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

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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