Using a Modified CPD Blood Bag to Store Blood from either ECMO or RRT Circuit Blood in Pediatric Patients

Area of Science:

• Pediatric Nephrology
• Transfusion Medicine
• Blood Conservation

Background:

• Donor blood exposure poses risks in pediatric patients undergoing renal replacement therapy (RRT).
• Autologous blood storage techniques can mitigate risks associated with allogeneic transfusions.
• Citrate phosphate dextrose (CPD) is a commonly used anticoagulant with a readily available reversal agent (calcium).

Purpose of the Study:

• To describe and validate a method for storing residual blood from RRT circuits in pediatric patients.
• To reduce the need for donor blood exposure in this vulnerable population.
• To adapt existing autologous blood storage techniques for RRT circuits.

Main Methods:

• Adapting citrate phosphate dextrose (CPD) whole blood storage bags for RRT circuits.
• Reducing CPD volume while maintaining the critical CPD-to-blood ratio.
• Implementing a technique used successfully for extracorporeal membrane oxygenation (ECMO) blood salvage.

Main Results:

• Successful implementation in over 30 pediatric patients over 7 years without incident.
• The adapted technique uses 23 mL of CPD for 165 mL of RRT circuit blood.
• No increase in anticoagulation laboratory parameters observed, unlike heparin or bivalirudin.

Conclusions:

• Adapted CPD bags provide a safe and effective method for storing residual RRT circuit blood in pediatric patients.
• This blood conservation strategy reduces reliance on donor blood.
• The technique is also applicable for storing residual blood from ECMO circuits.