Erythrocyte concentrate, infant

Code 'Blood Service'

EZL

Stem E5259V with various suffixes as a function of splitting into subproducts

E5259VB0

E5259VC0

E5259VD0

etc.

NIHDI Code

Hospitalized: 752 485

Non-hospitalized: 752 474

An erythrocyte concentrate type "infant" is prepared by splitting an erythrocyte concentrate type "adult" through a closed system. Its content corresponds to 90 to 100 ml of whole blood. An erythrocyte concentrate is prepared from human blood by centrifugation and removal of most of the plasma. The leukocytes in the erythrocyte concentrate are removed by filtration. To the concentrated and filtered erythrocytes is added a nutritive preservative, specifically saline-adenine-glucose-mannitol (SAGM). Only erythrocyte concentrates of blood group O, Kell-negative, are prepared as erythrocyte concentrate type "infant. The volume of an erythrocyte concentrate type 'infant' is 40 to 60 ml, storage solution (SAGM) and anticoagulant (CPD: citrate-phosphate-dextrose) included. An erythrocyte concentrate type 'infant' has a hematocrit of 0.50 to 0.70. Hemolysis at expiration is less than 0.8% of erythrocyte mass.

All erythrocyte concentrates are de-ukocyzed and contain less than 1 x¹⁰⁶ leukocytes/product.

An erythrocyte concentrate type "infant" is used to increase oxygen transport for blood loss and anemia in neonati and young children. The transfusion trigger depends on the clinical situation (oxygenation, ventilation...).

Dose

Transfusion of 10 ml of erythrocyte concentrate/kg body weight on average increases hemoglobin concentration by 3 g/dl.

Special precautions

For transfusion of an erythrocyte concentrate type 'infant', compatibility between donor, recipient or mother (if recipient less than three months old) should be ensured by selecting an erythrocyte concentrate compatible with the ABO and rhesus D blood type of the recipient and of the mother and by performing a cross test between red blood cells of the donor and serum/plasma of the recipient or the mother (up to three months after delivery). After one transfusion, all subsequent concentrates should be cross tested (also) with the child's serum/plasma. The compatibility study report should include the identity of the patient, the unique number of the erythrocyte concentrate and the result.

Immediately prior to transfusion, it should be verified that the unit to be administered is intended for that patient.

The delegated erythrocyte concentrate type 'infant' is suitable for top-up transfusions in neonates and young children. For transfusion of larger volumes, delegated erythrocyte concentrate 'adult' should be used.
In patients with severe immune deficiency and premature infants weighing less than 1500 grams, irradiated blood products are indicated.

Specially prepared reconstituted whole blood is used for exchange transfusion in newborns.

User Manual

Aseptic technique must be used during transfusion. The erythrocyte concentrate is administered intravenously via an infusion pump with standard filter (170-260 µ), the first few minutes under close observation for any transfusion reaction. The infusion rate is determined according to clinical condition and patient weight: an infusion rate of 5 ml/kg/hr is considered safe. The average transfusion duration of an erythrocyte concentrate is 1 to 2 hours. It is recommended that the duration for transfusion be limited to a maximum of 4 hours.

Prevent backflow of blood from the patient into the transfusion set: always hang the blood bag higher than the patient's arm and close the roller clamp when moving patient and/or blood bag.

Any residues are disposed of as medical waste.

Warming the blood before administration is not necessary.

Warming of blood products during administration is required only in case of massive transfusion ( > 15 ml/kg/h in children), including exchange transfusion - to avoid hypothermia of the patient - and in case of clinically important cold agglutinins. Special heating devices validated for this application must be used.

The most frequent side effects of blood product transfusion are chills, fever and symptoms of an allergic nature such as urticaria and itching.

Serious, potentially fatal, adverse reactions include: circulatory overfilling with pulmonary edema, transfusion-related acute lung disease (TRALI), bacterial sepsis,

hemolytic transfusion reaction and severe allergic reactions such as anaphylactic shock.

Further occurrences may include: hyperkalemia, posttransfusion purpura and transfusion-associated graft versus host disease (TA-GVHD).

Through blood and blood derivatives, infections can be transmitted: with viruses (B19 parvovirus, CMV*, HAV, HBV, HCV, HIV,...), with bacteria (syphilis), with protozoa (malaria, leishmania, trypanosomiasis) and with unknown pathogenic agents.

Iron accumulation may occur with frequent transfusions or transfusions over a long period of time.

If an acute transfusion reaction occurs, transfusion should be stopped immediately and appropriate therapy initiated.

The following laboratory tests may be useful in severe reactions: hemolysis parameters (haptoglobin, free hemoglobin, LDH, bilirubin), repeat cross-matching and blood group determination of patient and product, direct antiglobulin test, serum IgA, patient's hemoculture and bacteriological examination of the administered unit.

In case of a mild allergic transfusion reaction (itching, redness, urticaria), the transfusion can be continued if necessary after administration of antihistamines or corticosteroids.

* Deukocyte-derived blood products are generally believed to virtually eliminate the possibility of CMV virus transmission due to elimination of the white blood cells. For indications of the use of blood products derived from donors serologically negative for CMV: see under CMV-negative blood products.

No drugs or infusion fluids should be added to an erythrocyte concentrate. The hematocrit of an erythrocyte concentrate is such that dilution by the addition of isotonic saline is unnecessary. Calcium-containing and concentrated glucose solutions should not be administered through the same intravenous line as the erythrocyte concentrate.

An infant type erythrocyte concentrate should be stored between + 2 °C and + 6 °C. The normal storage time - when used for top-up transfusion - is 42 days. An erythrocyte concentrate should not be used after the expiration date and with signs of damage or decay.

Blood is drawn from voluntary, non-remunerated donors, selected in accordance with the standards laid down by Belgian legislation and the procedures of the Blood Service of Belgian Red Cross-Flanders.

With each donation, the donor is inspected by a physician and tested for ^antibodies against the human immunodeficiency viruses (anti-HIV-1 and HIV-2), for antibodies against the hepatitis C virus (anti-HCV), for the hepatitis B virus surface antigen (HBsAg) and for antibodies against Treponema pallidum. HIV, HBV and HCV are also detected by NAT testing.
Products from donations with positive test results are destroyed.

When products prepared from human blood are administered, transmission of an infectious agent cannot be completely excluded. The residual risk of transmission of HIV, HBV or HCV by unit transfusion is estimated at 1 in 4 to 6 x¹⁰⁶, 1 in 0.3 to 1 x¹⁰⁶ and 1 in 700,000, respectively.

Transmission of as yet unknown pathogens cannot be ruled out.

By medical prescription.