Bring the caffeine as we wrap up IUTs this week with our detailed step by step on the procedure itself. In this episode we talk about:

• The pre-operative process including consenting and lab studies
• Using the MCV value on a CBC to determine fetal vs. maternal sample (only works for the 1st IUT) 
• Fetal sample= 105-110
• Maternal sample = 80s-90s
• How much blood to order from the blood bank for a transfusion
• <24 weeks order 1/2 unit (split it - save the other half for the next IUT!) 
• 24-28 weeks order 1 unit
• 28-35 weeks order 2 units
• Fetal drug calculations
• Atropine = 0.02 mg/kg
• Fentanyl = 2 mcg/kg
• Vecuronium = 0.1 mg/kg
• Pre- & post-operative monitoring 
• Pre-op = 20 min strip of toco + FHR 
• Post-op = 2 hours continuous toco + FHR
• Patient positioning in the OR = left lateral tilt
• Patient comfort in the OR - aromatherapy kit, eye mask, spa music 
• How we warm up the blood in the OR, who checks it and what we check
• Brief sidebar on CMV - what it is, why we want CMV negative donor blood and what we do if we can't get CMV negative blood
• How to decide your needle type for the procedure
• 3-inch vs 6-inch length - depending on the depth measure on ultrasound
• Quincke tip vs. Whitacre tip
• Deciding gauge/size
• 22G (<22 weeks)
• 20G (>22 weeks)

• Role of a coulter and automated hemocytometer outside the OR
• Fetal labs to order at an IUT
  • At the 1st IUT
    • Initial Fetal Sample: CBC, ABO/Rh, (Fetal Antigen type), reticulocyte count, DAT
    • Final Fetal Sample: CBC, KB Stain +/- hemoglobin electrophoresis
  • On all subsequent IUTs for that pregnancy
    • Initial Fetal Sample: CBC, reticulocyte count
    • Final Fetal Sample: CBC, KB stain +/- hemoglobin electrophoresis
• Patient questions to ask your provider prior to having an IUT performed:
  • “How many IUT procedures do you perform in a year?”
  • “What are your outcomes?”
  • “Where/How did you get your training?”

Abbreviations:

• CBC = complete blood count
• MCV = mean corpuscular volume
• CMV = Cytomegalovirus
• KB Stain = Kleihauer-Betke Stain
• DAT = Direct Antiglobulin Test AKA Direct Coomb’s Test