Special Considerations in Pediatric Transfusions

Additive Solutions
There have been no reports of toxicity with transfusion of large volumes of red blood cells stored with additive, anticoagulant-preservative solutions (e.g. Opitsol AS5*). However, because of the theoretic risk of toxicity secondary to manitol and adenine contained in standard additive solutions, a limited number of red blood cells are stored in CPD (citrate/phosphate/dextrose), which contains neither manitol nor adenine. These CPD RBC’s are primarily given to infants receiving large volume or rapid transfusion; all units are < 5 days of age and leukoreduced.

The following guidelines have been adopted by the CHRMC Blood Usage Committee for RBC transfusio

Infants < 4 months of age*
ECMO, Liver Transplant	CPD RBC’s, leukoreduced
Rapid or Large Volume
Exchange Transfusion	Reconstituted Whole Blood (CPD Oneg RBC’s, AB FFP) leukoreduced RBC's
Children < 2years of age*
Cardiopulmonary bypass (<4 months of age irradiated)	- Priming for CPB CPD Whole Blood**, leukoreduced
	- Intraoperative CPB CPD RBC's, leukoreduced
Routine transfusions*	Standard Additive (Optisol AS5®). Or CPD, whatever is available

* See pages 9-10 for recommendations on blood component modification

** It should be noted that there are no viable platelets in Whole Blood because of refrigerated storage. Factor VIII activity decreases rapidly in storage and will not be present in therapeutic levels. Other coagulation factors, including fibrinogen, in whole blood are at essentially normal levels at 5 days.

Therapeutic Effect
In children receiving CPD RBC’s, 1mL/kg should raise the hct 1%. In children receiving RBC’s in standard additive, 1mL/kg should raise the hct .5 - .7%.