Dedicated donor unit transfusions reduces donor exposure in pediatric surgery patients

Abstract

BACKGROUND:Many strategies have been explored to reduce multiple donor exposures in neonates such as use of restrictive transfusion protocols, limiting iatrogenic blood loss, use of recombinant erythropoietin and single donor programs.METHOD:In our study we assessed the feasibility of dedicating single donor units with reserving all the components from the same donor for the specified neonates/infants undergoing surgery and estimating reduction of donor exposure. Fifty neonates undergoing surgery were included in the prospective study group and the transfusion details were compared with 50 retrospective cases with same inclusion criteria.RESULTS:An intra-operative blood loss of >13 ml/Kg was significantly associated with transfusion (P <0.05) which was most frequently administered in the intra-operative period. Donor exposure rate of overall transfusion was 1.15 in the study group as compared to 4.03 in the retrospective control group. In study group Donor Exposure Rate (DER): Transfusion Rate (TR) ratio was 1:1.5 and Transfusion per Donor Unit (TPDU) of 1.5, means that one donor unit contributed to 1.5 transfusions in each patient and contributed to 50% reduction in donor exposure in each patient as compared to retrospective control group.CONCLUSION:Our study showed that by practicing dedicated donor unit transfusion policy, for neonates undergoing surgery we could significantly reduce the donor exposure.

A cost-analysis study of using adult red cell packs and Pedi-Packs in newborn intensive care units in Southern Iran

“…The volume of our hypothetical quadruple Pedi-Pack set was similar to what was reported by Satyam et al and Cook et al studies [ 9 , 10 ]. However, other studies reported different values [ 11 , 12 , 15 ].…”

“…In this method, an appropriate volume is transferred by gravity into connected satellite packs whenever transfusion is required. [ 9 , 14 , 17 – 23 ].…”

“…Single donor program is a remarkable strategy to achieve a cost-effective method of neonatal transfusion, as a saving of $0.5 and $5.54 per transfusion were reported in two various studies, [ 18 , 21 ]. Furthermore, assigning Pedi-Packs as a single donor program using at least 4 satellite packs for up to 35–42 days stored RBCs was reported as a safe, convenient, and effective method for transfusion in neonates in several other cost-effectiveness studies as well [ 9 , 14 , 17 , 19 , 20 , 23 ].…”

Acute haemolytic transfusion reaction after transfusion of fresh frozen plasma in a neonate—Preventable by using solvent/detergent‐treated pooled plasma?

“…In addition, due to the pooling, multiple donor exposure in neonates can result in increased risk of adverse effects like transfusion transmitted infections and immunomodulation. 18 Although literature evidence of SD plasma in children is limited, there are several published studies. In a large prospective observational study the use of FFP and SD plasma were compared in critically ill children in 101 paediatric intensive care units in 21 countries.…”

Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients

“…For example, younger patients are more susceptible to electrolyte and metabolic consequences of transfusions (e.g., hyperkalemia, hypocalcemia), since the amount of blood given during surgery or massive transfusion can equal the total blood volume of a neonate, and the glomerular filtration rate of newborns does not reach maturity until near the first year of life (4,6,7). Moreover, many children's hospitals follow a dedicated donor strategy, wherein a single-donor unit is split into multiple pediatric packs for use in a designated patient (8)(9)(10), up to the date of expiration. This practice reduces the risk of multiple donor exposures, but with the consequence that older RBCs are then used for subsequent transfusions.…”