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red blood cells (Blood Component)Brand and Other Names:RBCs

 
 
 

Dosing & Uses

AdultPediatric

Insufficient Tissue Oxygen Delivery Due to Active Bleeding / Symptomatic Anemia

1 unit increase hemoglobin 1 g/dL in average sized adults without active bleeding or hemolysis; usually given over 1-2 hours but not longer than 4 hours

Rarely necessary to transfuse to hemoglobin >10 g/dL

Actively bleeding patients dosing and rate of administration varies depending on rate of bleeding and must be evaluated on a case by case basis

Other Information

Usually blood loss >20% estimated total blood volume

Insufficient Tissue Oxygen Delivery Due to Active Bleeding / Symptomatic Anemia

10-15 mL/kg increases hemoglobin 2-3 g/dL in patients without active bleeding or hemolysis

Actively bleeding patients dosing and rate of administration varies depending on rate of bleeding and must be evaluated on a case by case basis

Other Information

Usually blood loss >20% estimated total blood volume

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Adverse Effects

Frequency Not Defined

Hemolytic Transfusion Reactions

Febrile Non-Hemolytic Reactions

Allergic Reactions ranging from urticaria to anaphylaxis

Septic Reactions

Transfusion Related Acute Lung Injury (TRALI)

Circulatory Overload

Transfusion Associated Graft Versus Host Disease

Postransfusion Purpura

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Warnings

Contraindications

Should not be used to treat anemia that can be corrected with a non-transfusion therapy (e.g. iron therapy) unless immediate correction is urgently needed.

Not indicated solely to providing blood volume &/or oncotic pressure, a sense of well being, or to improve wound healing.

Cautions

If a transfusion reaction is suspected, the transfusion should be stopped, the patient assessed and stabilized, the blood bank notified, and a transfusion reaction investigation initiated. Massive or rapid transfusion may lead to arrhythmias, hypothermia, hyperkalemia, hypocalcemia, dyspnea, and/or heart failure.

All transfusions must be given via blood administration sets containing 170- to 260-micron filters or 20- to 40-micron microaggregate filters. No other medications or fluids other than normal saline should be simultaneously given through the same line without prior consultation with the medical director of the blood bank.

Patient’s should be monitored for signs of a transfusion reaction including vitals pre, during, and post transfusion.

Non-septic infectious risks include transmission of HIV (~1:2 mill), HCV (~1:1.5 mill), HBV (1:300k), HTLV, WNV, CMV, parvovirus B19, lyme disease, babesiosis, malaria, chaga’s disease, vCJD.

Iron overload in chronically transfused patients due to hemoglobinopathies or thalassemia.

Consult with blood bank medical director or hematologist if you have questions regarding special transfusion requirements.

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Pregnancy & Lactation

CMV-negative or CMV reduced risk (leukocyte reduced) RBCs should be used in pregnant women who are CMV-negative or whose CMV status is unknown.

Pregnancy Categories

A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA:Information not available.

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Pharmacology

Normal RBC lifespan is ~120 days.

Half-life of transfused RBCs is ~30 days in the absence of ongoing bleeding or hemolysis.

Each unit (~350-400mL) contains ~200-250mL of RBCs and thus ~200-250mg iron.

Mechanism of Action

Increases blood oxygen carrying capacity.

Restores intravascular volume in acute active bleeding although it should not be used solely for this purpose.

Improves platelet function in patients with uremic bleeding.

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