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Special Considerations in Pediatric Red Cell Transfusions

There is concern for toxicity of red cell additive solutions containing adenine & mannitol to cause liver & renal dysfunction if given in large doses. The storage age of the red cell unit can affect extracellular potassium in the unit; too much potassium can cause cardiac toxicity. For these reasons, the choice of red cell products is based on the dose.

Definitions

  • Routine or small volume transfusion: typically 10 mL/kg (Indications: Routine transfusion, anemic NICU patient from blood draws)
  • Large volume transfusion: 20-25 mL/kg (Indications: IUT, cardiac surgery with bypass, ECMO, trauma)
  • Infant blood protocol: 1 sample from baby <4m used until baby is 4m, to prevent excess phlebotomy during a concurrent hospital admission.

Products

(1) Assigned aliquots = RBC AS-3 Divided Unit

  • Volume: ~40mL (1/8 of a regular sized rbc unit plus preservative)
  • Preservative/Additive: Optisol = AS-5 (similar as CPD, plus mannitol & adenine)
  • Shelf-life: 42 days, one set of 8 units assigned to one patient
  • Attributes: Leukoreduced, HbS negative, Irradiated (if child <4m or if indicated otherwise)
  • HCT of unit: 57%
  • Indications: Used for small volume transfusions, reduces donor exposure because all 8 aliqouts are kept for one patient.
  • Dose: 10-15mL/kg will increase Hb ~1.6 g/dL

(2) Reconstituted Whole Blood: Used for manual exchange transfusions.

  • AS-3 leukocyte reduced
  • HbS negative
  • Irradiated red cells and AB plasma.

Platelets are not supplied in this product; post-procedure platelet count should be obtained.

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