Packed red blood cells

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General

Adult Dosing

  • One unit (250mL) raises hemoglobin by 1 g/dl
    • Usually transfuse at least 2 units at a time
  • Must transfuse no slower than 1 unit/4hr
    • If require slower transfusion (e.g. risk for volume overload) the pRBC can be split

Pediatric Dosing

  • 15 mL/kg

Special Populations

Types

  • Leukocyte reduced
    • Eliminates 70-85% of leukocytes
    • Reduces nonhemolytic febrile reactions
    • Prevents sensitization in patients who may require bone marrow transplant
    • Minimizes risk of HIV and CMV infection
  • Irradiated
    • Eliminates capacity of T-cells to proliferate (prevents graft-versus-host disease)
    • Consider in transplant patients, neonates and immunocompromised patients
  • Washed
    • Indicated for patients with hypersensitivity to plasma (such as IgA deficiency)

Indications

  • Hgb <6 g/dL: Recommended except in exceptional circumstances
  • Hgb 6 to 7 g/dL: generally likely to be indicated
  • Hgb 7 to 8 g/dL: should be considered in postoperative surgical patients, including those with stable cardiovascular disease, after evaluating the patient’s clinical status
  • Hgb 8 to 10 g/dL: generally not indicated, but should be considered for some populations (eg, those with symptomatic anemia, ongoing bleeding, acute coronary syndrome with ischemia)
  • Hgb >10 g/dL: generally not indicated except in exceptional circumstances

Contraindications

  • No absolute contraindications

Adverse Reactions

Serious

  • Hypocalcemia due to citrate (massive transfusion protocols) - check ionized calcium levels

Transfusion Reaction Types

Common

Pharmacology

  • Half-life: N/A
  • Metabolism: N/A
  • Excretion: N/A
  • Mechanism of Action: N/A

Comments

  • Can give type O Rh-positive pRBCs to a man or woman no longer of child-bearing age

See Also

References