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

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