Neonatal and pediatric blood bank practice in the United States: Results from the AABB pediatric transfusion medicine subsection survey

Abstract

Background There are limited standards guiding the selection and processing of blood components specific for neonatal and pediatric transfusions. Therefore, blood banks (BBs) and transfusion services must create their own policies and procedures. Study Design and Methods The American Association of Blood Banks (AABB) Pediatric Transfusion Medicine Subsection Committee developed a 74‐question survey to capture neonatal and pediatric BB practices in the United States. Results Thirty‐five centers completed the survey: a response rate 15.8%. Responses indicated that most carry a mixed inventory of red blood cells (RBCs); 94.2% allow more than one type of RBC product for small‐volume (SV) and large‐volume (LV) transfusions to neonatal and pediatric patients. Many had storage age thresholds for RBCs transfused to neonates (SV = 60%, LV = 67.7%) but not older pediatric patients. The use of Group O for nonurgent RBC transfusion in neonates was common (74.2%). Responses related to special processing of RBCs and platelets indicated that 100% RBC and platelets are leukocyte‐reduced (LR) for neonates and 97% for non‐neonates. Irradiation of RBCs and platelets was commonly performed for neonatal transfusion (88.6%). Providing cytomegalovirus (CMV) seronegative products, volume reduction, and washing were variable. All centers transfused single‐donor apheresis platelets; 20% allowed pathogen reduction (PR). The majority of centers have strategies limiting the amount of incompatible plasma transfused; however, few titrate ABO isoagglutinins in plasma‐containing products (20% for platelets and 9.1% for plasma). Conclusions Variability exists in BB practice for neonatal and pediatric transfusion. Future studies are needed to understand and define best BB practices in these patient populations.

Preparing small‐dose red cell concentrates (RCCs) for neonatal and pediatric transfusions: Impact of RCC volume, storage, and irradiation

“…13 While some centers limit the storage of RCCs for pediatric/neonatal transfusions anywhere from 5 to 14 days, others impose no limits on storage durations. 5 Therefore, establishing standards around allowable RCC storage is important.…”

“…[2][3][4] RCC irradiation can accentuate these deleterious outcomes, which proves to be of particular concern in neonates where irradiation is effectively a universal practice due to the susceptibility of this population to transfusionassociated graft versus host disease (TA-GvHD). [5][6][7] While irradiation practices for infants (up to 6 years of age) tend to vary between centers, being a member of this age group still represents one of the most common indications for receiving irradiated RCCs. 5 To minimize the elevated post-irradiation deterioration of red cells known to occur in vitro, most centers substantially reduce the allowable storage times for irradiated units, with some implementing policies that limit post-irradiation storage of neonatal RCCs to ≤24 h. 5 This is very much distinct from the standard 14 and 28 days post-irradiation storage times allowed by the Canadian Standards Association (CSA) and the American Association of Blood Banking (AABB), respectively.…”

“…[5][6][7] While irradiation practices for infants (up to 6 years of age) tend to vary between centers, being a member of this age group still represents one of the most common indications for receiving irradiated RCCs. 5 To minimize the elevated post-irradiation deterioration of red cells known to occur in vitro, most centers substantially reduce the allowable storage times for irradiated units, with some implementing policies that limit post-irradiation storage of neonatal RCCs to ≤24 h. 5 This is very much distinct from the standard 14 and 28 days post-irradiation storage times allowed by the Canadian Standards Association (CSA) and the American Association of Blood Banking (AABB), respectively. 8,9 The low volume of blood required (10-20 ml/kg) for these patients proves to be another pertinent consideration in pediatric and neonatal transfusions.…”

Neonatal and pediatric transfusion practices and policies in India: A survey‐based cross‐sectional assessment of blood centers

“…This is important when data is analyzed and published (on pediatric transfusion medicine) from these centers as the different definitions of the age group may make it difficult to compare the results. As reported by Reeves HM et al the majority of blood centers in the USA used the definition of fewer than 4 months to define neonates 11 …”

“…As reported by Reeves HM et al the majority of blood centers in the USA used the definition of fewer than 4 months to define neonates. 11 Iatrogenic blood loss due to multiple sampling is one of the leading causes of anemia in neonates admitted to NICUs. 12,13 Reducing the number and volume of blood sampling as well as the careful ordering of blood tests have been shown to reduce the need for blood transfusions.…”