Special Considerations in Pediatric Red Cell Transfusions

There is concern for toxicity of red cell additive solutions containing adenine & mannitol to cause liver & renal dysfunction if given in large doses. The storage age of the red cell unit can affect extracellular potassium in the unit; too much potassium can cause cardiac toxicity. For these reasons, the choice of red cell products is based on the dose.

Definitions

• Routine or small volume transfusion: typically 10 mL/kg (Indications: Routine transfusion, anemic NICU patient from blood draws)
• Large volume transfusion: 20-25 mL/kg (Indications: IUT, cardiac surgery with bypass, ECMO, trauma)
• Infant blood protocol: 1 sample from baby <4m used until baby is 4m, to prevent excess phlebotomy.

Products
(1) Pedi-pack = RBC CPD Divided Unit

• Volume: ~70mL (1/4of a regular sized rbc unit plus preservative)
• Preservative: CPD (contains anticoagulant citrate, phosphate, dextrose, does not contain mannitol or adenine)
• Shelf-life: <7 days “fresh”, expires on day 8
• Attributes: Leukoreduced, HbS negative, Irradiated (if child <4m or if indicated otherwise)
• HCT of unit: 65%
• Indications: Used for small or large volume transfusions
• Dose: 10 – 15 mL/Kg will increase Hb ~2-3g/dL or Hct 7-9%

(2) Assigned aliquots = RBC AS-5 Divided Unit

• Volume: ~40mL (1/8 of a regular sized rbc unit plus preservative)
• Preservative/Additive: Optisol = AS-5 (similar as CPD, plus mannitol & adenine)
• Shelf-life: 42 days, one set of 8 units assigned to one patient
• Attributes: Leukoreduced, HbS negative, Irradiated (if child <4m or if indicated otherwise)
• HCT of unit: 57%
• Indications: Used for small volume transfusions, reduces donor exposure because all 8 aliqouts are kept for one patient.
• Dose: 10-15mL/kg will increase Hb ~1.6 g/dL

(3) Reconsituted Whole Blood: Used for manual exchange transfusions. AS-5 leukocyte reduced, HbS negative, irradiated red cells and AB FFP. Platelets are not supplied in this product; post-procedure platelet count should be obtained.