Age of Blood in Children in Pediatric Intensive Care Units

Patients are considered eligible to participate in the trial if one of the following occur:

• First RBC transfusion is requested within the first 7 days (168 hours) of ICU admission.

OR

• First RBC transfusion is requested for a patient in the Emergency Room, and the PICU team is involved with the clinical care of the patient, and the patient will definitively be transferred to the ICU.

OR

• Patient assessed pre-operatively and for whom ICU admission is planned post-operatively, and who is determined to definitively require a first RBC transfusion during surgery.

Inclusion criteria

Eligible critically ill pediatric patients who have an expected length of stay after transfusion in the ICU > 24 hours based on the best judgment of the attending ICU staff.

Exclusion criteria

• Age at time of enrollment < 3 days from birth or has reached their 16th birthday.
• Post-conception age < 36 weeks at time of enrollment
• Documented RBC transfusion within the 28 days prior to fulfilling the eligibility criteria
• Previously randomized in this study
• Weight < 3.0 kg on ICU admission
• Known Pregnancy
• Conscious objection or unwillingness to receive blood products
• Not expected to survive beyond 24 hours, brain death or suspected brain death
• Limitation or withdrawal of care decisions have been made
• Enrollment in another randomized clinical trial which has not been approved for co-enrollment
• Patients for whom autologous and/or directed donation RBCs will be provided
• Patients for whom the treating physician routinely and systematically requests RBC ≤ 14 days of storage
• Patients for whom there systematically exist RBC aliquoting policies that mandate the initial use of units stored ≤ 14 days (ex: Pedi-Pack).
• On ECMO or plan to be immediately placed on ECMO at time of enrollment
• Patient predicted or presumed to require a massive transfusion (> 40ml/kg of all blood components in a 24 hour period) according to treating physician judgment
• Refusal by physician
• Inability to obtain consent
• Blood bank personnel experiences difficulties in securing blood products (difficult cross matches, rare blood groups and diseases like IgA deficiency)
• Insufficient number of ABO type compatible RBC units available in the blood bank at randomization with a storage time ≤ 7 days (minimum 1 unit regardless of patient age)
• All RBC units available for the patient are not leukocyte-reduced prior to storage