Washed versus unwashed red blood cells for transfusion for the prevention of morbidity and mortality in preterm infants

Keir, Amy; Wilkinson, Dominic; Andersen, Chad; Stark, Michael J.

doi:10.1002/14651858.cd011484

Cited by 4 publications

(5 citation statements)

References 32 publications

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“…However, the process RBCs undergo during the required washing sequences [89] removes not only 98% of plasma, but also up to 20% of RBCs [92]. There is currently insufficient evidence to support or refute washing of RBCs; this practice is not routinely recommended for neonatal small‐volume transfusion [68,93]. Given possible safety issues, some blood banks choose to remove the additive solution from RBC units for large‐volume transfusions [1,73].…”

Section: Optimal Transfusion Procedures and Productmentioning

confidence: 99%

Neonatal red blood cell transfusion

et al. 2020

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Transfusions are more common in premature infants with approximately 40% of low birth weight infants and up to 90% of extremely low birth weight infants requiring red blood cell transfusion. Although red blood cell transfusion can be life‐saving in these preterm infants, it has been associated with higher rates of complications including necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity and possibly abnormal neurodevelopment. The main objective of this review is to assess current red blood cell transfusion practices in the neonatal intensive care unit, to summarize available neonatal transfusion guidelines published in different countries and to emphasize the wide variation in transfusion thresholds that exists for red blood cell transfusion. This review also addresses certain issues specific to red blood cell processing for the neonatal population including storage time, irradiation, cytomegalovirus (CMV) prevention strategies and patient blood management. Future research avenues are proposed to better define optimal transfusion practice in neonatal intensive care units.

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Section: Optimal Transfusion Procedures and Productmentioning

confidence: 99%

Neonatal red blood cell transfusion

et al. 2020

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“…Blood products are involved in large and diverse randomized controlled trials (RCTs). [11][12][13][14][15] COVID-19 Convalescent Plasma (CCP) is collected from recently recovered donors and contains antibodies against the SARS-CoV2 virus. CCP has been studied as an experimental transfusion therapy in a number of RCTs worldwide.…”

Section: Introductionmentioning

confidence: 99%

“…Blood products are involved in large and diverse randomized controlled trials (RCTs) 11–15 . COVID‐19 Convalescent Plasma (CCP) is collected from recently recovered donors and contains antibodies against the SARS‐CoV2 virus.…”

Section: Introductionmentioning

confidence: 99%

A data‐informed system to manage scarce blood product allocation in a randomized controlled trial of convalescent plasma

Zeller

Shih

et al. 2022

Transfusion

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Background Equitable allocation of scarce blood products needed for a randomized controlled trial (RCT) is a complex decision‐making process within the blood supply chain. Strategies to improve resource allocation in this setting are lacking. Methods We designed a custom‐made, computerized system to manage the inventory and allocation of COVID‐19 convalescent plasma (CCP) in a multi‐site RCT, CONCOR‐1. A hub‐and‐spoke distribution model enabled real‐time inventory monitoring and assignment for randomization. A live CCP inventory system using REDCap was programmed for spoke sites to reserve, assign, and order CCP from hospital hubs. A data‐driven mixed‐integer programming model with supply and demand forecasting was developed to guide the equitable allocation of CCP at hubs across Canada (excluding Québec). Results 18/38 hospital study sites were hubs with a median of 2 spoke sites per hub. A total of 394.5 500‐ml doses of CCP were distributed; 349.5 (88.6%) doses were transfused; 9.5 (2.4%) were wasted due to mechanical damage sustained to the blood bags; 35.5 (9.0%) were unused at the end of the trial. Due to supply shortages, 53/394.5 (13.4%) doses were imported from Héma‐Québec to Canadian Blood Services (CBS), and 125 (31.7%) were transferred between CBS regional distribution centers to meet demand. 137/349.5 (39.2%) and 212.5 (60.8%) doses were transfused at hubs and spoke sites, respectively. The mean percentages of total unmet demand were similar across the hubs, indicating equitable allocation, using our model. Conclusion Computerized tools can provide efficient and immediate solutions for equitable allocation decisions of scarce blood products in RCTs.

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“…Kier et al . have performed a Cochrane review of studies of washed versus unwashed red cells transfused to treat the anaemia of prematurity in neonates [20]. They concluded that there is insufficient data to support or refute the use of washed RBCs to prevent the development of significant neonatal morbidities or mortality.…”

Section: Clinical Benefits For Other Indicationsmentioning

confidence: 99%

Washed red cells: theory and practice

et al. 2020

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Washing of red cells is sometimes performed to reduce allergic reactions due to contaminating plasma proteins or to reduce the concentration of potassium accumulating in the supernatant of red cells during storage as an alternative to transfusion of fresher red cells in patients at risk of hyperkalaemia. There are a variety of methods for washing red cells, and the laboratory data suggest that variables such as age of red cell before washing, washing method and solution, storage medium and length of storage time after washing can all effect the final red cell quality. Studies suggest that washing removes 90-95% plasma, but the proportion of units below 0Á05 mg/dl IgA (equivalent to IgA deficient) is variable dependent upon methods used. Although potassium levels are reduced immediately following washing, the rate of leakage following subsequent storage is method-dependent, requiring careful consideration of shelf life if potassium reduction is the goal. Other markers of red cell quality such as haemolysis are negatively impacted by washing so a reduced shelf life compared to standard red cells is appropriate, especially following irradiation. Data from animal models and clinical studies on possible additional benefits of washing, such as reduced lung or kidney injury, are mixed, ranging from some benefit to some harm, and further studies are warranted.

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Washed versus unwashed red blood cells for transfusion for the prevention of morbidity and mortality in preterm infants

Cited by 4 publications

References 32 publications

Neonatal red blood cell transfusion

Neonatal red blood cell transfusion

A data‐informed system to manage scarce blood product allocation in a randomized controlled trial of convalescent plasma

Washed red cells: theory and practice

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