Packed red blood cells

(Redirected from PRBCs)

General

Adult Dosing

  • One unit (250mL) raises hemoglobin by 1 g/dl
  • 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

Leukocyte Irradiated and Reduced (Depleted) Blood Products[1]

  • Leukocyte reduced: Prevents sensitization in patients who may require bone marrow transplant
  • Irradiated: Eliminates capacity of T-cells to proliferate (prevents Transfusion-associated graft-versus-host disease)
  • 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[2][3]
  • 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[4]
  • 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

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

  1. 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
  2. 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.
  3. 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.
  4. 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.

Authors:

Ross Donaldson