Whole Blood Components

RED BLOOD CELLS

Packed Red Blood Cells
Red blood cells, or packed red blood cells, are prepared from whole blood collected in one of several approved anticoagulant solutions. The usual 250-300 ml unit of red blood cells (RBCs) has a hematocrit of 55-80%, with some platelets and/or white cells removed during processing. Red blood cells are the component of choice for patients with a symptomatic deficit of oxygen-carrying capacity. RBCs may also be used to help restore cells lost following significant hemorrhage. Removal of plasma reduces the risk of adverse reactions. Red Blood Cells can be enhanced by:

• Red Blood Cells, Leukocytes Reduced
  Leukocyte reduced red blood cells are cells that have been filtered to remove many of the leukocytes in the unit. Leukocytes are removed using filters to obtain fewer leukocytes per unit for a patient dose. Leukocyte-reduced RBCs are offered in two configurations - single standard bag alone or with two or four pediatric packs attached. This product is used to reduce the risk of nonhemolytic, febrile transfusion reactions for those who have had febrile reactions following transfusion. Its use has also been shown to be effective in reducing platelet alloimmunization and CMV transmission. Leukoreduced red blood cells can also be used when CMV negative RBCs are unavailable. Pediatric packs are appropriate for use in infants.
  
• Red Blood Cells, Irradiated
  Red blood cells are irradiated to inactivate any lymphocytes present. Severely immunosuppressed patients who may develop graft-versus-host disease (GVHD) after transfusion of viable immunocompetent lymphocytes should receive irradiated red blood cells. Those at highest risk are those with congenital immunodeficiencies, transplant recipients, premature infants, fetuses receiving intrauterine transfusion, and those with aggressively treated neoplastic disease. Potassium levels may increase at rates higher than seen in non-irradiated red cells. This should be taken into account, depending on clinical circumstances.
  
• Red Blood Cells, Frozen/Rejuvenated, Deglycerolized
  Red blood cells-frozen, rejuvenated, deglycerolized are similar in function to liquid stored red blood cells. A unit contains at least 80% of the original red blood cells following the deglycerolization process. Virtually all plasma, platelets and most leukocytes are removed from the unit. The frozen blood inventory is the ideal source of rare blood cells. Frozen storage is also useful for the storage of autologous red cells beyond the time limits of liquid storage. Frozen red blood cells are the preferred component for patients sensitized to IgA. They are also indicated for patients sensitized to leukocyte and platelet antigens, along with leukocyte-reduced products obtained by filtration.
  
• Red Blood Cells, Washed
  Washing a unit of Red Blood Cells with sterile normal saline removes about 99% of plasma proteins, electrolytes and antibodies. Saline washed Red Blood Cells are indicated for patients with or for those who have allergic or febrile reactions to plasma components of the blood product. This product may be used in patients with antibodies to IgA or IgE immunoglobulins or thalassemic patients.
  
• Red Blood Cells, CMV Negative
  Red blood cells that have been tested for cytomegalovirus (CMV) and have been found to be negative. In the US, seropositivity for CMV varies from 40-90%, depending on geographic area. The risk of CMV infection from transfusion is greater in severely immunosuppressed patients who are CMV seronegative. These patients include recipients of bone marrow or solid organ transplants and premature infants whose mothers are CMV seronegative.
  
• Red Blood Cells, Hgb S Negative
  Red blood cells from a donor that does not have Hemoglobin S (sickle cell) trait or disease. About 0.1-0.2% of the African American population born in the United States have sickle cell anemia and about 9% carry the trait, but have no clinical signs. Indications for transfusion of red blood cells lacking Hemoglobin S include patients with sickle cell disease, fetuses and infants, and patients at risk of developing severe hypoxemia or acidosis.

WHOLE BLOOD

Whole blood contains approximately 500 ml of anticoagulated whole blood. The platelets and granulocytes are non-viable after a few days. Levels of labile clotting factors also decline with storage. Lymphocytes are viable. and can cause Graft vs. Host Disease (GVHD). Whole blood provides oxygen-carrying capacity and blood volume expansion. Whole blood may be useful in bleeding patients who have lost in excess of 20% of total blood volume. Patients with chronic anemia who have a normal blood volume should receive red blood cells (packed RBC's). Whole blood can be enhanced by being Irradiated, CMV Negative and Hgb S Negative.


PLATELETS PRODUCTS

Platelet Concentrate
Platelet concentrate contains platelets in 50-70 ml of plasma, and is prepared from individual units of whole blood by centrifugation. Platelet concentrates contain leukocytes which may transmit CMV, cause GVHD, lead to alloimmunization and cause febrile transfusion reactions. Platelets are used to treat bleeding caused by thrombocytopenia or functionally abnormal platelets. Prophylactic administration of platelets may be useful in patients with rapidly declining or low platelet counts (10,000 to 20,000/m L) secondary to cancer or chemotherapy. Platelets can be enhanced by being CMV Negative and Irradiated.


PLASMA PRODUCTS

Cryoprecipitate
Each bag of Cryoprecipitate contains an average of 80 or more units of Factor VIII (FVIII:C) and at least 150 mg of fibrinogen in less than 15mL of plasma. Cryoprecipitate is used in replacement of fibrinogen and Factor XIII and in platelet functional defect (uremia); it also is used in the treatment of von Willebrand disease and Factor VIII replacement when specific factor concentrates are unavailable.

Plasma - Fresh Frozen
Fresh Frozen Plasma (FFP) is separated and frozen within 8 hours of whole blood collection. It contains plasma proteins and all coagulation factors. A unit of FFP contains about 200 units of Factor VIII plus the other labile plasma coagulation factor, Factor V. FFP is used mainly to provide replacement coagulation factors when concentrate is not available or appropriate. FFP provides normal levels of all clotting factors and is used for patients with thrombotic thrombocytopenic purpura (TTP), for antithrombin III deficiency, for immediate hemostasis and reversal of the warfarin effect, and for massive transfusion with coagulopathy.

Plasma - ( Frozen Within 24 Hours of Collection)
Plasma (Frozen within 24 hours of collection) is separated and frozen within 24 hours of whole blood collection. It contains all stable plasma proteins found if FFP. This component contains about 150 units of Factor VIII . There is little difference in the levels of labile coagulation factors between FFP and Plasma. Factor V levels studied were essentially the same in plasma frozen at 8 hours and at 24 hours. On average, the major difference is a 25% reduction of Factor VIII. Indications for use of Plasma include all the uses of FFP except for replacement of labile coagulation factors such as Factor V and VIII.