Apollo Medicine 2011 December

Journal Scan
Volume 8, Number 4; p. 319

Transfusion medicine
RN Makroo*
*Director, Department of Transfusion Medicine, Molecular Biology and Transplant Immunology, Indraprastha Apollo Hospitals, Sarita Vihar,
New Delhi – 110076, India.

Reduction of donor exposures in premature infants by the use of designated adenine-saline preserved split red
blood cell packs. Mangel J, Goldman M, Garcia C, Spurll G. J Perinatol 2001;21:363–7.

Abstract: Objective: Critically ill neonates frequently require multiple small volume red blood cell (RBC) transfusions. Red
blood cell units assigned to individual infants, used sequentially in small aliquots until the original expiration date, can substan-
tially reduce donor exposures. In 1993, adenine–saline solution (AS-3) was introduced by the Canadian Red Cross as the
red cell storage medium to replace the citrate phosphate–dextrose–adenine anticoagulant preservative solution (CPDA-1). We
surveyed the safety and efficacy of using AS-3 split packs, stored up to 35 days, for premature infants. Study design: Units of
packed cells were aseptically welded to three satellite bags using a sterile connecting device. When blood was requested for a
small volume transfusion, the first satellite bag was used and the others were set aside for the same baby, for use till their expiration
date of 35 days. Results: Over a 1-year period, 56 infants received a total of 263 AS-3 transfusions from 97 donors with a
mean of 4.7 transfusions and 1.7 donor exposures per infant. Following a 7-mL/Kg RBC transfusion, the mean rise in hema-
tocrit (HCT) was 0.04, regardless of the age of the unit, mean change in serum potassium was −0.16 mmol/L and the mean
change in total bilirubin was +1.86 μmol/L. The post-transfusion HCT was not reduced with the use of the older red cell packs.
Conclusion: Designated AS-3-preserved split RBC packs effectively limit donor exposures, can safely be used for neonatal
small volume transfusions and give a constant transfusion effect after up to 35 days of storage.

COMMENT

Adverse effects resulting from multiple donor exposures, which included the risk of infection and allo-immunization hit adults
and neonates alike. Many centers have thus instituted systems to improve blood utilization and reduce donor exposures as far
as possible.
The authors have demonstrated with success that the use of AS-3 preserved split units do not alter the efficacy of the prod-
uct as it ages, while it decreases donor exposure. The use of older red cells, especially in paediatric patients, has been a bone of
contention since long. The authors deserve appreciation for their endeavor to tackle a sensitive issue like this.
The use of paediatric split units is currently a routine practice in most blood centers across the world. However, many centers
have reservations regarding the use of the parent unit till the date of expiry, i.e., 35 or 42 days (depending on the additive solution
used). This is predominantly due to the theoretical risk of hyperkalemia and low 2,3-DPG in stored blood and the high concen-
tration of dextrose in the additive solutions used. The authors have successfully demonstrated an adequate increase in hematocrit
without a significant change in potassium and bilirubin levels following the transfusion of split units as old as 35 days.
Department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, also follows strict neonatal transfusion
guidelines. Packed red cell is mixed with additive solution and stored for up to 42 days. As per the requirements, the neonatal
split units are prepared from the parent unit, at the time of issue, where in small aliquots of blood or blood components are
separated using a sterile connecting device. The parent unit is designated and kept aside for use in the same patient until expiry.
In addition to this, we make an attempt to provide platelet concentrate and FFP units of the same donor, wherever possible, to
further reduce the donor exposure. Any adverse effect among neonates receiving transfusion has not been observed till date.
From our experience, we can also state that we are in agreement with the authors’ concluding remarks that the satellite bags
prepared from a parent unit stored in additive solutions such as AS3 limit donor exposures, and are simple, safe, and effective
until their date of expiration.

Correspondence: Dr. RN Makroo, E-mail: makroo@apollohospitals.com

doi: 10.1016/S0976-0016(11)60021-5

© 2011, Indraprastha Medical Corporation Ltd