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.