New Association Bulletin Examines Neonatal RBC Transfusion and Mannitol Exposure

AABB released Association Bulletin #26-03 (AB #26-03), Neonatal Red Blood Cell Transfusion and Mannitol Exposure, which provides a summary of available evidence and practice considerations related to the use of red blood cell (RBC) units stored in mannitol-containing additive solutions for neonatal transfusion.

AB #26-03 notes that clinical data support the safety of small-volume transfusions using RBC units in neonatal and pediatric patients, but evidence regarding large-volume transfusions remains limited. It also highlights how supply chain changes and the transition to DEHP-free blood bags may further reduce availability of mannitol-free RBC storage solutions.

The bulletin summarizes published data on small- and large-volume neonatal transfusions, reviews the physiologic effects of mannitol exposure in neonates and discusses potential risks associated with rapid or high-volume transfusion. It also examines real-world transfusion practices in several countries and outlines possible strategies to reduce additive solution exposure, including washing and supernatant reduction of RBC units.

AB #26-03 was developed by an ad hoc working group of AABB member physicians with expertise in pediatric transfusion medicine, including members of the Clinical Transfusion Medicine Committee. Additional Association Bulletins are available on the AABB website.