title: Neonatal transfusion models to determine the impact of using fresh red blood cells on inventory and exposure.
abstract: BACKGROUND
  Data on age of blood and its impact on donor exposure and inventory in the paediatric setting are lacking. The standard of practice of reserving a specific red blood cell (RBC) unit for neonates who may require repeat transfusions is unique to the paediatric setting. Requiring transfusion of fresher RBC units may increase the exposure of neonates to multiple units and negatively affect the supply of fresh RBC. We constructed a transfusion model based on a 6 months of retrospective neonatal transfusion data at our institution.
  
  
  METHODS
  All neonates (≤4 months old) at Texas Children's Hospital who received a RBC transfusion from June to November 2011 were included and RBC transfusion data were compiled. The age of blood at the time of each RBC transfusion was recorded. These data were reviewed to calculate exposure and inventory impact if each transfusion had been restricted to RBC either ≤7 or ≤14 days old at transfusion.
  
  
  RESULTS
  A total of 216 neonates received 938 RBC transfusions. Of these, 393 (42%) were fresh RBC (≤14 days old), even without a required age guideline. Requiring fresh (≤14 days) RBC for all transfusions in this period would have resulted in 70 additional fresh units and one or more additional exposures in 44 patients. Requiring fresher (≤7 days old) RBC would have resulted in an additional 147 units and. one or more additional exposures in 54 patients.
  
  
  CONCLUSIONS
  The more conservative model of fresh (≤7 days old) RBC would greatly increase fresh RBC inventory requirements, and 25% of transfused neonates would require additional RBC exposure. Based on retrospective data and the two transfusion models, it can be concluded that requiring RBC ≤14 days old for neonatal transfusion would best balance the use of fresher RBC with the smallest increase in patient exposure (20%) and minimum impact on the RBC inventory.
authors.affiliation: Division of Transfusion Medicine and Coagulation, Texas Children's Hospital, Houston, United States of America.
authors.forename: Kerry
authors.initials: K
authors.lastname: Quinn
authors.affiliation: Division of Transfusion Medicine and Coagulation, Texas Children's Hospital, Houston, United States of America.
authors.forename: Maureen
authors.initials: M
authors.lastname: Quinn
authors.affiliation: Division of Transfusion Medicine and Coagulation, Texas Children's Hospital, Houston, United States of America.
authors.forename: Christina
authors.initials: C
authors.lastname: Moreno
authors.affiliation: Department of Pathology and Immunology, Baylor College of Medicine, Houston, United States of America.
authors.forename: Esther
authors.initials: E
authors.lastname: Soundar
authors.affiliation: Division of Transfusion Medicine and Coagulation, Texas Children's Hospital, Houston, United States of America.|Department of Pathology and Immunology, Baylor College of Medicine, Houston, United States of America.
authors.forename: Jun
authors.initials: J
authors.lastname: Teruya
authors.affiliation: Division of Transfusion Medicine and Coagulation, Texas Children's Hospital, Houston, United States of America.|Department of Pathology and Immunology, Baylor College of Medicine, Houston, United States of America.
authors.forename: Shiu-Ki
authors.initials: SK
authors.lastname: Hui
mesh_terms: D001771:Blood Banks / Q000458:organization & administration; D001782:Blood Donors; D001793:Blood Preservation; D004905:Erythrocyte Aging; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods; D006301:Health Services Needs and Demand; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007445:Inventories, Hospital / Q000706:statistics & numerical data*; D008962:Models, Theoretical; D012189:Retrospective Studies; D013997:Time Factors