edema, hypotension, fever, and severe hypoxemia.

(3) Reported only rarely in neonates due to the difficulty in distinguishing TRALI from other

causes of respiratory deterioration in sick infants;

however, it is documented in the setting of a

designated blood transfusion between mother

and infant (55).

c. Transfusion-associated circulatory overload

(1) Nonimmune alteration in pulmonary compliance and blood pressure due to volume overload

(2) Presents with respiratory distress, cardiogenic

pulmonary edema, and hypertension

5. Adverse metabolic effects

a. Hyperkalemia

(1) Blood that is irradiated and then refrigeratorstored may have K+

 levels of 30 to 50 mEq/L or

higher in the supernatant plasma.

(2) Small-volume transfusions of stored red cells do

not cause clinically significant elevations in

serum K+

 levels.

(3) Life-threatening hyperkalemia has been

described in sick infants and in those receiving

rapid infusions of large volumes of stored red

cells (24).

(4) Washed or fresh (<14 days) red cells are recommended for infants with profound hyperkalemia, renal failure, or when large volumes are

transfused rapidly.

b. Hypoglycemia or hyperglycemia

c. Hypocalcemia

d. Alterations in acid–base balance with large transfusions

References

1. Carson TH, ed. Standards for Blood Banks and Transfusion services. 27th ed. Bethesda, MD: American Association of Blood

Banks; 2011.

2. Josephson CD. Neonatal and pediatric transfusion practice. In:

Roback JD, eds. Technical Manual of the American Association of

Blood Banks. 16th ed. Bethesda, MD: American Association of

Blood Banks; 2008:639.

3. Wong EC, Paul WM. Intrauterine, Neonatal, and Pediatric

Transfusion Therapy. In: Mintz PD, eds. Transfusion Therapy:

Clinical Principles and Practice. Bethesda, MD: American

Association of Blood Banks; 2011:209.

4. Ferguson D, Hebert PC, Lee SK, et al. Clinical outcomes following institution of universal leukoreduction of blood transfusions of

premature infants. JAMA. 2003;289:1950.

5. Strauss RG. Data-driven blood banking practices for neonatal

RBC transfusions. Transfusion. 2000;40:1528.

6. Wong EC, Schreiber S, Criss VR, et al. Feasibility of red blood

cell transfusion through small bore central venous catheters used

in neonates. Pediatr Crit Care Med. 2004;5:69.

7. Nakamura KT, Sato Y, Erenberg A. Evaluation of a percutaneously placed 27-gauge central venous catheter in neonates weighing less than 1200 grams. Jpen. 1990;14:295.

8. Oloya RO, Feick HJ, Bozynski ME. Impact of venous catheters on

packed red blood cells. Am J Perinatol. 1991;8:280.

9. Frey B, Eber S, Weiss M. Changes in red blood cell integrity

related to infusion pumps: a comparison of three different pump

mechanisms. Pediatr Crit Care Med. 2003;4:465.

10. Strauss RG. How I transfuse red blood cells and platelets to infants

with the anemia and thrombocytopenia of prematurity. Transfusion.

2008;48:209.

11. Widness JA. Treatment and prevention of neonatal anemia.

NeoReveiws. 2008;9:e526.

12. Kirpalani H, Whyte RK, Andersen C, et al. The Premature Infants

in Need of Transfusion (PINT) study: a randomized, controlled

trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants. J Pediatr. 2006;149:

301.

13. Bell EF, Strauss RG, Widness JA, et al. Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in

preterm infants. Pediatrics. 2005;115:1685.

14. Whyte RK, Kirpalani H, Asztalos EV, et al. Neurodevelopmental

outcome of extremely low birth weight infants randomly assigned

to restrictive or liberal hemoglobin thresholds for blood transfusion. Pediatrics. 2009;123:207.

15. Blau J, Calo JM, Dozor D, et al. Transfusion-related acute gut

injury: necrotizing enterocolitis in very low birth weight neonates

after packed red blood cell transfusion. J Pediatr. 2011;158:403.

16. El-Dib M, Narang S, Lee E, et al. Red blood cell transfusion,

feeding and necrotizing enterocolitis in preterm infants.