Introduction
Transfusion practices show variations due to the clinical presentation of patients and differing understanding of transfusion benchmarks among clinicians.
The pediatric age group is especially vulnerable to such variations due to a higher oxygen consumption and higher cardiac output to blood volume ratio than the adult population [1]. Premature infants also have higher fetal hemoglobin (HbF) than fullterm infants with decreased erythropoietin production [1, 2]. Children differ from adults due to the wide variation in body size (up to 10fold) for any given age group [3, 4]. Approaches towards standard blood dosing include blood transfusion according to body weight (kg), total blood volume, body surface area (BSA), body mass index (BMI), and dose banding appropriate to the body surface area. These are some of the measures for blood dosing regimen with predictable endpoints [5–8].
Newborn children and infants have a higher variation of body weight than older children and adults in anthropometric indices e.g. a greater head circumference than chest circumference at birth and during the first year of life, a big trunk with relatively short legs, and older children displaying variations in weight for height due to undernutrition or wasting [5, 9]. A reference standard dosing regimen which estimates blood dose or RBC distribution volume as a mathematical function of body size for any age or weight category could result in predictive endpoints in transfusion [5, 10, 11]. A significant correlation between regression coefficients is one way to ensure such a relationship between the blood dose to be transfused and the body size, especially in pediatric patients.
A blood transfusion dose of 10 mL/kg body weight (bw) to 20 mL/kg within the pediatric population is acceptable under most guidelines [5, 7]. A standardization of RBC transfusion volume has been attempted, with several formulae based on physiological characteristics such as baseline hemoglobin (Hb), hematocrit of RBC unit, weight etc and their statistical relationships [5, 7, 10, 12]. A regression equation based relationship predicting the Hb (g/dL) levels and volume transfused (ml) according to body size has been attempted to estimate blood dosing [10, 11].
A potential cause of variation of posttransfusion hemogram is the ‘age of stored RBC’ effect on a patient’s Hb on attaining a steady baseline value. Fresh RBCs are no longer considered superior compared to the older (stored) RBCs for transfusion for the overall outcome of hospital stay [13]. An evaluation of whether older units attain comparable baseline Hb concentration 24 hours after transfusion as ‘new RBC units’ could affect transfusion therapy upon patients [13, 14].
Our observational study had the following aims:
Definitions
Pearson correlation coefficient typically measures a linear relationship between two continuous variables.
Linear regression is used to study the linear relationship between a dependent variable y and one or more independent variables x. The linear regression models describe the dependent variable by the equation y = a + bx; where a (the intercept) and b (the slop) of the regression line are estimated from an underlying relationship between variables y and x (adapted from Schneider et al. Dtsch Arztebl. 2010).
Body surface area: an accurate measurement of body size, usually determined by using the weight and height of a person.
Material and methods
This prospective cohort study involved data of pediatric (age 0–14) subjects admitted at a tertiary level hospital from 1 January to 31 December 2019. We adhered to the STROBE statement for the present study as a research template [15].

Item No. 
Recommendation 
Page No. 
Title and abstract

1 
(a) Indicate study’s design with a commonly used term in title or abstract 
2 
(b) Provide in abstract an informative and balanced summary of what was done and what was found 
2 

Introduction 

Background/ 
2 
Explain scientific background and rationale for investigation being reported 
4 
Objectives 
3 
State specific objectives, including any prespecified hypotheses 
5 
Methods 

Study design 
4 
Present key elements of study design early in paper 
6 
Setting 
5 
Describe setting, locations, and relevant dates, including periods of recruitment, exposure, followup, and data collection 
6 
Participants

6 
(a) Give eligibility criteria, and sources and methods of selection of participants. Describe methods of followup 
6 
(b) For matched studies, give matching criteria and number of exposed and unexposed 


Bias 
9 
Describe any efforts to address potential sources of bias 

Study size 
10 
Explain how study size was arrived at 
7 
Quantitative variables 
11 
Explain how quantitative variables were handled in analyses. If applicable, describe which groupings were chosen and why 
7–8 
Statistical methods

