PACKED CELLS

Blood crossmatched for a particular patient is cancelled automatically after 24 hours. Blood Bank should be notified as soon as it is known definitely that the patient will not need transfusion so blood can be used for some other patient. Crossmatch Transfusion - Blood Bank Requisition II should be used as a backup to Order Entry in the computer.

PC

Packed Cells Packed Red Cells Red Cell Concentrate Red Cells, Packed

The patient must have a red wristband for checking against component container label prior to administration. I.V. must be running and consent form must be signed. Many of the important clinical manifestations of transfusion reaction occur during the administration of the first 50-100 mL blood; therefore, the need for closest attention is during the early period of the transfusion. Temperature, pulse, and blood pressure must be taken and recorded before transfusion and then at 15 minutes after the transfusion is started and every hour during infusion.

The specimen must be labeled at the patient bedside and have two labels: Barcode label with date, accession number, patient name (last, first), medical records number, and test mnemonic Red label from wristband with patient name, medical records number, time, date, and phlebotomist mnemonic A red wristband containing patient name, medical records number, time, date, and phlebotomist mnemonic must be put on patient's wrist by person drawing specimen before leaving the bedside. An ABO confirmation sample must be drawn upon request by the Blood Bank.

Room Temperature

Blood <72 hours old

Grossly hemolyzed specimen; improperly labeled specimen; specimen drawn in wrong tube; quantity not sufficient for analysis; phlebotomist mnemonic missing

Daily, 24 hours

60 minutes from time specimen is received in Blood Bank. Patients already typed and screened for antibodies require 5 minutes. Presence of unexpected antibodies may require a day or two for identification.

The patient must have a red wristband for checking against component container label prior to administration. I.V. must be running and consent form must be signed. Many of the important clinical manifestations of transfusion reaction occur during the administration of the first 50-100 mL blood; therefore, the need for closest attention is during the early period of the transfusion. Temperature, pulse, and blood pressure must be taken and recorded before transfusion and then at 15 minutes after the transfusion is started and every hour during infusion. Complications of massive transfusions include citrate toxicity, especially in patients with liver disease; hemorrhagic diathesis in massive transfusion (from platelet loss and deficiency, and deficiency of labile plasma coagulation factors) can be treated by use of platelets and fresh frozen plasma; hyperkalemia (donor plasma contains 18-30 mEg/L potassium after 3 weeks; danger increased in patients with impaired renal function); microaggregate emboli (microaggregate filters are occasionally used with massive transfusion; one should not give fresh blood or platelets through them); fluid overload leading to adult respiratory distress syndrome (ARDS). High anion gap may develop (each unit of whole blood contains 17 mEq/L of sodium citrate; accumulation of citrate in shock); with renal failure and/or volume contraction, metabolic acidosis can develop. Blood <7 days old is recommended for neonatal exchange transfusion. There is little scientific justification for use of fresh whole blood; blood components are more appropriate.

Use Red blood cells are the component of choice for most anemic patients. Replace red cell mass; provide oxygen transport function; restore or maintain blood volume following blood loss; for patients with a symptomatic deficit of oxygen-carrying capacity. Additional Information Red cells have a hematocrit of approximately 55% with AS additive solution and 70-80% with CPD/CPDA without additive solution. Each unit contains approximately 200 mL red blood cells. The expiration date is 35-42 days after the date of collection, stored continuously between1°C to 6°C  until transfused. If the hermetic seal is broken during preparation, the red blood cells must be infused within 24 hours. Red blood cells must be ABO and Rh compatible. A crossmatch is necessary unless the situation is so urgent that withholding of blood might result in loss of life. In that situation, one can use type O blood.Generally packed red cells should not be used when anemia can be corrected with specific products (iron, B12, folic acid). Side effects and hazards: Hemolytic transfusion reactions might occur when clerical or other identification errors lead to an ABO mismatch. Reactions are characterized by shock, chills, fever, dyspnea, back pain, headache, and/or abnormal bleeding. Hemoglobinemia followed by hemoglobinuria occur. Renal shutdown and death may ensue. Treatment includes stopping the transfusion, managing the shock, and administering appropriate fluids and diuretics. Transmission of infectious disease:  Viral hepatitis, especially B and C , Malaria ,Syphilis, Cytomegalovirus infection, Rarely brucellosis, trypanosomiasis, Colorado tick fever, acquired immunodeficiency disease (AIDS), babesiosis, Chagas disease Immunization of the recipient to red blood cell, white cell, platelet, and protein antigens. Occasionally, in patients with serologically undetected or undetectable antibodies, delayed hemolytic reaction can develop. This type of reaction may mimic autoimmune hemolytic anemia with a positive direct antiglobulin (Coombs') test. Febrile reactions are frequently related to prior sensitization to HLA antigens on leukocytes and platelets. These patients may benefit from leukocyte-poor, washed, or frozen deglycerolized red blood cells. Allergic reactions are manifest by urticaria and occasionally chills and fever. In rare individuals lacking IgA who develop anti-IgA antibodies, anaphylactoid reactions may occur. Well washed red cells are required for further transfusions. Circulatory overload reactions are manifest by pulmonary edema when excessive blood volume is administered. Bacterial contamination of donor blood is rare. The presence of gram-negative bacilli may cause severe endotoxin shock, frequently associated with redness of the skin. Air embolism may occur when air enters the system during the changing of bags and sets. Iron overload may occur in patients given repeated transfusions over long periods of time.