Age of Blood in Children in Pediatric Intensive Care Units

Patients are considered eligible to participate in the trial if one of the following occur:

1. First RBC transfusion is requested within the first 7 days (168 hours) of ICU
admission.

OR

2. First RBC transfusion is requested for a patient in the Emergency Room, and the PICU
team is involved with the clinical care of the patient, and the patient will
definitively be transferred to the ICU.

OR

3. Patient assessed pre-operatively and for whom ICU admission is planned
post-operatively, and who is determined to definitively require a first RBC
transfusion during surgery.

Inclusion Criteria:

Eligible critically ill pediatric patients who have an expected length of stay after
transfusion in the ICU > 24 hours based on the best judgment of the attending ICU staff.

Exclusion Criteria:

- Age at time of enrollment < 3 days from birth or has reached their 16th birthday.

- Post-conception age < 36 weeks at time of enrollment

- Documented RBC transfusion within the 28 days prior to fulfilling the eligibility
criteria

- Previously randomized in this study

- Weight < 3.0 kg on ICU admission

- Known Pregnancy

- Conscious objection or unwillingness to receive blood products

- Not expected to survive beyond 24 hours, brain death or suspected brain death

- Limitation or withdrawal of care decisions have been made

- Enrollment in another randomized clinical trial which has not been approved for
co-enrollment

- Patients for whom autologous and/or directed donation RBCs will be provided

- Patients for whom the treating physician routinely and systematically requests RBC ≤
14 days of storage

- Patients for whom there systematically exist RBC aliquoting policies that mandate the
initial use of units stored ≤ 14 days (ex: Pedi-Pack).

- On ECMO or plan to be immediately placed on ECMO at time of enrollment

- Patient predicted or presumed to require a massive transfusion (> 40ml/kg of all blood
components in a 24 hour period) according to treating physician judgment

- Refusal by physician

- Inability to obtain consent

- Blood bank personnel experiences difficulties in securing blood products (difficult
cross matches, rare blood groups and diseases like IgA deficiency)

- Insufficient number of ABO type compatible RBC units available in the blood bank at
randomization with a storage time ≤ 7 days (minimum 1 unit regardless of patient age)

- All RBC units available for the patient are not leukocyte-reduced prior to storage