12 
(a) Describe all statistical methods, including those used to control for confounding 
7–9 
(b) Describe any methods used to examine subgroups and interactions 
7–9 

(c) Explain how missing data were addressed 
9 

(d) If applicable, explain how loss to followup was addressed 
9 

(e) Describe any sensitivity analyses 
NA 

Participants

13 
(a) Report numbers of individuals at each stage of study — e.g. numbers potentially eligible, examined for eligibility, confirmed eligible, included in study, completing followup, and analyzed 
Figure 1 
(b) Give reasons for nonparticipation at each stage 
NA 

(c) Consider use of a flow diagram 


Descriptive data 
14 
(a) Give characteristics of study participants (e.g. demographic, clinical, social) and information on exposures and potential confounders 
9 
(b) Indicate number of participants with missing data for each variable of interest 
<10% of total included data 

(c) Summarize followup time (e.g. average and total amount) 
7 

Outcome data 
15 
Report numbers of outcome events or summary measures over time 

Main results

16 
(a) Give unadjusted estimates and, if applicable, confounderadjusted estimates and their precision (e.g. 95% confidence interval). Make clear which confounders were adjusted for, and why they were included 
9–11 
(b) Report category boundaries when continuous variables were categorized 
9–11 

(c) If relevant, consider translating estimates of relative risk into absolute risk for a meaningful timeperiod (NA) 
NA 

Other analyses 
17 
Report other analyses done — e.g. analyses of subgroups and interactions, and sensitivity analyses 
9–11 
Discussion 

Key results 
18 
Summarize key results with reference to study objectives 
11 
Limitations 
19 
Discuss limitations of study, taking into account sources of potential bias or imprecision. Discuss both direction and magnitude of any potential bias 
13 
Interpretation 
20 
Give a cautious overall interpretation of results considering objectives, limitations, multiplicity of analyses, results from similar studies, and other relevant evidence 
13 
Generalizability 
21 
Discuss generalizability (external validity) of study results 
11–13 
Other information 

