Prospective, randomized trial of the safety and efficacy of a limited donor exposure transfusion program for premature neonates.

We investigated the safety and efficacy of using a single unit of packed red blood cells until its expiration date (35 days) to meet the transfusion needs of infants weighting < 1.5 kg. Unit concentration of potassium and infants' hematocrit value, K+ level, pH, and base excess were measured before and after transfusion. Compared with control infants, study infants had similar transfusion needs, but received blood from significantly fewer donors. The age of the blood received by study infants was significantly older and had a higher plasma K+ level. However, the change in infants' serum K+ levels before and after a transfusion was not significantly different in the two groups, and no adverse effects from transfusion of older blood were observed. We conclude that a protocol that allows use of an assigned unit of packed red blood cells preserved with citrate-phosphate-dextrose-adenine anticoagulant until its expiration date is safe, minimizes donor exposures, and meets the transfusion needs of low birth weight neonates.