A novel technique for safe paediatric blood transfusion.

Abstract

Sir, We read with great interest the review article on perioperative neonatal and paediatric blood transfusion by Avnish Bharadwaj et al.[1] We congratulate the author for a detailed review on pre-operative evaluation, intraoperative management and complications associated with paediatric and neonatal blood transfusion. We would like to highlight an important step which is routinely missed during neonatal blood transfusion which may lead to adverse complications. Administration of blood components to neonates is generally volume-specific and is usually performed using a calibrated chamber device in the form of a syringe or volumetric buretrol. A standard blood administration set incorporating a filter (170–200 μm) which filters out large clots and aggregates should be used for transfusion in both adults and paediatric patients.[2] But whenever blood is ordered for a neonate in small volumes, it is usually received in a syringe (50 ml) which cannot be transfused using the standard blood set. It is also a common practice to use infusion pumps to transfuse the blood received in syringe aliquots for accurate rate- and volume-controlled delivery, especially during surgery. So, in situations where the blood is received in a syringe and has to be transfused using an infusion pump, it becomes difficult to incorporate a filter in the infusion line. To overcome this difficulty, we created an innovative way where under sterile conditions, the rubber tube at the distal end of another infusion set is removed and used to connect between the tip of the syringe and proximal end of the blood administration set as shown in Figure 1. We adapted this technique in more than 30 neonates without any significant problems, which assures that the blood transfused is filtered. This technique has its own limitations: (i) Increase in cost as two infusion sets are needed for single patient, (ii) strict asepsis should be maintained while connecting the tubings and (iii) increased chance of disconnections. Despite these minor drawbacks, this technique can be safely adapted during neonatal blood transfusion which can avoid adverse complications. Figure 1 Blood administration set modified for syringe aliquots This problem can also be solved by assuring that the blood received in syringe aliquots are already filtered in the blood bank at the time of withdrawing into the syringe. In India, even in tertiary hospitals, it is not a routine practice for the blood banks to filter the blood before withdrawing into the syringe from the main bag. So, it becomes the duty of the anaesthesiologists to confirm whether the blood is filtered or not during withdrawal into the syringe. If this vital step is missed before transfusion, it can lead to adverse life-threatening complications. Blood banks should make it a standard practice to filter the blood before withdrawing into the syringe from the main bag. It should also be made mandatory to label all blood products released as syringe aliquots as “pre-filtered” to avoid any confusion at the time of transfusion. No blood products should be transfused to neonates in pre-filled syringe aliquots without the label “pre-filtered” pasted on it.[3]