Funding 
22 
Give source of funding and role of funders for present study and, if applicable, for original study on which present article is based 
Title page 
Institutional ethical approval of this study was obtained (No: 543/IECAIIMSRPR/2018).
We conducted the study according to a planned protocol (flow diagram) set out in Figure 1. We obtained a pretransfusion sample just before the transfusion, with a followup sample 24 hours after transfusion of a nontransfusiondependent patient. The samples were then tested by routine hemogram in an automated cell counter (Sysmex S100). We conducted this prospective cohort study under the following subcategories (Figure 1).
Model 1
Weight subgroups [≤10 kg (n = 72) and >10 kg (n = 86)] in nonbleeding patients for a regression equation evaluating change of blood dose with unit change in BSA.
Model 2
Transfusiondependent (n = 31) and nontransfusiondependent patients (n = 152) for comparison of the effect of RBC storage (≤15 days and >15 days) on posttransfusion Hb (g/dL) increment.
Inclusion criteria
Model 1
Pediatric patients aged 0–14 undergoing transfusion (red cells, whole blood).
Model 2}
Transfusion of whole blood/red blood cell units stored at the blood bank ≤15 days and >15 days to the following subgroup of patients: routine pediatric transfusion recipients considered as nontransfusiondependent and transfusiondependent patients [sickle cell disease (SCD); thalassemia major; blood dyscrasias etc. requiring repeated transfusions].
Exclusion criteria
Patients >14 years; surgical patients; emergency transfusions; actively bleeding patients under clinical evaluation; unrefrigerated blood categorized as fresh blood.
The outcome variables were as follows: blood dose calculated from BSA from the regression equation (y = a + bx) based upon blood dose and BSA as dependent and independent variables respectively.
An adjusted blood dose was acquired after fixing the blood dose to 15 mL/kg bw which yielded the final regression equation. We validated the adjusted blood dose from BSA by comparing the same with weightbased blood dose (15 mL/kg bw) for a standard blood dose according to BSA.
A statistical comparison of Hb increment after RBC transfusion in the transfusion dependent and nontransfusion dependent paediatric subjects (independent sample T test).
Potential confounders
Variation within regression equation depending on the sample size and patient characteristics. Transfusion variables such as underlying alloimmunization of the patient in the transfusiondependent group. Ongoing hemolysis, undiagnosed blood loss, sampling errors, patient variables such as dehydration and fluid administration.
Statistical calculations
Model 1
Pretransfusion and posttransfusion hemogram estimated in two weight categories [(≤10 kg (n = 72) and >10 kg (n = 86)]. The minimum sample size was derived using the correlation coefficient of blood dose to the BSA alpha probability p (<0.05); power (0.8) [16].
A Pearson correlation coefficient (CC) performed separately for each weight category (≤10 kg and >10 kg) to estimate CC of blood dose (mL) with weight (kg) and BSA (m2) (Table I).
Parameter 
Less than or equal to 10 kg body weight 
Greater than 10 kg body weight 
Range weight (kg) and BSA area (m2) 
Weight (0.8 kg to 10.40 kg) BSA (0.08 m2 to 0.52 m2) 
Weight (11 kg to 50 kg) BSA (0.53 m2 to 1.44 m2) 
Mean ±SD weight and BSA 
Weight 4.5 ±3.1 kg BSA 0.26 ±0.15 m2 
Weight 22.9 ±10.4 kg BSA 0.9 ±0.28 m2 
Mean ±SD pretransfusion Hb Blood dose 
Pretransfusion Hb 7.0 ±1.7 g/dL Blood dose 86.0 ±74.6 mL respectively 
Pretransfusion Hb 6.3 ±1.5 g/dL Blood dose 243.0 ±86.1 mL 
Pearson correlation coefficient (CC) blood dose with weight (kg) and BSA (m2) 
Weight 0.64 BSA 0.68 (p ≤0.01) 
Weight 0.47 BSA 0.50 (p <0.05) 
Regression coefficient (r2) blood dose with weight (kg) and BSA (m2) 
0.41 for BSA (p <0.05) 
0.25 BSA (m2) as predictor variable respectively (p ≤0.05) 
We performed a linear regression analysis (r2) for variation in blood dose (mL) administered to patients with a unit change BSA (m2) in our patient data. Blood dose (y) = b + ax [where y = blood dose (mL), b = constant equal to value of y when x = 0, a is the coefficient of x i.e. the slope of regression line of how much y changes with a unit change in x where x = BSA). To compute a regression equation between blood dose and the BSA, we used ‘blood dose’ as a ‘dependent variable’, with BSA (m2) as an ‘independent variable’.
A validation of this modified regression equation was performed on a standard weight/BSA chart.
Two modalities validated the adjusted equation:
Model 2
We compared the effect of RBC storage (≤15 days vs. >15 days) on pretransfusion and posttransfusion Hb g/dL of both multitransfused (transfusiondependent) and routinely transfused (nontransfusiondependent) patients. Two sample Ttest on 24 hours Hb levels for the duration of RBC storage (≤15 days vs. >15 days).
A ‘independent T testing’ of pretransfusion and posttransfusion Hb (≤15 days, >15 days RBC storage) for both transfusiondependent and nontransfusiondependent patients.
A comparison of increment for transfusiondependent and nontransfusiondependent patients for the effect of blood storage (RBC storage ≤15 days and >15 days) on the posttransfusion Hb levels (in g/dL) 24 hours after RBC transfusion (independent T test).
We estimated the following parameters for the patients:
We estimated missing data for weight/height using an IAP reference chart for the 5+ agegroup (gender specific) and Fenton chart for preterm neonates [4, 19, 20].
Patients lost to followup were not included in the present study.
We performed all statistical calculations on SPSS Statistics (version 26.0); independent Ttest of the blood dose (derived) and blood dose (15 mL/kg bw; 20 mL/kg bw) on Minitab (trial version) [21]. The calculations for each weight category (≤10 kg and >10 kg) and ‘days of storage’ on posttransfusion Hb were performed on Minitab (trial version) and Prism 9 for macOS [21, 22].
Results
We reviewed the parameters evaluated under Model 1 (≤10 kg (n = 72) and >10 kg (n = 86) category (Table I) collected over a 12 month period. CC of blood dose was performed with the weight of the subjects and corresponding BSA under both weight subgroups (Table I).
Both transfusion groups had a low to moderate, but significant, correlation coefficient (CC) of transfused blood dose with weight as well as BSA (p <0.05) (Table I, Supplementary Table 1 — see the supplementary file in the online version of the article).
Summary Model 1 

