The specifications of blood components for neonatal transfusion: a European study and critical review

Background Blood component safety measures implemented by Blood Establishments (BE) specifically for neonates are frequently precautionary rather than evidence based. We conducted a European survey on specifications for neonatal red blood cells, platelet, and plasma transfusions. Methods The survey was sent to transfusion experts in BEs in 38 European countries between May 2023 and January 2024. We received responses from 20/38 countries. Results Many BEs provide neonatal components with additional safety features not routinely applied for adults, and we found evidence of significant variation in practice. 12/19 BEs used a shorter shelf life for split units compared to adult components. For neonatal exchange, 12/19 used saline-adenine-glucose-mannitol (SAGM) replaced with FFP prior to issue. Three BEs performed additional donor or component testing for neonatal units, including screening for lead concentrations (1/20). Conclusion We identified three questions for which we conducted a critical literature review, around use of short-shelf life of red cells, use of additive solutions, and significance of lead concentrations for neonatal components. Although there were relevant articles addressing these questions, we found a lack of definitive evidence for much precautionary practice, and a need for wider study of the impact of lead in neonatal transfusions to inform future strategies.