Whereas ECMO treatment of neonatal patients has a relatively minor impact on a transfusion service, the same is not true for a program that uses this form of treatment for adults as well.

An analysis of the transfusion records of 91 neonatal patients subjected to extracorporeal membrane oxygenation (ECMO) is reported. Mean daily blood usage was 250 mL of red cells (RBCs), 80 mL of fresh-frozen plasma, and 2 units of platelets. Average time on ECMO was 4.6 days. Group O or ABO type-specific RBCs and group AB or ABO type-specific plasma products and platelets were transfused. RBCs were not washed, and neither RBCs nor other components were tested for anticytomegalovirus (CMV) or irradiated. No cases of posttransfusion CMV infection or graft-versus-host disease were observed. Hemolysis in eight patients was traced to occlusions in the ECMO circuit. All but three patients survived ECMO. Contrary to a previous report, an active ECMO program for neonatal patients imposes a minimal burden on the hospital transfusion service.

Eliminating the 37 degrees C reading from pretransfusion antibody screening tests imposes less risk than omitting the routine IAT-XM, and it avoids the time and costs of evaluating unwanted positive tests, thus reducing expenditures and delays in patient care.

The recently FDA-licensed anti-IgG gel test for pretransfusion antibody detection requires crossover validation before implementation. Six hundred coded samples sent for routine pretransfusion tests were used to compare GEL (ID-MTS, Ortho Diagnostic Systems Inc., Raritan, NJ) with Löw and Messeter's low-ionic-strength saline (LISS). There were 456 GEL-LISS-, 97 GEL+LISS+, 45 GEL-LISS+, and 2 GEL+LISStests. The 144 positive tests involved 157 antibodies; 67 of these (cold auto, anti-M, -Le, etc.) were considered harmless with respect to transfusion management. GEL-LISS+ tests included seven samples containing potentially significant antibodies (assumed from specificity): anti-K(4), -Jk a , -Fy b , and -S. Two potentially significant antibodies (anti-C and -D) were GEL+LISS-. Sensitivity and specificity for potentially significant antibodies were 92% and 96% for GEL, and 98% and 90% for LISS, respectively. The seven GEL-LISS+ samples associated with potentially significant antibodies were from six patients. Five of these antibodies, all detected in immune-suppressed patients, reacted predominantly as agglutinins in LISS. None of these seven antibodies were detected reliably by polyethylene glycol and LISS-additive tube methods. In light of the immune status of the patients with GEL-LISS+ agglutinins with specificity normally considered potentially significant, and because other valid methods did not detect these antibodies, their clinical importance is questionable. Excluding these questionable antibodies, GEL has the same sensitivity and better specificity than LISS. GEL is a valid method for pretransfusion antibody detection.