Model 
CC 
R square 
Adjusted R square 
Standard error 
1A 
0.67 
0.45 
0.46 
52.1 
1A* 
0.96 
0.95 
0.87 
17.0 
1B 
0.50 
0.26 
0.25 
75.0 
1B# 
0.98 
0.97 
0.94 
39.3 
BSA of range (0.08–0.52 m2) for weight ≤10 kg (n = 72) and (0.53–1.44 m2) for >10 kg (n = 86) had regression coefficient r2 = 0.46 and r2 = 0.26 (p <0.05) (Table I).
The regression equation of blood dose and BSA based upon ‘patient data’ for weight category of ≤ 10 kg [BSA range (0.08–0.52 m2)] and >10 kg (0.53–1.44 m2) was as follows:
We then adjusted blood dose to 15 mL/kg/bw for each weight category (≤10 kg and >10 kg) and derived blood dose, which formed the ‘adjusted regression equation’ with BSA. A scatter plot depicting the relationship of independent and dependent variables can be seen in Figures 2–5:
We then validated equation from data which compared patient weight (kg) and corresponding BSA (m2). We then validated this equation from an existing data of ‘Chemotherapy standardization group’ which compared patient weight (kg) and corresponding BSA (m2) [17].
The mean blood dose [(≤10 kg; n = 72) and (>10 kg bw; n = 86)] with standard 15 mL/kg bw was 67.4 ±46.5 mL and 342.2 ±157.7 mL respectively comparable to the blood dose (SD) calculated with derived regression equation using the BSA 67.42 ±45.46 m2 and 342 ±155.1 m2 (Table II).

Blood dose (15 mL/kg bw) 
Blood dose 
Calculated blood dose 
Blood dose (15 mL/kg) 
Blood dose 
Calculated blood dose 

N 
Valid cases 
72 
72 
72 
86 
86 
86 
M±ean ±SD 
67.4 ±46.5 
90.1 ±63.1 
67.4 ±45.4 
342.2 ±157.7 
456.0 ±210 
342.0 ±155.1 

