Related Experiment Video
Updated: Nov 29, 2025
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Reduced volume of red blood cell priming is safe for pediatric patients undergoing therapeutic plasma exchange
José Roberto Luzzi1, Claudio C Borba2, Sandra C Miyaji1
1Unidade de Hemoterapia e Hematologia Samaritano, São Paulo, Brazil.
Insights
Reducing red blood cell (RBC) priming volume in pediatric Therapeutic Plasma Exchange (TPE) is safe and lowers transfusion reactions. This study found less than 150 mL of RBC priming is associated with fewer adverse events in children over 10kg.
Area of Science:
- Pediatric Nephrology
- Hematology
- Transfusion Medicine
Background:
- Therapeutic Plasma Exchange (TPE) in children presents challenges due to equipment size.
- Red blood cell (RBC) priming mitigates hypovolemia risks but optimal volumes are unclear.
- Lowering RBC priming volume may reduce transfusion reactions.
Purpose of the Study:
- To assess the safety of reduced RBC priming volume during pediatric TPE.
- To compare a reduced RBC priming volume against manufacturer-recommended volumes.
Main Methods:
- A case-control study involving 15 pediatric patients (>10kg) undergoing TPE.
- 406 TPE procedures were divided into two groups: ≤150 mL RBC priming (Group 1) and 150-250 mL (Group 2).
- Comparison focused on hemoglobin/hematocrit levels and adverse reaction incidence.
Main Results:
- No significant differences in pre- and post-TPE hemoglobin or hematocrit between groups.
- The change in hemoglobin (Δ Hb) was comparable between Group 1 and Group 2.
- Group 2 (150-250 mL priming) showed significantly higher rates of adverse reactions (p=0.01) and allergic reactions (p=0.06) compared to Group 1 (≤150 mL priming).
Conclusions:
- Restricting RBC priming to ≤150 mL is safe for pediatric patients over 10kg undergoing TPE.
- Reduced RBC priming volume is linked to decreased transfusion-related adverse reactions.
- This finding supports optimizing priming protocols for pediatric TPE procedures.
Rational:
Therapeutic Plasma Exchange (TPE) procedures in pediatric patients are challenging due to the large extracorporeal volume of the cell separators, which were designed for adults. Red blood cell (RBC) priming is an alternative for overpassing the risks of hypovolemia, but data referring to the volume of packed RBCs to be infused are yet incomplete. Restricting the volume of RBC priming may potentially be associated with less transfusion reactions.
Goal:
To determine the safety of administering a reduced volume of RBC priming for pediatric patients undergoing TPE, in comparison to the standard volume recommended by the cell separators' manufacturers.
Methods:
This was a case-control study which enrolled 15 pediatric patients undergoing TPE and weighting more than 10Kg. The TPE procedures (n = 406) were divided in two groups: 1) Group1: TPE with ≤150 mL of packed RBC priming and 2) Group2: TPE with 150-250 mL of RBC priming. Groups were compared in terms of hemoglobin / hematocrit and occurrence of adverse reactions.
Results:
Group1 and Group2 did not differ significantly in relation to pre- and post-TPE hemoglobin (Hb) levels (p = 0.19 and p = 0.18, respectively). The Δ Hb (Hb pre-TPE - Hb post-TPE) was also not statistically different between the groups. The number of adverse reactions was significantly higher in Group 2 in relation to Group 1 (p = 0.01). The number of allergic reactions was also higher in Group 2 (p = 0.06).
Conclusions:
Restricting the volume of RBC priming to less than 150 mL is safe for pediatric patients weighting more than 10Kg and associated with lower rates of transfusion-related adverse reactions.
More Related Videos
07:40Preparation of Peripheral Blood Mononuclear Cell Pellets and Plasma from a Single Blood Draw at Clinical Trial Sites for Biomarker Analysis
Published on: March 20, 2021
10:48Isolation and Cryopreservation of Highly Viable Human Peripheral Blood Mononuclear Cells From Whole Blood: A Guide for Beginners
Published on: October 25, 2024
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
02:45Blood Transfusion and Agglutination
History
The history of blood transfusion dates back to the 17th century, when early attempts were made in animals. In 1818 James Blundell, a British doctor, performed the first successful human blood transfusion. Later in 1900, Karl...