Caitlin Raymond: When Technology Meets Physiology in Neonatal Patients
Caitlin Raymond, a board-certified Clinical Pathologist and current Transfusion Medicine Fellow at the National Institutes of Health, shared on LinkedIn:
”When innovation meets its limits — and why that matters for the smallest patients.
I was recently consulted on a premature infant, six weeks old and just 2.5 kg, already on ECMO and now facing sepsis.
The ICU team requested plasmapheresis for a presumed cytokine storm — a reasonable thought under the ASFA guidelines.
But when I calculated the baby’s total blood volume — only 250 mL — it became clear the procedure simply wasn’t possible.
Even with the best intentions and sound rationale, the machine itself had limits: the Terumo system requires a minimum 300 mL TBV, 10 % Hct, and 0.5 L plasma volume.
We ultimately recommended a whole blood exchange, the only feasible path forward for cytokine and toxin removal.
This case was a humbling reminder that in transfusion medicine, the boundaries of care aren’t always physiologic — sometimes they’re mechanical.
As technology evolves, we must continue to advocate for innovation that reaches every patient, not just the ones who fit within device specifications.
Read the full reflection here.”
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