Region’s newborns in crosshairs of possible blood shortage

Registered Nurses Lindsay Cousins (center) and Lisa Hayes (left) prepare a premature baby for a blood transfusion.
Registered Nurses Lindsay Cousins (center) and Lisa Hayes (left) prepare a premature baby for a blood transfusion in the NICU department of Rady Children’s Hospital in San Diego on Thursday. Newborns will be among the most threatened groups if an anticipated shortage of rare blood types materializes.
(Adriana Heldiz / The San Diego Union-Tribune)

Babies who need transfusions often require O negative blood which is threatened by supply shortage

Share

Newborns, especially those born prematurely, could be particularly affected if a supply chain shortage reduces availability of donated type O negative blood.

Last week, the San Diego Blood Bank put out an urgent call for donations with an emphasis on the 7 percent of the population walking around with this particular blood type, which is sought after because it can be accepted by anyone, regardless of blood type.

Though the situation has not yet turned dire, thin standing supplies, combined with a typical reduction in donations around the holidays, spurred those in charge of maintaining a robust supply to let the public know what’s at stake, should shortages occur.

Traumatic injury is usually the first thing that people think about when the possibility of a blood shortage appears on the horizon. While car accidents and other kinds of sudden injury definitely do create a need for O negative in situations where a person’s native type is not known, or there simply is not enough time to find it out, that’s not the whole picture.

Dr. Denise Malicki, chief of the division of pathology at Rady Children’s Hospital, explains that O negative is heavily used by children’s hospitals because its universality is of particular use for premature babies.

Genetics dictate that a child will not always inherit their mother’s blood type, but they will very likely end up with a wide selection of their mother’s antibodies floating around in their veins after birth. This is because antibodies, those tiny proteins that mark foreign cells for destruction by the immune system, can and do cross from mom to baby through the placenta before birth.

Bags of donated blood are stored in cooled refrigerators in the laboratory of Rady Children's Hospital in San Diego, CA .
Bags of donated blood are stored in cooled refrigerators in the laboratory of Rady Children’s Hospital in San Diego.
(Adriana Heldiz / The San Diego Union-Tribune)

This means that one could give a newborn a transfusion that perfectly matches the blood type they were born with but mom’s antibodies, created for a different blood type, can end up marking those cells as invaders that should be destroyed.

“The transfusion needs for infants, for neonates, can be a little more complex because of those maternal antibodies,” Malicki said. “So we will have to make sure that the blood we give the infant is compatible with both the infant and the mom if they don’t have the same blood type.”

Transfusions for premature babies, added Dr. Jeanne Carroll, a neonatologist at Rady, may be required for many different reasons, everything from addressing a lack of red blood cells at birth called anemia to blood loss from frequent samples collected as medical teams are trying to diagnose serious symptoms shortly after birth.

“You know, a premature infant may only have a quarter cup of blood in their entire body, so we can’t take a lot without replacing it,” Malicki said.

The never-ending need for blood is in literal motion inside Rady’s neonatal intensive care unit where some newborns are undergoing extracorporeal membrane oxygenation, a process that uses a machine outside the body to remove carbon dioxide and add oxygen when a young child’s lungs aren’t yet up to doing the job on their own.

It is regularly the case, Carroll said, that additional donated blood must be added, and it needs to be type O negative if there is a mismatch with the mother, a situation that, according to medical literature, occurs in about 15 percent of births.

RN Lisa Hayes prepares a premature baby for a blood transfusion in the NICU department of Rady Children's Hospital.
Registered Nurse Lisa Hayes prepares a premature baby for a blood transfusion in the NICU department of Rady Children’s Hospital in San Diego on Thursday.
(Adriana Heldiz / The San Diego Union-Tribune)

“We’re checking every six hours, and we also have continuous monitoring of what the red blood cell hemoglobin levels are, and that will give us an indication of if we need to transfuse blood sooner,” Carroll said.

The possible shortage revolves around a process called “apheresis” which removes blood from donors, separates just red blood cells, then reinjects plasma, platelets and white blood cells back into the body. Putting a large percentage of what’s collected right back into the body allows a second unit of red cells to be collected in the same manner during a single visit with no damage to a healthy donor.

The potential shortage involves particular collection kits for commonly-used apheresis machines used by Terumo Global Blood solutions. The company said in a statement last week that shortages of raw materials have led to the current shortage of “double red” collection kits.

At the moment, blood banks are looking extra hard for additional donors, especially if they have rare blood types.

Those age 17 or older, and who weigh at least 114 pounds, are eligible to donate blood if they are in general good health.

To schedule an appointment, visit sandiegobloodbank.org or call (619) 400-8251. Red Cross events can be accessed at redcrossblood.org.