Minimum; maximum values 
12.0; 156.0 
16.0; 208.0 
10.5; 152.3 
165.0; 750.0 
220.0; 1000.0 
145.2; 750.0 
This equation was further validated by using data from the data of a chemotherapy standardization group (Supplementary Tables 2A, 2B — see the supplementary file in the online version of the article) (≤10 kg and >10 kg) [19].
Weight [kg] 
BSA [m2] 
BD 
BD equation [BSA m2] 
BD 
2.0 
0.16 
30.0 
33.63 
40.0 
2.5 
0.19 
37.5 
43.52 
50.0 
3.0 
0.21 
45.0 
50.11 
60.0 
3.5 
0.24 
52.5 
60.00 
70.0 
4.0 
0.26 
60.0 
66.59 
80.0 
4.5 
0.28 
67.5 
73.19 
90.0 
5.0 
0.30 
75.0 
79.787 
100.0 
5.5 
0.32 
82.5 
86.38 
110.0 
6.0 
0.34 
90.0 
92.97 
120.0 
6.5 
0.36 
97.5 
99.56 
130.0 
7.0 
0.38 
105.0 
106.16 
140.0 
7.5 
0.40 
112.5 
112.75 
150.0 
8.0 
0.42 
120.0 
119.34 
160.0 
8.5 
0.44 
127.5 
125.94 
170.0 
9.0 
0.46 
135.0 
132.53 
180.0 
9.5 
0.47 
142.5 
135.83 
190.0 
10.0 
0.49 
150.0 
142.42 
200.0 
10.4 
0.51 
156.0 
149.02 
208.0 
Weight [kg] 
BSA [m2] 
BD 
BD 
BD equation [BSA m2] 
11.00 
0.53 
165.0 
220.0 
139.749 
12.00 
0.56 
180.0 
240.0 
156.648 
13.00 
0.59 
195.0 
260.0 
173.547 
14.00 
0.62 
210.0 
280.0 
190.446 
15.00 
0.65 
225.0 
300.0 
207.345 
16.00 
0.68 
240.0 
320.0 
224.244 
17.00 
0.71 
255.0 
340.0 
241.143 
18.00 
0.74 
270.0 
360.0 
258.042 
20.00 
0.79 
300.0 
400.0 
286.207 
21.00 
0.82 
315.0 
420.0 
303.106 
22.00 
0.85 
330.0 
440.0 
320.005 
23.00 
0.87 
345.0 
460.0 
331.271 
24.00 
0.90 
360.0 
480.0 
348.17 
25.00 
0.92 
375.0 
500.0 
359.436 
32.00 
0.95 
480.0 
640.0 
376.335 
33.00 
1.10 
495.0 
660.0 
460.83 
34.00 
1.10 
510.0 
680.0 
460.83 
36.00 
1.20 
540.0 
720.0 
517.16 
The blood dosages calculated with 15 ml/kg bw were not statistically different from dosage calculated by the regression equation for BSA (0.08–0.52 m2) and (0.53– –1.44 m2) Independent sample Ttest (p = 0.91 and 0.53) (Supplementary Tables 3A, 3B — see the supplementary file in the online version of the article).
Weight up to 10 kg 


Body weight [kg] 
Body surface area [m2] 
BD 
BD 
Calculated 

Mean 
6.24 
0.34 
93.66 
124.88 
94.9 

Median 
6.25 
0.35 
93.75 
125.00 
96.2 

Standard deviation 
2.65 
0.11 
39.89 
53.19 
35.5 

Minimum 
2.0 
0.16 
30.00 
40.00 
33.6 

Maximum 
10.4 
0.51 
156.00 
208.00 
149.0 


25 
3.87 
0.25 
58.12 
77.50 
64.9 
50 
6.25 
0.35 
93.75 
125.00 
95.7 

75 
8.62 
0.44 
129.37 
172.50 
127.5 
Weight greater than 10 kg 


Body weight [kg] 
BSA [m2] 
BD [15 ml/kg] 
BD [20 mL/kg] 
Calculated blood dose [mL] 

