Erythrocyte concentrate, washed (and irradiated)

Code 'Blood Service'

Not irradiated:

E4999V00

E4999VA0

Irradiated:

E5000V00

E5000VA0

NIHDI Code

Hospitalized: 752 463

Non-hospitalized: 752 452

A washed erythrocyte concentrate is prepared by additional processing of a delegated erythrocyte concentrate. In a closed and automated system, the erythrocytes are washed repeatedly with cold isotonic saline (NaCl 0.9%) to remove all residual plasma. Fresh storage solution (SAGM) is added to the washed red blood cells. The volume of a washed erythrocyte concentrate is a minimum of 210 ml, including storage solution.

A washed erythrocyte concentrate has a hematocrit value between 0.50 - 0.70 and contains at least 40 g of hemoglobin. The protein content is less than 0.5 g per washed erythrocyte concentrate.

All erythrocyte concentrates are de-ukocyzed and contain less than 1 x¹⁰⁶ leukocytes/product.

If desired, the product is irradiated. The irradiation dose is not less than 25 Gray and not more than 50 Gray. Irradiation is performed after washing.

Washed erythrocyte concentrate is used only in specific indications: the treatment of anemia or bleeding in patients with antibodies to plasma proteins, especially patients with anti-IgA, and in patients who repeatedly showed a severe allergic transfusion reaction after transfusion of blood products. Newborns with enterocolitis associated with expression of T antigen should also be given washed erythrocyte concentrate. In exceptional cases, washed erythrocyte concentrate may be used for mass transfusion in neonati to reduce potassium ion concentration.

Dose

Transfusion of one erythrocyte concentrate increases the hemoglobin concentration in a 70-kg person not actively bleeding by an average of 1 g/dl and the hematocrit value by ± 3%.

Special precautions

When selecting an erythrocyte concentrate for washing, in addition to ABO and rhesus D, any irregular antibodies present in the recipient must also be considered. The recipient should be tested for these beforehand. For women younger than 50 years, Kell-negative erythrocyte concentrates are preferably used. Before administration, the washed erythrocyte concentrate must be cross-matched with a serum sample from the recipient by the laboratory of the requesting hospital. The report of the compatibility study should include both the identity of the patient, the unique number of the erythrocyte concentrate and the result.

Immediately prior to transfusion, it should be verified that the unit to be administered is intended for that patient.

In patients with severe immune deficiency, irradiated blood products are indicated.

User Manual

Aseptic technique should be used for the duration of the transfusion. Delivery sets and filters should be replaced in a timely manner in case of multi-unit transfusion. The erythrocyte concentrate is administered intravenously via a perfusion set with standard filter (170-260 µ). For the first 10 to 15 minutes, a low infusion rate is set and the patient is closely observed for any transfusion reaction. Then the infusion rate is increased according to the clinical condition. The average transfusion duration of an erythrocyte concentrate is 1 to 2 hours. It is recommended that the duration for transfusion of one unit be limited to a maximum of 4 hours.

Any residues are disposed of as medical waste.

Warming the blood at room temperature before administration is not necessary.

Warming of blood products during administration is required only in case of massive transfusion (> 50 ml per minute, or > 15 ml/kg/h in children), including exchange transfusion, - to avoid hypothermia of the patient -, and in case of clinically important cold agglutinins. Special heating devices validated for this application should be used.

The most frequent side effects of blood product transfusion are chills, fever and symptoms of an allergic nature such as urticaria and itching.

Serious, potentially fatal, adverse reactions include: circulatory overfilling with pulmonary edema, transfusion-related acute lung disease (TRALI), bacterial sepsis,

hemolytic transfusion reaction and severe allergic reactions such as anaphylactic shock.

Further occurrences may include: posttransfusion purpura, chemical disturbance in massive transfusion (hyperkalemia), transfusion-associated graft versus host disease (TA-GVHD) (if not irradiated).

Through blood and blood derivatives, infections can be transmitted: with viruses (B19 parvovirus, CMV*, HAV, HBV, HCV, HIV...), with bacteria (syphilis), with protozoa (malaria, leishmania, trypanosomiasis) and with unknown pathogenic agents.

Iron accumulation may occur with frequent transfusions or transfusions over a long period of time.

If an acute transfusion reaction occurs, transfusion should be stopped immediately and appropriate therapy initiated.

The following laboratory tests may be useful in severe reactions: hemolysis parameters (haptoglobin, free hemoglobin, LDH, bilirubin), repeat cross-matching and blood group determination of patient and product, direct antiglobulin test, serum IgA, patient's hemoculture and bacteriological examination of the administered unit.

In case of a mild allergic transfusion reaction (itching, redness, urticaria), the transfusion can be continued if necessary after administration of antihistamines or corticosteroids.

* Deukocyte-derived blood products are generally believed to virtually eliminate the possibility of CMV virus transmission due to elimination of the white blood cells. For indications of the use of blood products derived from donors serologically negative for CMV: see under CMV-negative blood products.

The erythrocyte concentrate should not be mixed with drugs or infusion fluids. Physiological saline solutions may be administered along with blood, but not added to the blood bag.

A washed erythrocyte concentrate should be administered within 48 hours of preparation.

When used for mass transfusion in neonati or young children, it should be administered within the time frame of 6 hours after preparation. It is stored between + 2 °C and + 6 °C.

An erythrocyte concentrate should not be used with signs of damage or decay.

Blood is drawn from voluntary, non-remunerated donors, selected in accordance with the standards laid down by Belgian legislation and the procedures of the Blood Service of Belgian Red Cross-Flanders.

With each donation, the donor is inspected by a physician and tested for antibodies against the human immunodeficiency viruses (anti-HIV-1 and HIV-2), for antibodies against the hepatitis C virus (anti-HCV), for the hepatitis B virus surface antigen (HBsAg) and for antibodies against Treponema pallidum. HIV, HBV and HCV are also detected by NAT testing.
Products from donations with positive test results are destroyed.

When products prepared from human blood are administered, transmission of an infectious agent cannot be completely excluded. The residual risk of transmission of HIV, HBV or HCV by unit transfusion is estimated at 1 in 4 to 6 x¹⁰⁶, 1 in 0.3 to 1 x¹⁰⁶ and 1 in 700,000, respectively.

Transmission of as yet unknown pathogens cannot be ruled out.

By medical prescription, after order.

Order at least 24 hours before the desired delivery time.