What red cell products are ECMO centers using by age (of RBC) and anticoagulant?

A colleague comments that an e-Network Forum document posted HERE regarding ECMO from 2004 indicated that “transfusion of AS1/3 RBCs are tolerated as well as CPD/A RBCs by infants on ECMO, suggesting that the removal of supernatant or washing is unnecessary”. She wonders if any relevant additional data or practice experience have been reported in the past 4 years?

The following comments have been received.

ADDENDA August 29, 2008

1. A transfusion medicine physician in upstate New York reports that his hospital does not have any ECMO related blood storage time restrictions except that for newborn infants they use blood stored less than 3 weeks, wash the red cells before using them, and give only ABO identical red cells, platelets, FFP and cryoprecipitate. They do not wash red cells for older children, nor do they have time restrictions on storage beyond the label expiration date, but they do give only ABO identical components. He acknowledges that the washing and storage strategies for newborns are largely historical in his institution although there is some, probably legitimate, concern about potassium load in unwashed/older red cells. Since most of their infants being treated have acidosis and borderline high normal potassium levels, they have chosen not to change their policy and stop using washed red cells. They rarely do ECMO for non-pediatric patients and when they do, the outcomes are not good.

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Ira A. Shulman, MD
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