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Chapter 438: Transfusion Medicine

Margo R. Rollins; Cassandra D. Josephson

INTRODUCTION

Transfusion of blood components is essential for treating pediatric patients with a variety of disorders. Neonatal and pediatric transfusion practices are generally categorized by the following age groups: (1) infants up to 4 months of age, and (2) infants/children between 4 months and 18 years of age. This chapter addresses specific aspects of pediatric transfusion medicine, namely blood components, indications, physician ordering practices, component preparation in the blood bank, bedside administration, and potential adverse events related to each age group and blood component. 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 emergently.

PACKED RED BLOOD CELLS

Composition and Volume

Packed red blood cells (pRBCs) are the most commonly transfused component of whole blood (WB). They are derived by centrifugation or, less frequently, acquired directly from a donor by an apheresis technique that produces non–WB–derived pRBCs. See Table 438-1 for types of pRBC products, volume per unit, hematocrit, and storage periods. Various anticoagulant solutions are used to preserve pRBCs and may uniquely affect each neonatal/pediatric recipient.

TABLE 438-1PACKED RED BLOOD CELL PRODUCTS
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TABLE 438-1PACKED RED BLOOD CELL PRODUCTS
Component Approximate Volume (mL) Hematocrit Comments
pRBCs 250 < 50–80% Made from WB
CPD or CPDAa     Storage 4°C
      Contains 108 WBCs
      Cannot be infused as rapidly as WB due to increased viscosity
      35-day storage period
pRBCs Additive Solution (AS-1, AS-3, AS-5)b 350 50–60% Made from WB
      Storage 4°C
      Contains 108 WBCs
      Red cell product most commonly available
      42-day storage period
Prestorage leukoreduction (LR-pRBCs) 250–350 50–80% Made from WB
      < 5 × 106 WBCs
      ≥ 85% of original red cell mass
      Does not prevent transfusion-associated graft-versus-host disease (TA-GVHD)
      35- to 42-day storage period
Washed pRBCs 200   Washing removes most of plasma and approximately 80% of leukocytes
      24-hour storage period after washing
Irradiated pRBCs 250–350   Reduced storage time due to potassium leak after irradiation
      Prevents TA-GVHD
      Storage 28 days after irradiation or by original expiration date, whichever comes first
Frozen deglycerolized pRBCs 200   Usually reserved for rare blood phenotypes
      May be stored frozen for 10 years
      Plasma reduced
      Approximately 90% LR after deglycerolization and washing
      24-hour storage period after deglycerization

aCitrate, phosphate buffer, adenine, dextrose.

bAdenine, dextrose, saline, mannitol (most plasma removed and replaced with additive solution)

LR, leukoreduction; pRBCs, packed red blood cells; WB, whole blood; WBCs, ...

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