Blood products

Background

Types

• Packed red blood cells
• Platelet transfusion
• Fresh frozen plasma
• Cryoprecipitate transfusion
• Humate-P
• Prothrombin complex concentrates

Transfusion Risk Ratios

Rate	Complication
1:10	Febrile non-hemolytic transfusion reaction per pool of 5 donor units of platelets (1 pack)
1:100	Minor allergic reactions (urticaria)
1:300	Febrile non-hemolytic transfusion reaction per unit of RBC (1 pack)
1:700	Transfusion-associated circulatory overload per transfusion episode
1:5,000	Transfusion-related acute lung injury (TRALI)
1:7,000	Delayed hemolytic transfusion reaction
1:10,000	Symptomatic bacterial sepsis per pool of 5 donor units of platelets
1:40,000	Death from bacterial sepsis per pool of 5 donor units of platelets
1:40,000	ABO-incompatible transfusion per RBC transfusion episode
1:40,000	Serious allergic reaction per unit of component
1:82,000	Transmission of hepatitis B virus per unit of component
1:100,000	Symptomatic bacterial sepsis per unit of RBC
1:500,000	Death from bacterial sepsis per unit of RBC
1:1,000,000	Transmission of West Nile Virus
1:3,000,000	Transmission of HTLV per unit of component
1:3,100,000	Transmission of hepatitis C virus per unit of component
1:4,700,000	Transmission of HIV per unit of component

Leukocyte Irradiated/Depleted RBCs

• Gamma or X-radiated blood components to prevent Transfusion-associated graft-versus-host disease for at risk patients
• If tranfusion required for crashing patient, do not delay tranfusion of uncrossed blood to irradiate products beforehand
• Requires minimum 25 Gy irradiation, not to exceed 50 Gy for all:
  • Packed red cells
  • Platelets
  • Granulocyte components, regardless of immunocompetency
  • First or second degree relatives, regardless of immunocompetency
  • HLA-selected components, regardless of immunocompetency
• Irradiated products should be administered shortly after irradiation
• Those products not used for intended recipient may be returned safely to stock for others not requiring irradiated components, though with reduced shelf life
• Not necessary to irradiate FFP, cryoprecipitate, fractioned plasma products

At Risk Patients Requiring Irradiated Products

• Congenital immunodeficiency syndromes (T-cell deficiencies)
• Neonates, especially if premature
• Exchange transfusions in pre-term and term infants
• Intrauterine transfusions
• Acquired immunodeficiencies to include:
  • Lymphoma
  • Leukemia
  • Aplastic anemia
  • Neutropenia
• Patients receiving:
• Stem cell transplants or harvesting
  • Purine analogue chemotherapies (fludarabine, cladribine, deoxycoformicin, bendamustine, clofarabine, etc.)
  • Certain biologic immunosuppresants (alemtuzumab)

Not Routinely Needing Irradiated Products

• HIV, AIDS
• Concurrent, non-severe common viral infection
• Rituximab treatment
• Routine solid organ transplant
• Routine infant cardiac surgery

See Also

• Transfusions
• Acute transfusion reaction
• Extravascular hemolytic tranfusion reaction
• Graft-vs-host disease
• Transfusion-associated graft-versus-host disease
• Massive Transfusion Protocol
• Coagulopathy (Main)
• TXA