title: Splitting blood and blood product packaging reduces donor exposure for patients undergoing cardiopulmonary bypass.
abstract: BACKGROUND
  Cardiopulmonary bypass for congenital heart surgery requires packed red cells (PRBC) and fresh frozen plasma (FFP) to be available, both for priming of the circuit as well as to replace blood loss. This study examines the hypothesis that splitting one unit of packed red blood cells and one unit of fresh frozen plasma into two half units reduces blood product exposure and wastage in the Operating Room.
  
  
  METHODS
  Beginning August 2013, the blood bank at Children's National Medical Center began splitting one unit of packed red blood cells (PRBC) and one unit of fresh frozen plasma (FFP) for patients undergoing cardiopulmonary bypass (CPB). The 283 patients who utilized CPB during calendar year 2013 were divided into 2 study groups: before the split and after the split. The principal endpoints were blood product usage and donor exposure intra-operatively and within 72 hours post-operatively.
  
  
  RESULTS
  There was a significant decrease in median total donor exposures for FFP and cryoprecipitate from 5 to 4 per case (p = 0.007, Mann-Whitney U-test). However, there was no difference in the volume of blood and blood products used; in fact, there was a significant increase in the amount of FFP that was wasted with the switch to splitting the unit of FFP.
  
  
  CONCLUSIONS
  We found that modification of blood product packaging can decrease donor exposure. Future investigation is needed as to how to modify packaging to minimize wastage.
authors.affiliation: Children's National Health System, Washington, DC, USA mnuszkow@cnmc.org.
authors.forename: M M
authors.initials: MM
authors.lastname: Nuszkowski
authors.affiliation: Children's National Health System, Washington, DC, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Jonas
authors.affiliation: Children's National Health System, Washington, DC, USA.
authors.forename: D
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Children's National Health System, Washington, DC, USA.
authors.forename: N
authors.initials: N
authors.lastname: Deutsch
mesh_terms: D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion / Q000379:methods*; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma; D011184:Postoperative Period; D019064:Product Packaging; D011379:Prognosis; D012189:Retrospective Studies; D014019:Tissue Donors; D055815:Young Adult
keywords: blood products; cardiopulmonary bypass; donor exposure; prime volume; small circuits