Red blood cells stored in anticoagulant versus additive solution for large volume transfusions in pediatric patients undergoing cardiopulmonary bypass.

BACKGROUND

The safety of red blood cells (RBCs) in additive solutions (AS) for large-volume transfusion (LVT) in pediatrics remains understudied. This study examines the laboratory and clinical impact of CPD-stored products versus CP2D/AS-3 products in pediatric patients receiving LVT during cardiac surgery.

STUDY DESIGN AND

METHODS

A retrospective review compared patients undergoing Norwood or heart transplant procedures 28 months before and after a transition from CPD to CP2D/AS-3 blood products. Laboratory values were compared pre-surgery, immediately post-surgery, and 1 day later, along with clinical outcomes.

RESULTS

This study included 89 patients: 46 in the CPD group and 43 in the AS-3 group. Patient weight and transfused RBC, platelet, and cryoprecipitate units were similar between groups. Plasma usage was higher in the AS-3 group, and 28% of the CPD group received whole blood. Sodium, glucose, and phosphorus were significantly higher in the AS-3 group immediately post-surgery, but not 1 day later. Lactate was significantly higher immediately post-surgery in the AS-3 group undergoing Norwood procedure, likely due to their significantly younger age. Conversely, lactate was significantly lower immediately post-surgery in the AS-3 group undergoing heart transplants and remained lower on day one. Mortality, total length of stay (LOS), and intensive care unit LOS were similar between groups.

DISCUSSION: This analysis suggests that AS-3 may transiently increase sodium, glucose, and phosphorus immediately after LVT during pediatric cardiac surgery. These changes are consistent with LVT exposure to CP2D/AS-3 and fully resolved by 24 h, with no effect on patient mortality or LOS.