Transfusing red cells to a patient with corresponding antibodies can result in a severe or fatal reaction.

Just a few millilitres can trigger an immediate immune response leading to shock and disseminated intravascular coagulation, which can result in severe bleeding, or renal failure.

The red cell components routinely available are as follows:

• Red cells in additive solution (the usual red cells provided for the majority of patients);
• Washed red cells;
• Phenotype (Rh and K) matched red cells;
• Red cells for intrauterine transfusion (IUT);
• Red cells in additive solution for neonatal use;
• Red cells in additive solution for neonates and infants (known as large volume transfusion [LVT]);
• Red cells for neonatal exchange transfusion.

Units for IUT and LVTs must be <5 days old (following donation) to minimise the risk of hyperkalaemia.

Below is the red cell guidance for children and infants:

| Acute Paediatrics | • Hb threshold of 70g/L in stable non-cyanotic patients. • Hb increase target ≤ 20g/L in non-bleeding infants and children. | | --- | --- | | Surgery (non-cardiac) | • Treat pre-op iron deficiency anaemia. • Peri-op Hb threshold of 70g/L in stable patients without major comorbidity or bleeding. • Consider tranexamic acid in children at risk of significant bleeding. • Consider cell salvage in children at risk of significant bleeding. |

Neonates

These are the suggested transfusion thresholds for neonates (child up to 28 days old).Generally, transfuse 15mL/kg for non-bleeding neonates at a rate of: 5mL/kg/hr. Phlebotomy should be minimised where possible, using small tubes to minimise blood loss. Where the term or preterm neonate does not require resuscitation, undertake delayed cord clamping.