Standardizing blood dose using body surface area and analyze the effect of blood storage on hemoglobin increment within pediatric patients

Introduction: Pediatric patients exhibit a wide variation in weight which results in diverse transfusion practices. This study aims to standardize red blood cell (RBC) doses according to body surface area (BSA) and to analyze the role of RBC storage in post-transfusion hemoglobin levels. Material and methods: In this original prospective cohort study on hospitalized pediatric patients aged up to 14, we classified patients into transfusion-dependent (n = 31) and non-transfusion-dependent (n = 158). The non-transfusion-dependent group was further classified into ≤10 kg (n = 72) or >10 kg (n = 86) according to body weight (bw). We derived a regression equation between BSA and blood dose in non-transfusion-dependent subjects, and modified the equation by fixing blood dose to 15 mL/kg bw for only BSA based blood dose. We measured pre-transfusion and post-transfusion hemoglobin (Hb) (g/dL) levels, and ascertained effects of blood storage ≤15 days (n = 15) and >15 days (n = 16) on post-transfusion Hb g/dL. Results: Pediatric patients ≤10 kg and >10 kg bw (n = 158); mean (standard deviation) of weight and BSA were 4.5 (3.1) kg; 22.9 (10.4) kg; [0.26 (0.14) m2; 0.9 (0.28) m2] respectively. The regression equation ≤10 kg and >10 kg bw when adjusted. Blood dose fixed at 15 mL/kg bw adjusted blood dose ≤10 kg; 15 mL/kg bw = −19.12 + 329.69 BSA m2. The regression equation >10 kg bw: adjusted blood dose >10 kg bw;15 mL/kg bw = −158.8 + 563.3X BSA (m2). The adjusted blood dose with BSA did not exceed 20 mL/kg bw. No significant differences were observed in pre and post-transfusion Hb g/dL in transfusion-dependent (n = 31) versus non-transfusion-dependent patients (n = 158) due to the RBC storage duration. Conclusions: RBC blood dose can be standardized by regression equation between standardized RBC dosage and BSA. Post-transfusion Hb g/dL is not dependent on days of RBC storage at the blood bank