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

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2022-08, Vol.62 (8), p.1506-1510
• Main Authors: Olafson, Carly, William, Nishaka, Howell, Anita, Beaudin, Lynnette, Gill, Balkar, Clarke, Gwen, Stephens, Stephanie, Lopes‐Carvalho, Dora, Lane, Debra, Schubert, Peter, McTaggart, Ken, Acker, Jason P.
• Format: Article
• Language: English
• Subjects: ABO system; Adenine; Cell size; Dextrose; gamma‐irradiation; Irradiation; Mannitol; neonatal transfusions; Neonates; pediatric transfusions; Pediatrics; Potassium; Radiation; Radiation dosage; small‐dose RCCs; Transfusion
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/trf.17027

Background Preparing small‐dose red cell concentrates (RCCs) is a common practice for pediatric and neonatal transfusions. However, there is a lack of quality monitoring data to indicate that both the preparation and storage of small‐dose RCCs does not alter in vitro red cell quality. The present study seeks to provide data to support this practice. Materials and methods To evaluate quality of stored small aliquots, six ABO/Rh matched leukoreduced citrate phosphate‐dextrose/saline‐adenine‐glucose‐mannitol (LR CPD/SAGM) RCCs were pooled and split into 30 ml aliquots, 80 ml aliquots, and a standard 290 ml unit, with testing performed for up to 43 days post‐collection. To evaluate the impact of irradiation on small‐dose RCC preparation, a total of 48 independent LR CPD/SAGM RCCs were used (non‐irradiated: n = 24; irradiated: n = 24). Aliquoting with/without irradiation was performed within 7 days of collection and baseline testing was performed within 24 h of aliquot production. Results Limited variability in hemolysis, mean cell volume, and extracellular potassium concentrations were seen between the different aliquot sizes throughout the 43‐day storage period. Aliquot production did not accentuate damage based on any of these tested parameters in both the non‐irradiated and irradiated subsets. A significant increase was seen in the potassium concentrations in the irradiated parent and aliquot samples relative to their non‐irradiated counterparts. Conclusions Non‐irradiated small‐aliquot dose RCCs meet in vitro quality criteria required for safe transfusion throughout the 42‐day storage period. The same can be said for aliquots derived from irradiated units and tested within 24 h of aliquot production.