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Abstract: PO1968

Partial Extracorporeal Circuit Blood Primes Are Safe and Do Not Decrease Hematocrit in Small Children

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Collins, Michaela, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • French, Xavier, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Krallman, Kelli A., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Roy, Jean-Philippe, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

Partial blood primes (PBP) for extracorporeal therapies have the potential to decrease unique number of blood unit exposures in children when compared to full blood primes (FBP). Pediatric patients (pts) receive a blood prime when the extracorporeal circuit volume (ECV) exceeds 10-15% of their total blood volume (TBV). FBP use packed red blood cells (PRBC; Hct 60%) for the entire ECV while PBP utilize a standardized approach for less PRBC volume per circuit, allowing the same unit to be used for 3-12 treatments depending on ECV. We aimed to show that PBP does not result in more hemodilution or need for transfusions compared to FBP.

Methods

Data from pts receiving continuous kidney replacement therapy (CKRT) or intermittent therapies (INT), including hemodialysis, plasma exchange and aquapheresis, with FBP were collected retrospectively whereas data from PBP were collected prospectively beginning 8/2019 after a change in local practice. The primary outcomes were 1) pre- and post- treatment hematocrit (Hct) and 2) number of transfusions required between FBP and PBP.

Results

14 pts (median 8.9kg; IQR 6.6, 12) across 42 CKRT filters and 26 pts (9.3kg; 3.4, 14) with 226 INT between 11/2018 and 1/2021 were analyzed. 11 CKRT filters were PBP (26%) and 11 INT pts received PBP (42%). Although pts receiving PBP had lower pre-procedure HCT (29.4% v 33.1%, p=0.03), there was no difference in change of Hct over time between PBP and FBP (p=0.9). Mean (SD) Hct and percent change are shown in Table 1. PRBC transfusion rate did not differ between PBP and FBP (31.8% vs. 26.1%, p=0.4). We estimate the use of PBP saved 4 PRBC units of exposure in CKRT and 29 units of exposure in INT.

Conclusion

The use of PBP does not result in hemodilution compared to FBP, nor does it result in the need for more transfusions. PBP is a safe alternative to FBP, it improves blood product stewardship and has the potential to reduce sensitization in children with ESKD or at risk for CKD, which may facilitate kidney transplant.

Table 1. Hct Levels and Change by Blood Prime Type (all values mean (SD))
 Pre-Treatment Hct (%)Post-Treatment Hct (%)Percent Change
 FBPPBPFBPPBPFBPPBPp-value
CKRT33.0 (6.3)28.1 (6.1)33.9 (6.8)30.1 (5.7)3.2 (12.6)10.1 (23.4)0.3
INT33.2 (6.5)30.7 (4.0)35.7 (5.7)31.3 (4.5)10.9 (26.9)3.3 (16.0)0.5