Therapeutic Techniques

Abstract

A wide variety of blood components are currently available for clinical use. (1)(2) This article reviews the components that may be used for neonates and the considerations that should guide the selection of products for specific applications. Some of the specialization that is recommended for preterm infants is less important for term infants, and some of the metabolic concerns in the setting of massive transfusion (ie, one blood volume or greater) are not relevant in the setting of aliquot transfusions (ie, 10 to 15 mL/kg). Clinicians are urged to consult their transfusion service physicians for advice in choosing the most appropriate blood component for their particular clinical situation and for guidance when the ideal component is not available. Most RBC components available today are derived from the collection of 450 to 500 mL of whole blood into sterile plastic bags containing citrate-phosphate-dextrose (CPD) anticoagulant. The whole blood is spun to sediment out the RBCs, and most of the plasma is removed by pushing it into a preattached satellite bag. Generally, 100 to 110 mL of a nutrient additive solution is added back to the packed RBCs, creating an “additive RBC” product that has a final hematocrit of 55% to 60% (0.55 to 0.60). A variety of additive solutions are in use today, each of which contains a particular mix of glucose, adenine, and in some cases, mannitol (Table⇓). These solutions prolong the shelf life of the RBC product from 21 days (packed RBCs in CPD) to 42 days (additive RBCs). A transfusion of 10 mL/kg of additive RBCs would be expected to raise the patient’s hematocrit by 7% to 8% (0.07 to 0.08). | | AS-1 | AS-3 | AS-5 | |:--------------------------:| ----- | ----- | ---- | | Dextrose | 2,200 | 1,100 | 900 | | Adenine | 27 | 30 | 30 | | Mannitol | 750 | — | 525 | | Sodium chloride | 900 | 410 | 877 | | Sodium citrate | | 588 | | | Citric acid | | 42 | | | Monobasic sodium phosphate | | 276 | | Table. Content of Some Red Cell Additive Solutions (AS) (mg/100 mL) Some blood banks collect a small proportion of their whole blood donations into bags …