Blood products

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Background

Transfusion Risk Ratios[1]

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

Products

Types

Unit Conversions

Blood product unit conversions

Special Considerations

Leukocyte Irradiated/Depleted RBCs[2]

  • 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
Generally Accepted Indications For Irradiated Blood Products[3][4]
  • Immunocompromised stem cell recipients
  • Organ transplant recipients
  • Patients undergoing marrow transplantation
  • Intrauterine transfusion
  • Neonatal exchange transfusions
  • Premature and low birthweight neonates
  • Hodgkin lymphoma
  • Congenital cell-mediated immunodeficiencies (DiGeorge, Wiskott-Aldrich, Leiner's, 5'-nucelotidase deficiency)
  • Acquired immunodeficiencies to include:
    • Leukemia, CLL
    • Aplastic anemia
    • Neutropenia
  • Patients receiving:
    • Purine analogue chemotherapies (fludarabine, cladribine, deoxycoformicin, bendamustine, clofarabine, etc.)
    • Certain biologic immunosuppresants (alemtuzumab)
  • Donations from biologic relatives
  • Donations from HLA-matched donors
  • Genetically homogenous populations
  • Probably indicated int:
    • Hematologic malignancies other than Hodgkin lymphoma
    • Solid tumors treated with cytotoxic agents
Indications For Leukoreduced Blood Products[5]
  • Chronically transfused
  • Cardiac surgery
  • Solid organ or stem cell transplant recipients, before and after
  • Previous febrile nonhemolytic transfusion reactions
  • CMV seronegative patients at risk

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

References

  1. Wagner, L. Why Should Clinicians Be Concerned about Blood Conservation? ITACCS. 2005 PDF
  2. Treleaven J et al. Guidelines on the use of irradiated blood components: Prepared by the BCSH Blood Transfusion Task Force. British Society for Haematology. Jan 2013. http://www.bcshguidelines.com/documents/irrad_bcsh_072010.pdf
  3. Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force. Treleaven J, Gennery A, Marsh J, Norfolk D, Page L, Parker A, Saran F, Thurston J, Webb D. Br J Haematol. 2011;152(1):35.
  4. 2.AABB Technical Manual, 17th ed, Roback JD, Grossman BJ, Harris T, et al, (Eds). American Association of Blood Banks Press, Bethesda 2011. p.755.
  5. The reintroduction of nonleukoreduced blood: would patients and clinicians agree? Rosenbaum L, Tomasulo P, Lipton KS, Ness P. Transfusion. 2011 Dec;51(12):2739-43. Epub 2011 May 26.