Reduction of donor exposures in premature infants by the use of designated adenine-saline preserved split red blood cell packs

OBJECTIVE: Critically ill neonates frequently require multiple small volume red blood cell (RBC) transfusions. RBC units assigned to individual infants, used sequentially in small aliquots until the original expiration date, can substantially 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 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 up until 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, mean rise in hematocrit (hct) was 0.04, regardless of the age of the unit, mean change in serum potassium was −0.16 mmol/l and mean change in total bilirubin was +1.86 μmol/l. The posttransfusion 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.