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Red blood cell transfusion in infants and children: Selection of blood products

Jun Teruya, MD, DSc
Section Editor
Donald H Mahoney, Jr, MD
Deputy Editor
Carrie Armsby, MD, MPH


Transfusions of red blood cells (RBCs) are given to children for a wide range of indications, including anemia due to congenital or acquired disease, or blood loss from trauma or surgery. Once the decision to transfuse RBCs has been made, the most appropriate RBC product must be chosen. Donated whole blood used for transfusion is modified in several ways that remove varying proportions of non-red cell components, thereby allowing selection of RBC products based upon clinical needs.

This topic will review the different RBC products and indications for their use in infants and children. Other aspects of RBC transfusion in infants and children are discussed in separate topic reviews:

(See "Red blood cell transfusion in infants and children: Indications".)

(See "Red blood cell transfusion in infants and children: Administration and complications".)

(See "Red blood cell transfusions in the newborn".)

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Literature review current through: Oct 2017. | This topic last updated: Sep 06, 2017.
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  1. AABB, American Red Cross, America’s Blood Centers, and Armed Services Blood Program. Circular of Information for the use of human blood and blood components. Available at: http://www.aabb.org/tm/coi/Documents/coi1113.pdf (Accessed on December 08, 2014).
  2. Dhabangi A, Ainomugisha B, Cserti-Gazdewich C, et al. Effect of Transfusion of Red Blood Cells With Longer vs Shorter Storage Duration on Elevated Blood Lactate Levels in Children With Severe Anemia: The TOTAL Randomized Clinical Trial. JAMA 2015; 314:2514.
  3. Fergusson DA, Hébert P, Hogan DL, et al. Effect of fresh red blood cell transfusions on clinical outcomes in premature, very low-birth-weight infants: the ARIPI randomized trial. JAMA 2012; 308:1443.
  4. Roseff SD, Luban NL, Manno CS. Guidelines for assessing appropriateness of pediatric transfusion. Transfusion 2002; 42:1398.
  5. Manno CS, Hedberg KW, Kim HC, et al. Comparison of the hemostatic effects of fresh whole blood, stored whole blood, and components after open heart surgery in children. Blood 1991; 77:930.
  6. Mou SS, Giroir BP, Molitor-Kirsch EA, et al. Fresh whole blood versus reconstituted blood for pump priming in heart surgery in infants. N Engl J Med 2004; 351:1635.
  7. Technical manual, 18th Ed, Fung M, Grossman BJ, Hillyer CD, Westhoff CM, Eds (Eds), American Association of Blood Banks, Bethesda, MD 2014.
  8. Gilbert GL, Hayes K, Hudson IL, James J. Prevention of transfusion-acquired cytomegalovirus infection in infants by blood filtration to remove leucocytes. Neonatal Cytomegalovirus Infection Study Group. Lancet 1989; 1:1228.
  9. Hayashi Y, Sawa Y, Nishimura M, et al. Clinical evaluation of leukocyte-depleted blood cardioplegia for pediatric open heart operation. Ann Thorac Surg 2000; 69:1914.
  10. Derleth DP. Use of white cell-reduced red cells for transfusion through peripheral arterial lines. Transfusion 1994; 34:86.
  11. Fergusson D, Hébert PC, Barrington KJ, Shapiro SH. Effectiveness of WBC reduction in neonates: what is the evidence of benefit? Transfusion 2002; 42:159.
  12. Yeager AS, Grumet FC, Hafleigh EB, et al. Prevention of transfusion-acquired cytomegalovirus infections in newborn infants. J Pediatr 1981; 98:281.
  13. Spinella PC, Dressler A, Tucci M, et al. Survey of transfusion policies at US and Canadian children's hospitals in 2008 and 2009. Transfusion 2010; 50:2328.
  14. Fergusson D, Hébert PC, Lee SK, et al. Clinical outcomes following institution of universal leukoreduction of blood transfusions for premature infants. JAMA 2003; 289:1950.
  15. Przepiorka D, LeParc GF, Werch J, Lichtiger B. Prevention of transfusion-associated cytomegalovirus infection. Practice parameter. American Society of Clinical Pathologists. Am J Clin Pathol 1996; 106:163.
  16. Laupacis A, Brown J, Costello B, et al. Prevention of posttransfusion CMV in the era of universal WBC reduction: a consensus statement. Transfusion 2001; 41:560.
  17. Nichols WG, Price TH, Gooley T, et al. Transfusion-transmitted cytomegalovirus infection after receipt of leukoreduced blood products. Blood 2003; 101:4195.
