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Modifications to blood components

OVERVIEW

This is a list of commonly applied modifications to blood components that are available and provided through the Australian Red Cross Lifeblood.

WASHED RED CELLS (RBC)

  • Indicated for patients requiring red cells with a low protein supernatant, such as those who continue to have recurrent transfusion reactions (e.g. patients with IgA deficiency and antibodies to anti-IgA
  • May also reduce the incidence of recurrent febrile, urticarial and anaphylactic reactions
  • Consider for:
    • Patients with paroxysmal nocturnal haemoglobinuria (PNH)
    • Patients with T-activation with no low anti-T titre units available
    • Severe autoimmune haemolytic anaemia

CMV SERONEGATIVE (RBC / PLT)

  • Description:
    • CMV red cells and platelets are identified by testing selected donations for CMV antibodies
  • Clinical indications:
    • CMV seronegative recipients at risk of severe CMV disease
  • Patient groups:
    • Pregnant women regardless of CMV statusRecipients of intrauterine transfusionNeonates (up to 28 days post expected date of delivery)Granulocyte transfusions for CMV-negative patients
    • Other patient groups safe with leucodepleted blood products:
      • Solid organ transplants
      • Haemopoietic stem cell transplants (HSCT)
      • Haematology and oncology patients
      • Immunodeficient patients, including HIV patients
  • Note:
    • FFP, cryoprecipitate and other plasma-derived components do not transmit CMV
    • If not available, leucodepleted blood is also very safe

FROZEN RED CELLS (RBC)

  • Description:
    • Glycerol is added to red cells as a cryoprotectant before freezing between -65oC and -80oC
    • Can be stored for up to 10 years
  • Clinical indications:
    • Treating anaemia or blood loss
  • Patient groups:
    • Rare red cell phenotypes, or multiple red cell antibodies and for autologous collections
  • Note:
    • Prior to transfusion glycerol must be removed by washing with saline, then resuspended in additive solution and used within 24 hours
    • Thawing and processing time is several hours

IRRADIATED (RBC/PLT/GRANULOCYTES)

  • Description:
    • Gamma irradiation used to inactivate viable T-lymphocytes found in red cells, platelets and granulocytes which can cause transfusion-associated graft versus host disease (TA-GVHD) – almost universally fatal
    • Minimum irradiating dose 25 Gy with no part receiving more than 50 Gy
  • Clinical indications:
    • Prevention of TA-GVHD susceptible patients
  • Patient groups:
    • Definite:
      • Directed donations from blood relatives
      • Intrauterine transfusion and all subsequent neonatal exchange transfusions
      • Congenital cellular immunodeficiency disorders
      • Allogenic and autologous haematopoietic stem cell transplantation
      • Hodgkin lymphoma
      • Patients receiving nucleoside analogues for malignant or non-malignant disorders
      • Patients receiving alemtuzumab for malignant or non-malignant disorders and transplantation
    • Possible:
      • Premature infants weighing <1.3kg
      • All newborn infants
      • Acute Leukaemia
      • Non-Hodgkin Lymphoma
      • Patients w/ B cell malignancy (receiving non-nucleoside analogue-containing chemotherapy and/or radiotherapy leading to lymphopenia <0.5 x109L
      • T cell malignancies
      • Patients receiving high doses of chemotherapy and/or irradiation causing lymphopenia <0.5 x109L
      • Patients receiving long-term or high-dose steroids as therapy for malignancies
      • Aplastic anaemia receiving immunosuppressive therapy
    • Unclear if should be used in massive transfusions for trauma patients
  • Note:
    • Irradiation increases the efflux of extracellular potassiumPost-irradiation shelf-life is 14 days (can be irradiated up to day 14 post-collection)
    • IUT and exchange transfusion must be less than 5 days old at irradiation and used within 24 hours (potassium load)
    • Red cells for neonatal and small-volume infant must be less than 14 days old, and used within 48 hoursPlatelets can be irradiated at any stage during their shelf-life of 5 days
    • Granulocytes for all recipients should be irradiated as soon as possible after production and transfused shortly thereafter

PHENOTYPED (RBC/PLT)

  • Description:
    • For patients requiring specific antigen-negative red cell or platelet components due to alloimmunisation
  • Clinical indications:
    • Prevention of management of alloimmunisation to red cell or platelet (HPA or HLA) antigens.
  • Patient groups:
    • With red cell or platelet alloantibodies
    • On long-term transfusion support
    • With warm autoimmune haemolytic anaemia (AIHA)
    • Receiving anti-CD38 (or similar) therapies

RED CELLS FOR INTRAUTERINE TRANSFUSION (RBC)

  • Description:
    • Hyper-concentrated red cell component less than 5 days old w/ haematocrit 0.7-0.85
    • Plasma / additive solution has been removed
    • Red cells can then be resuspended in additive solution to achieve desired haematocrit
    • Red cells for IUT must be irradiated
  • Clinical indications:
    • Treatment of foetal anaemia associated w/ haemolytic disease of the foetus and newborn (HDFN)
  • Patient groups:
    • Foetuses at risk of anaemia
  • Notes:
    • ABO, RhD compatible with both mother and foetus, K negativeAg negative for maternal alloantibodies, IAT crossmatch compatible with maternal plasma and CMV seronegativeIf foetal blood group is unknown, use O-
    • Once irradiated, red cells must be used within 24 hours

References


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CCC 700 6

Critical Care

Compendium

Dr James Pearlman LITFL Author

ICU Advanced Trainee BMedSci [UoN], BMed [UoN], MMed(CritCare) [USyd] from a broadacre farm who found himself in a quaternary metropolitan ICU. Always trying to make medical education more interesting and appropriately targeted; pre-hospital and retrieval curious; passionate about equitable access to healthcare; looking forward to a future life in regional Australia. Student of LITFL.

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