Red Cells

Component Description

All red cell products must be stored in a monitored blood refrigerator (2-6°C) and have a shelf life of up to 42 days.

Product type	Description	Vol mL	HCT	Leucocyte Count
Red Cells	Blood collected into a bag with anticoagulant, then centrifuged to remove most of the plasma. Additives prolong shelf life.	>240mL	0.50 - 0.70	Normal physiological
Red Cells, Buffy Coat Removed	Blood collected into a bag with anticoagulant, then centrifuged to remove most of the plasma and buffy coat. The buffy coat contains the white cells and platelets. Additives prolong shelf life. Not available from all ARCBS centres and requires specific request. More leucocytes in this product than in filtered red cells.	>230mL	0.50 - 0.70	<1.2 x 10^9/unit
Red Cells, Paediatric Leucocyte Depleted	Blood collected into a bag without anticoagulant, then centrifuged to remove most of the plasma and buffy coat. The buffy coat contains the white cells and platelets. Additives prolong shelf life. Red cells then leucodepleted by filtration. Original pack is then divided into four smaller packs suitable for low volume red cell transfusions.	25 – 100mL	0.50 - 0.70	<1.0x10^6/unit
Red Cells, Leucocyte Depleted	Blood collected into a bag with anticoagulant, then centrifuged to remove most of the plasma. Additives prolong shelf life. Red cells are leucodepleted by filtration.	>200mL	0.50 - 0.70	<1.0x10^6/unit
Red Cells Washed	Red cells (see above) washed with 0.9% isotonic saline to remove most proteins, antibodies and electrolytes. Shelf life 24 hours if resuspended in saline. Shelf life may be up to 28 days if resuspended in additive solution and manufactured in a closed system. Not available from all ARCBS centres and requires specific request.	>130mL	0.65 – 0.75 without additive, 0.50 – 0.70 with additive	Not as efficient as leucodepletion by filtration, but does reduce the numbers. Last wash supernatant total protein, 0.5g/unit.

Indications for Use

Clinically significant anaemia with symptomatic oxygen carrying deficit
Red cell replacement for traumatic or surgical blood loss.

Precautions

Consider the cause of anaemia. Is a transfusion required?
Treat haematinic deficiency (iron, vitamin B12 and folate) anaemia with supplements. Consider transfusion when clinical condition is unstable.

Compatibility

TESTING – a current pre-transfusion specimen is required (group and screen).

ABO

For red cells, compatibility is as follows:

Patient Group	Compatible Donor
A	A, O
B	B, O
AB	AB, B, A, O
O	O

Note: Group O red cells may be used for all patient ABO groups. Other rules apply for products containing plasma, including whole blood.

Rh(D)

All transfusions should be Rh(D) compatible
Rh(D) negative red cells can be given to Rh(D) positive patients.

Note: In certain circumstances, such as bleeding emergencies or in times of low stocks, Rh(D) positive red cells may be issued to Rh(D) negative patients e.g. men and post-menopausal women (after consultation with the haematologist / treating medical officer).

Dosage and Administration

One unit of red cells is approximately 240mL
One unit raises Hb by approximately 10g/L in adults
One paediatric unit is approximately 50mL.

Transfusion Set-up

Note: this is a guide only – individual hospital guidelines should be followed.

Administer through a new IV blood giving set incorporating a 170-200 micron filter (large particle filter which only removes aggregates and other large particles)
For red cells requiring bedside leucodepletion, a white cell filter suitable for use with red cell units is required. These filters are designed to remove white cells but allow red cells, platelets and proteins to go through. Specific set-up is required – see product inserts and talk to your local Transfusion/Haematology Nurse Consultant or Transfusion Service Provider. Do not ‘flush’ these filters after use.
Units labelled as leucodepleted product do not need a white cell filter at the bedside BUT still need a standard blood administration set incorporating a 170-200 micron filter (see above).

Patient Monitoring

Start transfusion within 30 minutes of removing blood from fridge
If you cannot start within 30 minutes, return blood to the blood fridge until required
Check patient vital signs (pulse rate, respiration rate, blood pressure and temperature) at the start of transfusion AND at least after 15 minutes, at the end of the transfusion AND if there is ANY reaction. Record observations in patient’s notes.

When to Transfuse?

Plan ALL transfusions during business hours. Emergency transfusions should be the only transfusions given after hours
Transfuse ONE unit at a time

How Long Should a Transfusion Take?

Generally two to four hours
Each unit must be fully transfused within four hours of starting
May be given faster in acute bleeding situations
Consider using a blood warmer for massive transfusion situations.