  18. Josephson CD, Castillejo MI, Caliendo AM, et al. Prevention of transfusion-transmitted cytomegalovirus in low-birth weight infants (≤1500 g) using cytomegalovirus-seronegative and leukoreduced transfusions. Transfus Med Rev 2011; 25:125.
  19. Benson JW, Bodden SJ, Tobin JO. Cytomegalovirus and blood transfusion in neonates. Arch Dis Child 1979; 54:538.
  20. Adler SP, Chandrika T, Lawrence L, Baggett J. Cytomegalovirus infections in neonates acquired by blood transfusions. Pediatr Infect Dis 1983; 2:114.
  21. Lamberson HV, Dock NL. Prevention of transfusion-transmitted cytomegalovirus infection. Transfusion 1992; 32:196.
  22. Logan S, Barbara J, Kovar I. Cytomegalovirus screened blood for neonatal intensive care units. Arch Dis Child 1988; 63:753.
  23. Miller WJ, McCullough J, Balfour HH Jr, et al. Prevention of cytomegalovirus infection following bone marrow transplantation: a randomized trial of blood product screening. Bone Marrow Transplant 1991; 7:227.
  24. Ziemann M, Heuft HG, Frank K, et al. Window period donations during primary cytomegalovirus infection and risk of transfusion-transmitted infections. Transfusion 2013; 53:1088.
  25. Roback JD. CMV and blood transfusions. Rev Med Virol 2002; 12:211.
  26. Pelszynski MM, Moroff G, Luban NL, et al. Effect of gamma irradiation of red blood cell units on T-cell inactivation as assessed by limiting dilution analysis: implications for preventing transfusion-associated graft-versus-host disease. Blood 1994; 83:1683.
  27. Funkhouser AW, Vogelsang G, Zehnbauer B, et al. Graft versus host disease after blood transfusions in a premature infant. Pediatrics 1991; 87:247.
  28. Strauss RG. Blood banking and transfusion issues in perinatal medicine. In: Hematologic problems of the neonate, Christensen RD (Ed), WB Saunders, Philadelphia 2000. p.405.
  29. Lee AC, Reduque LL, Luban NL, et al. Transfusion-associated hyperkalemic cardiac arrest in pediatric patients receiving massive transfusion. Transfusion 2014; 54:244.
  30. Hall TL, Barnes A, Miller JR, et al. Neonatal mortality following transfusion of red cells with high plasma potassium levels. Transfusion 1993; 33:606.
  31. Horsey PJ. Hyperkalaemia associated with transfusion of plasma reduced blood. Anaesthesia 2000; 55:294.
  32. Baz EM, Kanazi GE, Mahfouz RA, Obeid MY. An unusual case of hyperkalaemia-induced cardiac arrest in a paediatric patient during transfusion of a 'fresh' 6-day-old blood unit. Transfus Med 2002; 12:383.
  33. Strauss RG. Routinely washing irradiated red cells before transfusion seems unwarranted. Transfusion 1990; 30:675.
  34. Yawn BP, Buchanan GR, Afenyi-Annan AN, et al. Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members. JAMA 2014; 312:1033.
  35. Yoshihara H, Yoneoka D. National trends in spinal fusion for pediatric patients with idiopathic scoliosis: demographics, blood transfusions, and in-hospital outcomes. Spine (Phila Pa 1976) 2014; 39:1144.
  36. Henry DA, Carless PA, Moxey AJ, et al. Pre-operative autologous donation for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2002; :CD003602.
  37. Rock G, Berger R, Bormanis J, et al. A review of nearly two decades in an autologous blood programme: The rise and fall of activity. Transfus Med 2006; 16:307.
  38. Fontaine MJ, Winters JL, Moore SB, et al. Frozen preoperative autologous blood donation for heart transplantation at the Mayo Clinic from 1988 to 1999. Transfusion 2003; 43:476.
  39. Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP. Transfusion medicine. Second of two parts--blood conservation. N Engl J Med 1999; 340:525.
  40. Standards for Blood Banks and Transfusion Services, 30th ed, Ooley PW (Ed), American Association of Blood Banks, Bethesda, MD 2015. p.39.
  41. Floss AM, Strauss RG, Goeken N, Knox L. Multiple transfusion fail to provoke antibodies against blood cell antigens in human infants. Transfusion 1986; 26:419.
  42. Reddy Palla MM. Exchange transfusion. In: Neonatology: Management, procedures, on-call problems, diseases and drugs, 7th, Gomella TG, Cunningham MD, Eyal FG, Zenk KE (Eds), McGraw-Hill, New York 2013. p.267-270.
  43. Diab YA, Wong EC, Luban NL. Massive transfusion in children and neonates. Br J Haematol 2013; 161:15.
  44. Win N, Doughty H, Telfer P, et al. Hyperhemolytic transfusion reaction in sickle cell disease. Transfusion 2001; 41:323.