Transfusions of red blood cells (RBCs) are given to children in a wide variety of clinical settings. This includes children with 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 who require RBC transfusions. The indications, methods of administration, and complications of RBC transfusion in infants and children are discussed separately. (See "Red blood cell transfusion in infants and children: Indications" and "Red blood cell transfusion in infants and children: Administration and complications".)
RED BLOOD CELL PRODUCTS
Whole blood — The use of whole blood in pediatric patients is limited. Whole blood is most often used for patients undergoing major cardiac surgery. Whole blood has also been given for exchange transfusion in newborns for severe hemolytic disease or hyperbilirubinemia, and in patients undergoing massive transfusion; however, reconstituted blood (packed red cells and fresh frozen plasma) is more commonly used for these indications . Some clinicians have advocated whole blood when patients are placed on extracorporeal membrane oxygenation (ECMO) .
Fresh whole blood (generally less than 48 hours old) has been reported to improve hemostasis in infants undergoing cardiac surgery [2,3]. This was shown in a randomized trial of 61 infants less than one month of age who underwent cardiac surgery and cardiopulmonary bypass . Patients who received blood reconstituted with fresh red blood cells (RBCs), platelets, and plasma from a single donor had less postoperative chest tube volume loss, lower need for inotropic support, shorter ventilatory time, and shorter hospital stay, as compared to those who received packed RBCs. It should be noted, however, that the control group in this study used relatively old packed RBCs (14 ± 8 days old).
On the other hand, a randomized trial of 96 infants requiring cardiopulmonary bypass found no advantage, and perhaps disadvantages, in the use of fresh whole blood compared to reconstituted packed RBCs and fresh frozen plasma for priming the pump circuit . In addition, fresh whole blood increased perioperative fluid accumulation and the length of stay in the intensive care unit. Thus, use of fresh whole blood for pediatric cardiac surgery remains controversial. In addition, whole blood is not readily available in most areas of the United States.