)
After the single volume exchange
Post transplant
Once a week for on month post transplant
Every 4-6 months after transplant
Additional titers are performed as requested.
Related Documents
R576 Heart Transplant Isohemagglutinin Titers
B220 Component Preparation: Volume Reduce Red Blood Cells
Braine H, Cytomegalovirus Infection in Clinical Transplantation: "Approaches
to Prevention of Posttransfusion CMV Infection" Controversies in Transfusion
Medicine AABB 1990.
Attachment: Instructions for Reconstituting Volume Reduced EBC with
Saline to a 50% Hematocrit for Candidates and Patients Who Have Had
ABO Incompatible Heart Transplants.
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