Glad you mentioned washing with Plasmalyte A, which we have shown leads to less hemolysis than normal saline during 24 hours of storage.  A bit more expensive, but more physiologic and hemolysis is not a good thing for patients. It is also FDA approved for use in blood component administration.  When patients with acute myeloid leukemia (younger than 50, without high risk cytogenetics) receive washed platelets and red cells during induction therapy, consolidation and transplant, their mortality rate drops from 50% at five years to 20% in our hands.  Also abrogates essentially all febrile and allergic reactions to transfusion, so we use it in patients with repeated or severe reactions to leukoreduced red cells and platelets. We have also never had a reported case of TRALI or TACO to about 100,000 transfused components over the last 20 years or so.  The contempt for washed transfusions amongst our colleagues is both tragic and misplaced. Washed transfusions can save lives and reduce patient suffering.  Also reduces inflammation post-transfusion in pediatric cardiac surgery, and may reduce mortality.  Randomized trial data, by the way.

Edited February 18, 20223 yr by Neil Blumberg

Resurrecting this thread with a related question.  Is the potassium level in stored blood considered the same regardless of whether the units are leukoreduced?  I have an old table for non-leukoreduced units but can't find data on leukoreduced units.  This is in the context of large transfusions to neonates who hemorrhage at birth or come into the ED as traumas etc.  We don't have time (nor ability at our small hospitals) to replace plasma in units nor to aliquot but I want to understand the potassium and mannitol (AS-1) risks if we are transfusing more than 20 mL/kg emergently to a baby.  We usually use our stored, irradiated pedi units for neonatal emergency massive transfusions, but I am wondering if we should use non-irradiated RBCs for lower potassium. We don't have an irradiator so use stored, irradiated units for our NICU for small volume transfusions with no problems.  It is when they give larger volumes quickly that I have concerns.  Any advice appreciated.