Whole Blood consists of red blood cells (RBC), plasma, plasma proteins, and about 60 mL anticoagulant/preservative solution in a total volume of about 500 mL.
Packed RBCs consists primarily of RBCs, a small amount of plasma, and about 100 mL anticoagulant/preservative solution in a total volume of about 250 to 300 mL/unit. RBCs restore or maintain oxygen carrying capacity while preventing fluid overload, and reducing the risk of metabolic complications from whole blood transfusion. The average adult dose administered is 2 units; pediatric doses are generally calculated as 5 to 15 mL/kg. Packed RBCs are typically contaminated with white blood cells (WBC) that may increase the risk of minor transfusion reactions and alloimmunization. WBCs are also called leukocytes.
Leukocyte poor RBCs have 70% of WBCs removed by washing or freezing the product in the blood bank or using a small-pore filter during administration. This product prevents febrile reactions from leukocyte antibodies.
WBCs (granulocyte concentrates) consist of a minimum of 1 X 1010 granulocytes, variable amounts of lymphocytes (usually less than 10% of the total number of WBCs), 6 to 10 units of platelets, 30 to 50 mL RBCs, and 200 to 400 mL plasma. It is obtained via apheresis, generally of multiple donors. The dosage is usually 1 unit daily for approximately 5 to 10 days, discontinuing if no therapeutic response. The process for WBC transfusion is the same as red cell transfusion. Premedication with antihistamines, acetaminophen, steroids, or meperidine may be required to prevent an adverse reaction.
ALERT| WBCs must be infused within 24 hours of collection; because WBCs have a short survival time and therapeutic benefit is directly related to dose and viability. |
ALERT| Do not administer amphotericin B immediately before or after WBC transfusion because pulmonary insufficiency has been reported with concurrent administration. Many institutions recommend a 4-hour gap to avoid this risk. |
Plasma consists of platelets suspended in plasma. Products vary according to the number of units (each unit is a minimum of 5.5 X 1010 platelets), and the volume of plasma is 50 – 400 mL.
Plasma (Fresh or Fresh Frozen) consists of water (91%), plasma proteins including essential clotting factors (7%), and carbohydrate (2%). Each unit is the volume removed from a unit of whole blood (200-250 mL. Plasma restores clotting factors, except platelets, and expands plasma volume. Storage in liquid state results in the loss of labile clotting factors V and VIII so that only plasma that has been fresh frozen can be used to treat factor V and VIII deficiencies. The dosage depends on clinical situation and assessment of prothrombin time (PT), partial thromboplastin time (PTT), or a specific factor assays.
Platelets may be obtained by centrifuging multiple units of whole blood and expressing off the platelet-rich plasma (multiple-donor platelets) or from a single volunteer platelet donor using automated cell separation techniques (aphaeresis). The use of single donor products decreases the number of donor exposures, thus decreasing the risk of alloimmunization and transfusion-transmitted disease. Platelet transfusions are usually a 6 unit IV bolus infused over 20 to 30 minutes. Dosage is generally 1 unit of platelets for each 10 kg; however, patients who are actively bleeding or undergoing surgical procedures may require more.
ALERT| Platelets must not be refrigerated. |
Patients may become alloimmunized to human leukocyte antigens (HLA) through exposure to multiple platelet products. Apheresis products form HLA-matched platelet donors may be necessary. However, HLA-matched transfusions are often difficult to obtain due to the tremendous number of possible HLA combinations in the population.
Cryoprecipitate consists of certain clotting factors suspended in 10 to 20 mL plasma. Each unit contains approximately 80 to 120 units of factor VII (antihemophilic and von Willebrand factors), 250 mg fibrinogen, and 20% to 30% of the factor XIII present in a unit of whole blood. Indications include correction of deficiencies of factor VIII (i.e., hemophilia A and von Willebrand’s disease), factor XIII, and fibrinogen (i.e., DIC). The adult dosage is generally 10 units, which may be repeated every 8 to 12 hours until the deficiency is corrected or until hemostasis is achieved.
| Blood Component | Indications |
| Whole blood | - Blood volume loss from hemorrhage, trauma, or burns
- Exchange transfusion in sickle cell disease
|
| Packed RBCs | - Anemia
- Blood volume loss from hemorrhage, trauma, or burns
|
| Leukocyte poor RBCs (70% of leukocytes removed) | - Same as packed RBCs for the following reasons:
- Immunocompromised patients
- Restores RBCs in patients who have had two or more nonhemolytic febrile reactions
|
| WBCs (leukocytes) | - Life-treatening bacterial or fungal infection unresponsive to other therapy in patients with severe neutropenia
- granulocytopenia
|
| Platelets | - Bleeding caused by decreased circulating platelets
- Bleeding caused by functionally abnormal platelets
- Improves platelet count preoperatively in a patient whose count is less than 50,000
|
| FFP (fresh frozen plasma) | - Helps control bleeding due to blood loss in blood clotting disorders related to:
- liver disease and failure
- disseminated intravascular coagulation (DIC)
- dilutional coagulopathy resulting from massive blood replacement
- congenital or acquired clotting factor deficincies
- undetermined coagulation factor deficiency
- replace a specific factor when that factor is not available
- warfarin reversal
|
| Albumin 5% (buffered saline) or Albumin 25% (salt-poor) | - Volume lost because of shock due to burns, trauma, surgery, or infections
- Hypoproteinemia
|
| Factor VIII concentrate | - Hemophilia A
- Willebrand's disease
|
| Cryoprecipitate | - Factor VI11 deficiency
- Fibrinogen disorders
- Factor XIII deficiency
|
