Commentary on the safety of red cells preserved in extended‐storage media for neonatal transfusions

Abstract

Red cells preserved in extended-storage media are the standard product dispensed by many regional blood centers. When the red cells are intended for neonatal transfusion, concern exists about the safety of the relatively high quantities of additives present in these media. Definitive studies to address these concerns are not available. Therefore, to estimate the effects of additives and to delineate circumstances in which they might be harmful, the quantities transfused in defined clinical settings were calculated, and the following recommendations are offered for transfusing infants less than 4 months of age. First, red cells preserved in extended-storage media should present no substantive risks when used for small-volume (approximately 10 mL/kg) transfusions of premature infants and can be used without additional processing. Second, the risks of the most premature neonatal patients or those with severe renal and/or hepatic insufficiency cannot be defined clearly, and, because data are not available to ensure safety for these infants, removal of the additive medium and resuspension of the red cells in saline or albumin solution immediately before transfusion are recommended. Third, following a similar rationale, it seems prudent to avoid using entire units of red cells preserved in extended-storage media in massive transfusion settings (e.g., exchange transfusion, cardiac surgery, and extracorporeal membrane oxygenation). In these settings, the preservative medium should be removed and the red cells resuspended in the fluid that is most appropriate for the procedure that is planned. It must be emphasized that these recommendations are based on calculations and hypothetical settings, not actual data. Accordingly, they are tentative and should be altered as definitive information becomes available.

Collection and 28-Day Storage of Human Placental Blood

“…Blood banking strategies designed to accommodate the needs of the small infant have addressed problems related to handling of small blood volumes, limiting donor exposure, and minimizing blood wastage (30)(31)(32)(33)(34). Holland et al (35) have suggested that delayed clamping of the umbilical cord decreases transfusion requirements during the first week of life.…”

Fetal, Neonatal and Childhood Transfusions

“…There are theoretical concerns over potential toxicity of adenine and mannitol if given in large volumes to neonates [3], but a randomized trial showed apparent safety of these additives in neonatal cardiac surgery [4], and they are widely used for neonatal cardiac surgery in the UK with no evidence of adverse effects. Several retrospective studies have also reported an association between red blood transfusions and subsequent necrotizing enterocolitis (NEC) in neonates [5,6], but proof of a causal association requires prospective studies.…”

Blood component therapy

“…The RBC units stored in citrate-phosphate dixtrose-adenine (CPDA) solution with hematocrit 60-70% or in additive solution like saline -adenine-glucose mannital (SAGM) with hematocrit of about 50-60% are safe and efficacious for small volume transfusions. 8 It is also established that transfusing stored, rather than fresh red cell units present no risks when used for small volume transfusion as regard to potassium level, red cell 2, 3 diphosphoglycerate or other constituents present in additive solutions. 9 However, after 5 days of storage, the plasma potassium content is substantially elevated, so < 5 day-old blood should be used in case of rapid and large-volume transfusions.…”