Monday, June 04, 2007

Save a Life, Give Blood!

"Blood Bank."

"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.


Awesome Mom said...

Thanks for that reminder! I really need to donate blood more often. Evan has received several transfusions and each time I have been so grateful that strangers took the time to donate it.

Anonymous said...

Yep, as an ED Nurse at a trauma center, I get to see LOTS of blood get used. Our biggest problem is we give so many PRBc's that we have to start pushing platelets, too to keep them from bleeding out all of the newly infused blood...

Judy said...

Then you probably get to give the FFP (fresh frozen plasma) to get the rest of the clotting factors -- or do you try to get them to ICU or Big City Medical Center for that?

Katie said...

Thanks for this post. I lost count of how many transfusions my son had during his 3 months in the NICU, but they saved his life numerous times - and turned my usually very cynical and terrified-of-needles brother into a proud, card-carrying blood donor.

Judy said...

My thanks to your brother. We need all the donors we can get -- and we do go through a lot of blood with some of our preemies!

Anonymous said...

I got my blood donation card last year type A negative, gave blood twice. Passed all the requirements. Then I read of theories of mental illness , which I am supposed to have. Theories that it may be caused by virus. The blood tests they do are for known virus and antibodies. No one has detected a reliable mental illnes virus. I do not take any psychiatric medicine/drug so I don't fear giving an accidental psych drug tranfer, I fear giving mental illness to someone accidentally. So I no longer donate.

Judy said...

That is the first time I've heard that particular theory. I understand your reluctance to donate until you know more about this. It's really hard to know what to believe some times.

Anonymous said...

Tuesday, 10 April, 2001, 00:22 GMT 01:22 UK
Virus link to schizophrenia

audio clip

Jane said...

I donate a couple of times a year, but this makes me want to step it up. NOW I know why the dang Red Cross is always calling me- I'm CMV (-). I mentioned that to the Red Cross nurse last time, and she said- oh that's not that important, it doesn't come in to play very often. Thanks for setting me straight! I'm a nurse- but I'm ER, so I didn't realize that babies needed CMV- blood.

Judy said...

The Red Cross nurse may not be aware that our NICU babies need CMV negative blood.

I'm going to have to edit my post. I found a whole list of people who benefit from CMV negative blood.

And thanks very much for your generosity!

jokergirl said...

I know it would not remove the blood shortage entirely, but it would probably help if the red cross/US legislature were not alienating a lot of willing donors by being over-careful in refusing donations.
Whenever I see a discussion on blood donation on the web, there are a lot of people who said they would love to donate but can't, usually because they a) have tattoos or piercings, or b) have been in Europe for 6 months. (You may not I'm not even touching the gay issue) I know it's because of the Creutzfeld/Jacob scare, bur where do you think European people would get their blood from if it was really that much of an issue?


Judy said...

Tattoos and piercings aren't generally a problem if they've been in place a while or done in a facility that meets certain sanitary standards (not required in all jurisdictions).

I think we have our own issues with variant CJD and I think that the Red Cross must have let up on that some, since my brother-in-law is donating again (Merchant Marine officer -- food issues).