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Factors that influence oxygen supply

Hgb conc, pp of O2, gas exchange in lungs, cardiac output, blood flow to target organs, tissue demands

Components containing RBC's

Whole blood
RBC's leukocyte reduced
RBC's saline washed
RBC's frozen/ deglycerolized
RBC's rejuvenated

Two indicator's for RBC transfusion

1) RBC products indicated for acute blood loss to stop bleeding and maintain intravascular volume/prevent shock
2)in patients with chronic anemia if signs of hypoxia are present

Whole Blood indications

for simulataneous increase in red cell mass and plasma volume
reduces donor exposure in mass transfusion
* patients who are actively bleeding and have lost >25% of blood volume, and at risk for hypovolemic shock

Whole Blood Contraindications

1) patients with chronic anemia who are normovolemic
2) patients who are hypovolemic but who do not need red cell mass
3) patients at risk for volume overload

Whole blood dose

one unit raises Hgb by 1 g/dL
in pediatrics 8 mL/kg raises by 1 g/dL
infuse within 4 hours through a filter

RBC

formed from WB products or apheresis
CPDA-1 or additive solution added preservatives

RBC dose

Adult dose: one unit raises by 1 g/dL
pediatric dose: 8 mL/kg raises by 2 g/dL

RBC indications

treat anemia in normovolemic patients such as renal failure
decreases risk for volume overload

RBC leukoreduced

prepared from whole blood to remove the majority of leukocytes ( by filtration)
removed pre or post storage- pre is better to reduce the amount of cytokines
can also be collected by apharesis

AABB standard for leukoreduction

<5 x 10^6 residual leukocytes/unit

3 indications for use of Leukocyte reduced blood products

1) decrease risk of febrile non-hemolytic transfusion reactions
2) to prevent HLA alloimmnunization in patients receiving long term therapy
3) decreasing risk for CMV infection

may also reduce the immunomodulatory effects of transfusion and reduce risk of Crutzfeld-Jacob disease

RBC's Washed

cells washed with saline and resuspended
leukocyte numbers are reduced, platelet and cellular debris are removed
have decreased storage time, increased cost

RBC washed indications

important in the IgA deficient
prevent severe anaphylactic reactions- remove plasma proteins
intrauterine and neonatal transfusion- removes potassium and citrate

RBC frozen/ deglycerolized

glycerol added to CPDA-1 blood less than 6 days old
High glycerol or low glycerol methods
thawed and washed with saline glucose solutions
can be stored up 10 years

RBC frozen/ deglycerolized indications

long term storage of autologous blood
rare blood requirements
does reduce leukocytes but not to full requirements
expensive to prepare, so limited to needs for rare blood

RBC components storage

store at 1-6 degrees celsius
administered through blood filter in 4 hours or less

Selection of RBC components for transfusion

ABO identical or donor compatible
whole blood must be ABO identical
Rh neg to Rh neg
alloantibodies compatible

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