Blood component preferences of transfusion services supporting infant transfusions: a University HealthSystem Consortium benchmarking study

Abstract

Although the majority of institutions will use ASs, a significant number of institutions will not. The reasons for these policies were not elicited. Most respondents did not have a policy requiring washing beyond a specified number of days of storage or days after irradiation. Since RBCs stored for prolonged periods of time after irradiation have increased plasma potassium, it is important to develop policies to prevent clinically significant posttransfusion hyperkalemia in at-risk patients when RBCs are irradiated and not used immediately. More work still needs to be done to resolve these fundamental precepts of neonatal transfusion.

Immunosuppressive effects of red blood cells on monocytes are related to both storage time and storage solution

“…These AS provide substrate for ongoing production of ATP and are designed to maintain RBC viability. Many institutions, however, preferentially use CPD‐only units for infants 27 . The concern that older RBC products seem to be more immunosuppressive suggests that changes related to storage may play a role in RBC‐induced immune suppression.…”

Cesium cessation? An advantage of pathogen reduction treatments

“…Hyperkalemic posttransfusion fatalities in neonates have been reported 41 . No uniform practice exists in this setting with respect to permissible storage times after irradiation 42 . This complex decision depends upon many variables including the clinical status (e.g., hyperkalemia, renal function, acid‐base status, metabolic rate, medications), age of unit irradiated, anticoagulant‐preservative (CPD units have higher potassium concentrations), and the anticipated rate and volume of transfusion.…”

Research Opportunities to Improve Neonatal Red Blood Cell Transfusion

“…The cumulative data from these trials suggest that transfusion of older RBC units, compared to younger RBC units, does not lead to harm. Regardless, the majority of institutions have standard operating procedures limiting the age of blood transfused to neonates [45, 46]. In addition, multiple other aspects of RBC preparation such as irradiation, using washed vs. unwashed RBCs [47], and the comparative effectiveness of strategies to prevent transfusion-transmission of infections [48] have not been as rigorously studied with sufficient power to adequately evaluate their safety.…”

“…A 2010 survey of 28 academic medical centers transfusing neonatal patients showed inherent blood banking practice variability with regard to the type of RBC anticoagulant-preservative solution transfused [45]. More recently, the blood banks participating in the Transfusion of Prematures (TOP) trial were surveyed on their blood banking practices for extremely low birth weight (ELBW) infants [46].…”

“…More recently, the blood banks participating in the Transfusion of Prematures (TOP) trial were surveyed on their blood banking practices for extremely low birth weight (ELBW) infants [46]. Similar to the 2010 survey [45], this survey of 29 institutions also showed blood bank practice variability in target RBC ages for neonatal transfusion, type of RBC anticoagulant-preservative solution transfused, and timing of irradiation of products.…”