Name: Red Blood Cells

Whole Blood (WB)

Red Blood Cells (RBCs)

Red Blood Cells, Pheresis.

These products can be leukoreduced, washed, irradiated, and/or frozen/thawed/deglycerolized.

Description/Contents: 450-500 mL blood from the donor is collected into an anticoagulant/preservative solution and undergoes no further processing if used as WB. RBCs are prepared from WB by the removal of most of the plasma, or they may be obtained by apheresis collection. RBCs are stored in one of several saline-based anticoagulant/ preservative solutions, yielding a hematocrit (Hct) between 55-80%.

Indications: The major indication for RBC product transfusions is prevention or treatment of symptoms of tissue hypoxia by increasing the oxygen-carrying capacity of blood. The transfusion requirements of each patient should be based on clinical status rather than on predetermined Hct or hemoglobin (Hgb) values.

• Symptomatic chronic anemia in normovolemic patients, if pharmacologic therapy is not effective or available.

• Prophylactic transfusion to prevent morbidity from anemia in patients at greater risk of tissue hypoxia.

• Active bleeding, with signs and symptoms of hypovolemia unresponsive to crystalloid or colloid infusions.

• Preoperative anemia <9 gm/dL with impending major blood loss.

• Sickle cell disease:

• Anemia due to renal failure/hemodialysis refractory to erythropoietin therapy.

Dosage/Administration: Red Cells require compatibility testing and should be ABO and Rh compatible. One unit of RBCs should increase the hemoglobin of a 70 kg adult by approximately 1 gm/dL in the absence of volume overload or continuing blood loss. Clinical signs and symptoms should be assessed after every unit of red blood cell transfusion so that the need for additional transfusion and the patient's blood volume status can be assessed. Patients with chronic anemia, who are volume expanded, and other patients susceptible to fluid overload should be transfused slowly. The initial transfusion period should be carefully monitored with a slow transfusion rate to allow the early detection of a transfusion reaction. Transfusion should be completed within 4 hours per unit. Alternatively the unit may be divided by the Blood Bank in advance and administered in two or more aliquots.

Alternative Therapy: Diagnosis and treatment of nutritional anemias (iron, B12, and folate deficiencies) will usually avoid the need for transfusion. Erythropoeitin has been shown to reduce transfusion needs in patients with chronic renal failure and other patients with chronic anemia. Autologous transfusion (pre-operative donation, isovolemic hemodilution, perioperative blood recovery, and post-operative blood salvage) have been shown to reduce red cell requirements in carefully selected patients. DDAVP, aprotinin, and other pharmacologic agents have been shown to reduce blood loss d uring some surgical procedures.

Triulzi DJ (ed.) Blood Transfusion Therapy; A Physician's Handbook, 6^th ed. American Association of Blood Banks. Bethesda, MD, 1999.

Guidelines for Blood Utilization Review. American Association of Blood Banks. Bethesda, MD, 2001.

American Society of Anesthesiologists Task Force on Blood Component Therapy. Practice guidelines for blood component therapy. Anesthesiology 1996;84:732-47.

Simon TL, Alverson DC, AuBuchon J, et al. Practice parameter for the use of red blood cell transfusions. Arch Pathol Lab Med 1998;122:130-8.

Transfusion Guidelines

Plasma Guidelines	Antithrombin III Guidelines
Platelet Guidelines	Activated Protein Guidelines
Red Cell Guidelines	Factor IX Guidelines
Cryoprecipitate Guidelines	Factor VIII Guidelines
AICC/Porcine Factor VIII Guidelines	IVIG Guidelines Coagulation Factor VII Guidelines

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