(5) The likelihood of development of hypocalcemia resulting from the
infusion of large amounts of citrate during massive transfusion has been
overemphasized. Administration of calcium during massive transfusion is probably not
(6) Warming of blood may be necessary if large amounts of blood are being
transfused rapidly. Procedures for warming blood are discussed below.
b. Pediatric Transfusions.
(1) Children who are not actively bleeding should receive RBCs for the
same reasons that RBCs are superior to WB for adults. If transfusions of small volumes
of blood are to be administered, 1 donor unit can be collected into a multiple container
and divided into small volumes as needed.
(2) Premature and newborn infants usually require very small volumes of
blood, such as 30 to 60 ml of WB or RBCs, although an additional 30 ml is required to
fill the administration set. In some hospitals, this has led to the use of "syringe"
transfusions from "walking" donors. Syringe transfusions are not desirable because (1)
the donor medical history is usually inadequate, (2) pretransfusion testing of donor
blood is usually not performed, (3) compatibility testing is usually not performed, (4)
proper ratio of anticoagulant is often not used, (5) no filters are used for administration,
(6) identification systems are often inadequate, and (7) risk of CMV hepatitis or AIDS
from untested blood.
(3) Transfusion of small volumes of blood should be carried out through the
facilities of the blood bank where well-trained personnel perform proper medical
histories and pre-transfusion and compatibility testing of the blood. Blood for these
special transfusions can be collected into a multiple bag and divided; or 480 to 490 ml
can be collected into a double bag and 30 to 60 ml removed into the satellite bag for
pediatric transfusion. Small collection containers with CPD anticoagulant in 150 ml
primary with a 150 ml satellite bag are now available. Thus, one donor could give up to
three times during a 2-month interval, and each donation split into 2 to 4 parts.
(4) Compatibility testing for neonates (newborn children less than a year
old) is different from those for adults. Initial testing must include ABO and Rh typing of
the neonatal recipient's RBCs. An antibody screening test, which may be done either
on the newborn or mother's serum or plasma, is also done. If the antibody screen is
negative and group O or ABO specific, or compatible with both mother and child, to
include the same Rh type, then compatibility testing and further typing may be omitted
during the first 4 months of life.