Monday, June 04, 2007
Save a Life, Give Blood!
"I need platelets for baby Anemic. Do you have any for her?"
"No. Sorry. I'll have to get those for you from the Red Cross."
"How long will that take?"
"At least 4 hours."
"Oh. Let them know the platelet count is 35,000"
"Didn't come up much after the last transfusion, did it?"
"No. Looks like it's going to be a long night. Can you send me some packed red cells while we're waiting for the platelets?"
"Sure thing. I'll have those ready in 15 minutes and I'll call when the platelets come in."
"Thanks. I'll send someone down for the blood in a few minutes."
The conversation could happen pretty much any day in any busy Neonatal ICU -- or adult ICU, for that matter. Platelets are one of the blood components responsible for clotting. There are many illnesses and traumas that can make the platelet count drop precipitously. Packed red cells (PRBC) are the cells in blood that carry oxygen. Babies, and to a lesser extent, adult ICU patients, often need transfusions simply because we have to take so much blood out for lab testing. We try to limit the draws, and we only take tiny amounts, but in a critically ill patient it adds up.
Babies can lose blood as a result of surgery, hemorrhaging into the brain or the intestine (usually a result of necrotizing enterocolitis). Blood cells can be destroyed by infection, and rarely as a result of Rh incompatibility. It's rare, but it still happens. Transfusions can be our only option.
When transfusing a newborn, we can't just use any blood. The blood has to pass all the screening tests used to test blood for adults -- and one more. The blood has to test negative for Cytomegalovirus (CMV). 50-85% of adults in the US test positive for CMV, so we are seldom able to use directed donor blood. The families who request directed donation are upset at first, but once we explain the potential devastating effects of CMV infection in newborns, they realize that we are only trying to protect their baby. CMV can cause profound neurological damage in people whose immune system isn't working properly -- and especially in premature infants because their immune systems are immature.
With 50-85% of adults testing positive for CMV, we sometimes have to wait for safe blood for our babies. In the summer, when donations drop off, that is much more likely. While you're planning your summer, please give some thought to scheduling time to donate blood whether you're CMV negative or not -- someone is waiting for it.
Images shamelessly stolen from the World Blood Donor Day web site.
Update: Since posting, I've discovered that there is a whole list of people who need CMV negative blood. The list includes prenatal transfusions (slaps head), transfusions for CMV negative pregnant women, organ and bone marrow recipients (unless they or the organ are CMV positive). There's a longer list below that one on the same page of people who might benefit.