RBC Aliquots

Aliquotted RBCs is the product most often transfused during the neonatal period or infants younger than 4 months of age. Indications for transfusion include anemia caused by spontaneous fetomaternal or fetoplacental hemorrhage, twin-twin transfusion, obstetric accidents, and internal hemorrhage. Blood drawn from infants for laboratory testing (iatrogenic anemia) also may warrant a neonatal transfusion if more than 10 percent of the blood volume has been removed. Transfusions for neonates require only small volumes of RBCs (10 to 25 mL); several aliquots may be prepared from a singledonor unit. A multiple pack system or a quad pack is available for use when a single unit of whole blood is collected in a bag with four integrally attached containers; such a system can increase the number of transfusions an infant can receive from one donor. Each pack retains the original outdate of the primary bag within a closed system. Sterile connecting devices can be used to maintain a closed system in attaching Pedipaks to a unit of RBCs. The precise volume of blood desired can be aspirated into a syringe through a large-bore needle inserted through an injection site coupler. The filled syringe should be closed securely with a sterile cap and labeled with expiration date, patient identification, volume transfused, preservative, and ABO type. The aliquotted blood has an expiration time of 24 hours and should be stored at 16_C until issued. Initial testing for neonates includes ABO, Rh, and antibody screen for unexpected antibodies, which can be performed on serum or plasma from the infant or mother. AABB Standards74 states repeat ABO and Rh typing may be omitted for the remainder of the neonates hospital admission; in the event the initial screen for RBC antibodies is negative, it is not necessary to crossmatch donor RBCs for the initial or subsequent transfusions. If the antibody screen is positive for clinically significant RBC antibodies, the neonate must receive blood that does not contain the corresponding antigen or is compatible by the antiglobulin crossmatch. The anticoagulant most often used for neonate transfusions is CPDA-1. A transfusion of 10 mL/kg in a unit with a hematocrit level of 80 percent should raise the hemoglobin by 3 g/dL.75 Some institutions, however, have begun using additive solutions for neonatal transfusions when the volume transfused is minimal. Concerns with additive solutions involve the constituents adenine and mannitol and their toxic effects on the renal system. Most physicians advocating the use of additive solutions do so in the limited setting of smallvolume transfusions.

RBCs Irradiated
Patients who are immunocompromised or who are receiving a bone marrow or stem cell transplant, fetuses undergoing a intrauterine transfusion, and recipients of units from blood relatives or of HLA selected platelets must receive irradiated blood and/or platelets to inhibit the proliferation of T cells and subsequent transfusion-associated graft-versus-host disease. RBCs, platelets, and granulocyte concentrates contain viable T lymphocytes.