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Monte Minute - Red Blood Cell Transfusion - Carly Glick

posted Sep 10, 2014, 10:10 AM by Kevin Hauck

Red Blood Cell Transfusion

Carly Erin Glick MD

  • Indications for transfusion
    • Active ongoing bleeding
    • Treatment of symptomatic anemia with hemoglobin <10 with symptoms meaning hypotension, tachycardia, chest pain unresponsive to fluids
    • Adults in ICU with hemoglobin <7
    • Post-op patients with hemoglobin <8 or symptomatic
    • Hemodynamically stable patients with preexisting CV disease with hemoglobin <8 or symptomatic
  • Dosage/administration
    • 1 unit RBC will increase hemoglobin by ~1 g/dL or hematocrit by ~3%
    • Must be ABO compatible
    • Recommend transfusing slowly over first 15 minutes then can speed up and completing transfusion within 4 hours
  • Composition
    • Whole blood with plasma removed
    • Most have 42 day blood bank shelf life and need to be stored at 1-6 degrees Celsius
  • Processing of RBCs
    • Leukocyte reduction
      • Decrease risk of recurrent febrile, nonhemolytic transfusion reactions
      • Decrease CMV transmission rate
      • Decrease risk of HLA-alloimmunization
      • Indications
        • Chronically transfused
        • Patients undergoing cardiac surgery
        • Potential and known recipients of solid organ or hematopoietic cell transplants
        • Previous febrile nonhemolytic transfusion reactions
        • CMV seronegative at risk patients
    • Washing—removes residual plasma
      • Decreases risk of analphylaxis in IgA deficient patients
      • Decreases reaction in patients w/ h/o recurrent, severe allergic reactions to blood products
      • Indications
        • Severe/recurrent allergic reactions to transfusion
        • IgA deficiency
    • Irradiated
      • Prevents graft-vs-host disease in patients with immune deficiency
      • Indications
        • Cancer patients immunosuppressed by chemotherapy
        • Lymphoma, leukemia
        • Patients with stem cell and solid organ transplants
  • Pretransfusion testing—ABO group, Rh type, antibody screen
  • Posttransfusion testing—can check hemoglobin as soon as 15 minutes after transfusion as long as patient not actively bleeding
  • Remember in severe life threatening bleeds you need to notify blood bank for emergency release as there are regulations on amount of products released

Adverse reactions to transfusions

  • Infectious risks—HIV (1 in 1.5 million), Hep C (1 in 1.1 million), Hep B ( 1 in 280,000), West Nile Virus
  • Acute hemolytic transfusion reaction—occur from preformed antibodies to incompatible product, ABO incompatibility
    • Presentation—fever, chills, hypotension, AKI, DIC, flank pain
    • Management—stop transfusion, send repeat type and cross-matching, give normal saline, alert blood bank
  • Delayed hemolytic transfusion reaction—immune response to incompatible red cell antigen
    • Presentation—fever, jaundice, dropping hemoglobin after 1-2 weeks of transfusion
    • Management—no treatment required unless hemolyzing
  • Febrile nonhemolytic transfusion reaction—from preformed antiWBC antibodies
    • Presentation—fever within 2 hours of starting transfusion without other etiology of fever
    • Decrease risk with leukocyte reduced products
    • Management—stop transfusion, r/o hemolysis, give antipyretics
  • Allergic (uticarial) reaction—from antibody to donor plasma proteins
    • Presentation—uticaria, pruritis, flushing, wheezing
    • Management—stop transfusion, give antihistamines
  • Anaphylaxis—from antibody to donor plasma proteins
    • Presentation—hypotension, urticaria, bronchospasm, angioedema
    • Treatment—stop transfusion, epinephrine IM, IVF
  • Transfusion-related lung injury (TRALI)—preformed HLA or neutrophil antibodies
    • Presentation—hypoxemia, hypotension, pulmonary edema, fever within 6 hours of transfusion

 

 

Sources:

2012 Clinical Practice Guide on Red Blood Cell Transfusion

Annals of Internal Medicine

Uptodate

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