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For open heart surgery our perfusion team washes the red cells in the OR (faster than we can) and uses those with a small amount of FFP (for babies usually < 1 year especially those < 4kg). Our policy is to provide 1 fresh, <6 day old, irradiated (<24 hours) AS3, CPD, CPDA-1 or CP2D packed red cell for post CPB but we give then two <= 10 day old unit (irradiated, AS3, CPD, CPDA-1 or CP2D) and mark them "To Be Washed" for priming the CPB. For non-pump cardiac surgeries we wash if the patient is <4kg. I would love to get away from washing RBCs for surgeries (we also wash for major open belly procedures on <4kg infants) but over 20 years ago a patient died because of a K+ overload from a RBC that was irradiated 3 days prior to surgery even thought the unit was still <6 days old. Now I can't even get our Transfusion Committee to even discuss the topic. Guess I just wait until more surgeons retire.