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LETTER TO EDITOR
Year : 2015  |  Volume : 59  |  Issue : 8  |  Page : 527-528  

A novel technique for safe paediatric blood transfusion


1 Department of Anaesthesiology and Critical Care, Indira Gandhi Medical College and Research Institute, Puducherry, India
2 Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Web Publication17-Aug-2015

Correspondence Address:
Stalin Vinayagam
FR4, Sri Anbalaya Apartments, 17th Cross Street, Krishna Nagar, Puducherry - 605 013
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.163012

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How to cite this article:
Dhanger S, Vinayagam S, Venkatesan K. A novel technique for safe paediatric blood transfusion. Indian J Anaesth 2015;59:527-8

How to cite this URL:
Dhanger S, Vinayagam S, Venkatesan K. A novel technique for safe paediatric blood transfusion. Indian J Anaesth [serial online] 2015 [cited 2021 Mar 7];59:527-8. Available from: https://www.ijaweb.org/text.asp?2015/59/8/527/163012

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

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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]

 
   References Top

1.
Bharadwaj A, Khandelwal M, Bhargava SK. Perioperative neonatal and paediatric blood transfusion. Indian J Anaesth 2014;58:652-7.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Australian and New Zealand Society of Blood Transfusion Ltd. (ANZSBT), Royal College of Nursing (RCNA). Guidelines for the Administration of Blood Products. 2 nd ed. Sydney Australian and New Zealand Society of Blood Transfusion Ltd. (ANZSBT), Royal College of Nursing (RCNA); 2011. Available from: http://www.anzsbt.org.au/publications/documents/ANZSBT_Guidelines_Administration_Blood_Products_2n dEd_Dec_2011_Hyperlinks [Last accessed on 2015 Feb 05].  Back to cited text no. 2
    
3.
Strauss RG, Crawford GF, Elbert C, Floss AM, Liesch M. Sterility and quality of blood dispensed in syringes for infants. Transfusion 1986;26:163-6.  Back to cited text no. 3
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