Mean 
21.4 
0.81 
321.6 
428.8 
297.4 

Median 
20.5 
0.80 
307.5 
410.0 
294.7 

Standard deviation 
7.9 
0.19 
118.8 
158.4 
110.0 

Minimum 
11.0 
0.53 
165.0 
220.0 
139.7 

Maximum 
50.0 
1.2 
540.0 
720.0 
517.2 


25 
15.75 
0.67 
221.3 
315.0 
203.1 
50 
22.50 
0.86 
337.5 
450.0 
322.8 

75 
34.50 
1.12 
401.3 
690.0 
363.7 
Blood doses calculated with bw (20 mL/kg) for ≤10 kg and >10 kg were significantly different compared to ‘calculated dose’ from the regression equation with mean [standard deviation (SD) higher in volume (mL) compared to the regression equation for BSA (0.08–0.52 m2) and (0.53–1.44 m2)] (independent test; p = 0.05 and 0.006) (Supplementary Tables 2A, 3B — see the supplementary file in the online version of the article).
Model 2: a comparison of blood storage period (≤15 days and >15 days) in ‘transfusion dependent group’(n = 31); we did not observe a significantly different value of pretransfusion Hb 5.7 ±2.1 g/dL and 5.5 ±1.7 g/dwith (p = 0.75); posttransfusion Hb 8.4 ±2.1 g/dL and 9.1 ±2.2 g/dL (p = 0.29) and Hb increment 2.7 ±1.5 and 2.3 ±1.4 (p = 0.51) (2 sample T test) (Table III).
Parameter 
Less than or equal to 15 days RBC storage 
Greater than 15 days RBC storage 
Mean ±SD storage duration [days] RBC* 
9.2 ± 3.6 (n = 79) 
26.4 ± 6.4 (n = 79) 
Mean ±SD pretransfusion Hb [g/dl]* 
6.6 ± 1.5 
6.6 ± 1. 7 
Mean ±SD posttransfusion Hb [g/dl]* 
9.2 ± 1.9 
9.0 ± 2.2 
Mean ±SD Hb increment [g/dl]* 
2.5 ± 1.4 
2.4 ± 2.0 
Mean ±SD storage duration [days] RBC# 
8.8 ± 3.4 (n = 16) 
26.4 ± 6.3 (n = 15) 
Mean ±SD pretransfusion Hb [g/dl]# 
5.7 ± 2.1 
5.5 ± 1.7 
Mean ±SD posttransfusion Hb [g/dl]# 
8.4 ± 2.0 
9.1 ± 2.2 
Mean ±SD Hb increment [g/dl]# 
2.7 ± 1.5 
2.4 ± 1.4 
Nontransfusiondependent group (n = 158) did not have significant difference: pretransfusion Hb 6.6 ±1.5 g/dL and 6.6 ±1.7 g/dL (p = 0.94); posttransfusion Hb 9.2 ±1.9 g/dL and 9.0 ±2.2 g/dL (p = 0.68) and Hb increment 2.5 ±1.4 and 2.4 ±2.0 respectively. (Twotailed independent T test (p >0.61) (Table III).
Transfusiondependent and nontransfusiondependent patients had significant differences in the pretransfusion Hb (≤15 days and >15 days) (p = 0.016) with no statistical difference in posttransfusion Hb (p = 0.08). The Hb increments when compared for transfusion dependent and nontransfusion dependent were nonsignificantly different (p = 0.89; Table III).
Discussion
Pediatric patients where the blood transfusion is in small aliquots targeting Hb show variation depending on physical parameters such as age, BSA, and blood dosage [2, 10, 23]. An objective of transfusion recommendations corresponding to BSA is to achieve the desired clinical response among patients with minimal allogeneic transfusions and transfusion associated sideeffects [23–25].
The reasons for choosing nonbleeding, nontransfusiondependent subjects to estimate blood dose equation were as follows: 1) blood is mostly administered to pediatric patients as per body weight, and not in units as in adults; and 2) nonbleeding patients are less likely to have posttransfusion Hb increment impacted by ongoing blood loss or hemodilution because of volume replacement.
The storage duration of RBC also does not adversely affect survival during the hospital stay [27, 28]. We assessed pretransfusion Hb and 24 hours posttransfusion Hb as a function of ‘days of storage’ ex vivo and subsequent RBC survival. Posttransfusion Hb was chosen to assess days of storage effect because Hb assessment is generally performed to ascertain steady state response following RBC transfusions [13, 28].
A classification of underweight or overweight pediatric population requires age and sexbased standardization with a reference population under evaluation. BSA band based blood dosing or weight to BSA conversion, especially in infants and children, needs further validation by clinical trials to establish safety in this context [5, 8, 10]. BSA based dosing has been documented to show discrepancies in adults and very young children [23, 29, 30]. In the present study, with adjusted equation based on ‘BSA’, a more streamlined correlation of blood dose and BSA with higher regression coefficient was observed for both weight categories (≤10 kg and >10 kg) (Supplementary Table 1 — see the supplementary file in the online version of the article). (Figures 2–5).
This equation may show some variation within different representative populations, which however is unlikely to affect significantly the accuracy of calculating blood dose according to the BSA of the patient.
