Use of Older Red Blood Cells in Low Birth Weight Infants

Very low birth weight infants, particularly those of less thon 30 weeks’ gestation, usually require multiple red blood cell transfusions. Exposure to blood from multiple donors increases the potential for adverse effects, particularly transfusion-associated infections. In this study we hypothesized that using older packed red blood cell (PRBC) transfusions would not significantly alter acid base and serum electrolytes, but would decrease exposure to blood from mulitiple donors. The blood was preserved in citrate phosphate dextrose adenine (CPDA) solution and provided as a main unit with one empty satellite bag so that two separate transfusions can be given before the expiry date 35 day later. The infants’ arterial blood gas, hemoglobin, plasma sodium, potassium, and calcium were measured just before and 1-2 hours ofter each transfusion. Seven infants (mean±SE, birth weight 1186±103 gm, gestational age 29.6±0.7 weeks) received 18 transfusions of 15 Ml/kg of PRBC over 3 hours. The median (range) age of the PRBC transfused was 8 days (1-27 days). Following transfusion, there was a significant increase in hemoglobin (10.5±0.3 to 13.3±0.2 gm/dL) and calcium concentrations (2.20±0.08 to 2.34±0.06 mmol/L). Acid base, plasma sodium, and potassium concentrations were not significantly different. Vital signs remained stable during the transfusions. We conclude that CPDA preserved older PRBC may be safe for use in premature infants and they can be used to decrease donor exposure risk for infants requiring multiple blood transfusions.