Liz, Our process is this: We get a fresh unit of whole blood collected in CPDA-1 anticoagulant straight from our small donation center. We then centrifuge the unit so it is hard-packed. It is then stored like this. When it is required for a neonate top-up we then remove most of the plasma to make the packed cell with a HCT between 70 and 80%. We then take the required volume necessary from the packed cells and reserve the rest of the unit for that particular neonate (if the birth weight is < 1Kg). All our top-ups are leucoreduced, sickle cell negative and G6PD normal. They are not irradiated -at present. I actually want to change this process and use units collected in additive solution (in my case SAG-M). The packed cells would be made as normal for a RBC unit and then when a top-up is required an aliquot would simply be taken from the unit. There would be no more centrifugation involved. Fresh blood would be used initially and then the unit reserved for the neonate throughout the shelf-life of the unit. For various reasons this would make my life a lot easier in my Blood Bank. I have discussed this with my neonatologists and they seem okay with this. I told them that the HCT of the units would be only 60-70% if I did this method, but they would adjust their volume requirements accordingly. My concern was the extra mannitol and potassium I would be giving with these units. But every bit of literature I have read (British, American, BCSH, AABB) concerning neonatal top-ups with SAG-M units says this is not a problem. The amounts involved in top-up transfusions are too small to be a cause for concern. So is my current method acceptable? Is my proposed use of SAG-M units acceptable? Are they both okay? Thanks to everyone for the interest in this topic!