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Transfusion of blood components is essential for treating children with various neonatal and pediatric disorders. Neonatal and pediatric transfusion practices can be classified into two age groups: infants up to 4 months of age and infants/children greater than 4 months of age. This chapter addresses specific aspects of pediatric transfusion medicine, namely the constituents of blood, indications, physician ordering, component preparation in blood banks, administration, and potential adverse events in each age group. It is important to note that prior to ordering or administering any blood product or component, informed consent explaining indications, treatment plan(s), benefits, and risks must be obtained unless a transfusion is required in an emergency.

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Composition and Volume

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Packed red blood cells (pRBCs) are the most commonly transfused component of whole blood. They are derived by centrifugation or, less frequently, are acquired directly from the donor by apheresis techniques, known as non-whole blood derived. See Table 442-1 for types of pRBC products, volume per unit, dosage, hematocrit and storage solution, and storage periods. Diverse anticoagulant preservative solutions are used to conserve red blood cells and may uniquely affect each neonatal/pediatric recipient. While additive solutions (AS) have evolved to extend the shelf life of red cells, the safety of the concentration of adenine and mannitol in AS and their associated renal toxicity when given to neonates has come into question. Additionally, the use and safety of AS-preserved pRBCs in massive transfusions for trauma, cardiac surgery, or exchange transfusions for infants less than 4 months old has not been established. The use of AS-preserved red cell units in this population in specific clinical situations must be approached with caution.2-5

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Table 442-1. Packed Red Blood Cell Products 

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