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 -65^oC and -80^oC
  • 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 and Links

CCC Transfusion Series
Blood Products	Cryoprecipitate, Fresh Frozen Plasma (FFP), Platelets, Red Cells (RBCs) Concentrates: Prothrombinex, Factor VIIa, Fibrinogen Concentrate
Reversal	Rivaroxaban / Apixaban / Enoxaparin: Andexanet Alfa, Rivaroxaban and Bleeding Dabigatran: Idarucuzimab, Dabigatran and bleeding Heparin: Protamine Warfarin: Vitamin K / FFP / PTx, Warfarin Reversal, Warfarin Toxicity
Testing	Coagulation Studies, TEG / ROTEM (Thromboelastography), Platelet function assays
General Topics	Acute Coagulopathy of Trauma, Blood Bank, Blood conservation strategies, Blood Product Compatibilities, Blood transfusion risks, Disseminated Intravascular Coagulation, Massive blood loss, Massive transfusion protocol (MTP), Modifications to blood components,Procedures and Coagulopathy, Storage Lesions, TRALI, Transfusion Literature Summaries, Transfusion Reactions

References

• Australian Red Cross Lifeblood. (2020, June). Blood Component Information: An Extension of Blood Component Labels. Retrieved January 18, 2023, from https://www.lifeblood.com.au/sites/default/files/resource-library/2021-12/78.-Blood_Component_Information_1.pdf

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