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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

StepAction
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.