Chapter 45: Transfusion Therapy

Product: Whole Blood Administration

Whole blood is given over a maximum of 4 hours through a 170-μm filter^1,2,3

Preparation/Composition

1. Donor blood 450–550 mL containing red blood cells (RBCs), plasma, clotting factors, and anticoagulant

2. Platelets and granulocytes are not functional

Indications

RBC replacement in acute blood loss with pronounced hypovolemia

Notes

1. Whole blood is not routinely available and is rarely required in hematology-oncology patients. It is not a source of viable white blood cells (WBCs) or platelets

2. Shelf life: 21 days in CPD (citrate-phosphate-dextrose); 35 days in CPDA-1 (citrate-phosphate-dextrose-adenine) preservatives

Product: Red Blood Cells Preparation/Composition

1. RBCs obtained by apheresis collection or prepared from whole blood by centrifugation^1,2,3

2. RBCs collected in CPDA-1 anticoagulant have a hematocrit of 65–80% and a storage volume of 250–400 mL

3. RBC collections from which plasma has been removed and 100 mL of adenine-containing RBC nutrient solution (eg, AS-1) has been added, have a hematocrit of 55–60% and a volume of 300–350 mL

Administration

1. RBCs are administered over a maximum period of 4 hours through a 170-μm filter

2. Do not add medications to blood products. If needed to decrease viscosity, 0.9% sodium chloride injection is the only compatible intravenous solution that may be added to RBCs; however, this is rarely needed with current additive solutions

Indications

1. Improves oxygen carrying capacity in anemic patients

2. In most stable asymptomatic patients without cardiovascular disease, transfusion is initiated if hemoglobin is <7 g/dL

3. Transfusion thresholds in patients with cardiovascular disease who are asymptomatic are not well defined; results of clinical trials are awaited. Higher transfusion thresholds (9–10 g/dL) may be appropriate for patients with symptomatic cardiac disease^3,4,5,6

Notes

1. Patients with febrile nonhemolytic transfusion reactions benefit from leukoreduced blood products

2. Premedication with acetaminophen 650–1000 mg orally, may also be given

3. Patients with allergic transfusion reactions are treated with diphenhydramine 25–50 mg orally or intravenously

4. Shelf life: 35 days in CPDA-1; 42 days if stored in additive solutions like AS-1 (contains sodium chloride 154 mmol/L, adenine 2 mmol/L, glucose 111 mmol/L, and mannitol 41.2 mmol/L)

Product: Washed Red Blood Cells Preparation/Composition

Washing RBCs with 1 L 0.9% sodium chloride injection (0.9% NS) removes more than 98% of plasma proteins. RBCs are then resuspended in 0.9% NS at an approximate hematocrit of 75%^1,2

Indications

1. Patients with a history of severe or recurrent allergic reactions

2. For patients with paroxysmal nocturnal hemoglobinuria, routine washing of group-specific RBCs is not required

3. Washed RBCs are used to decrease potassium load in neonates with cardiac or renal disease

Administration

Washed RBCs must be transfused within 24 hours

Notes...