The regression equation calculated with 15 mL/kg bw reference values, and the calculated blood dose from the corresponding BSA did not exceed 20 mL/kg body weight (Supplementary Tables 2A, 2B — see the supplementary file the in the online version of the article).
Blood transfusion among patients with cardiac failure and children with malnourishment when transfused according to the BSA (m2) and Hb (g/dL) threshold is likely to prevent overtransfusions and related adverse sideeffects.
The blood transfusionrelated to BSA can be standardized according to bands of BSA receiving a similar dosing regimen [8]. This measure could prevent erratic transfusion to a patient, especially preterm and newborns, since there is considerable heterogeneity in the blood volume and BSA formula in this age group [3, 23]. A regression equation that accommodates such borderline cases with clinical trialbased validation of BSA based dosing from a large representative population size should be the next step for BSA based blood transfusion dosing.
A comparison of fresh versus old RBC (≤15 days and >15 days) for posttransfusion hemogram values among the pediatric population is another step towards attainment of a predictable posttransfusion Hb (g/dL) as an endpoint parameter. A single RBC unit for transfusion of newborns decreases potential donor exposure and chances of infection transmission and immune transfusion reactions.
We evaluated transfusiondependent and nontransfusiondependent populations separately to evaluate the effect of RBC storagebased lesions and test the similarity of posttransfusion hemogram after RBC transfusion among diverse test subjects. The blood transfusion in the present study attained similar endpoints (posttransfusion Hb and Hb increment) irrespective of patient type or RBC storage duration. The importance of more such studies to evaluate ‘a steadystate hemogram’ or other standardized parameters such as ‘tissue oxygenation’ should be a baseline to assess effect of storage duration upon the efficacy of RBC transfusion [31, 32].
This study had a small number of test subjects with limited standardization related to critical confounding variables such as known alloimmunization status, especially in transfusiondependent patients; a high or low responder to transfusion demarcation might have been more evident in a larger sample size [10]. Posttransfusion hemogram parameters might have modified the effect of storage due to underlying clinical diagnosis. Missing data of weight and height obtained from the growth chart could have overlooked the physiological variations due to malnutrition or growth retardation, though it is unlikely to be significant. Previous recommendations of transfusing a patient from BSA advise caution in infants under six months and up to 12 months with a combination of weight and BSA for calculating the infusion dose [23].
This present study attempts to standardize endpoints of transfusion among the pediatric population; however, our study’s findings should be replicated further in a clinical trial setting before incorporating them into routine patient use.
Conclusions
Blood dose according to the BSA is an appropriate substitute for weightonly based dosing for blood transfusion. However, clinicians utilizing any transfusion regimen with BSA must validate the equation in a clinical trial setting. The duration of blood storage does not affect the posttransfusion Hb in transfusiondependent or nontransfusiondependent patients.
Acknowledgements
Staff members of the Department of Transfusion Medicine and Blood Bank for extending all possible help for this study. Mrs Laxmi Karsh (data entry operator) for data collection and coordinating with the Department of Pediatrics; statistical calculation Howtostats.com [You Tube]; Dr Todd Grande [You Tube]; Dr Phalguni Padhi for guidance towards the growth chart of neonatal patients, and Dr Dhananjay Sahu for collection of data for transfusiondependent patients.
Conflict of interest
This work was accepted as an abstract for oral presentation at the annual conference of the ISBT 2020 and was published as an abstract of the conference Supplement.
Data and material available upon request.
Authors’ contributions
SS — concept, research and ethical approval, first author, corresponding author, statistical calculations, interpretation and conclusions; SJ — scientific suggestions for manuscript, coinvestigator in study, patient coordination; MP — patient coordination and data collection; AS — calculations, sample size, effect of blood storage duration on posttransfusion Hb (g/dL) levels; AG — availability of departmental resources, mentoring
Ethical approval
No 543/IECAIIMSRPR/2018.