Packed red blood cells

General

• Type: Blood components
• Dosage Forms: IV, IO
• Common Trade Names: N/A

Adult Dosing

• One unit (250mL) raises hemoglobin by 1 g/dl
  • Usually transfuse at least 2 units at a time
• Must transfuse no slower than 1 unit/4hr
  • If require slower transfusion (e.g. risk for volume overload) the pRBC can be split

Pediatric Dosing

• 15 mL/kg

Special Populations

• Pregnancy Rating: N/A
• Lactation: N/A
• Renal Dosing: N/A
• Hepatic Dosing: N/A

Types

• Leukocyte reduced
  • Eliminates 70-85% of leukocytes
  • Reduces nonhemolytic febrile reactions
  • Prevents sensitization in patients who may require bone marrow transplant
  • Minimizes risk of HIV and CMV infection
• Irradiated
  • Eliminates capacity of T-cells to proliferate (prevents graft-versus-host disease)
  • Consider in transplant patients, neonates and immunocompromised patients
• Washed
  • Indicated for patients with hypersensitivity to plasma (such as IgA deficiency)

Indications

• Hgb <6 g/dL: Recommended except in exceptional circumstances
• Hgb 6 to 7 g/dL: generally likely to be indicated
• Hgb 7 to 8 g/dL: should be considered in postoperative surgical patients, including those with stable cardiovascular disease, after evaluating the patient’s clinical status
• Hgb 8 to 10 g/dL: generally not indicated, but should be considered for some populations (eg, those with symptomatic anemia, ongoing bleeding, acute coronary syndrome with ischemia)
• Hgb >10 g/dL: generally not indicated except in exceptional circumstances

Contraindications

• No absolute contraindications

Adverse Reactions

Serious

• Hypocalcemia due to citrate (massive transfusion protocols) - check ionized calcium levels

Transfusion Reaction Types

• Acute
  • Intravascular hemolytic tranfusion reaction
  • Febrile nonhemolytic tranfusion reaction
  • Allergic tranfusion reaction
  • Transfusion-associated circulatory overload (TACO)
  • Transfusion-related acute lung injury (TRALI)
  • Transfusion-associated graft-versus-host disease
  • Fluid overload
  • Sepsis
• Delayed
  • Extravascular hemolytic tranfusion reaction
  • Graft-vs-host disease
  • Transfusion infections

Pharmacology

• Half-life: N/A
• Metabolism: N/A
• Excretion: N/A
• Mechanism of Action: N/A

Comments

• Can give type O Rh-positive pRBCs to a man or woman no longer of child-bearing age

See Also

• Blood products
• Massive transfusion