Erythrocyte concentrate, adult

Code 'Blood Service'

E5259V00

E5259VA0

NIHDI Code

Hospitalized: 752 463

Non-hospitalized: 752 452

An erythrocyte concentrate is prepared from human blood by centrifugation followed by the removal of most of the plasma. To the concentrated erythrocytes is added a nutritive preservative, specifically saline-adenine-glucose-mannitol (SAGM). Deleukocyting is done by filtration. The volume of an erythrocyte concentrate type "adult" is not less than 214 ml and not more than 340 ml, anticoagulant (CPD: citrate-phosphate-dextrose) and 105 ml of preservative solution (SAGM) included. The exact volume is indicated on the label. An erythrocyte concentrate has a hematocrit value between 0.50 and 0.70 and contains at least 40 g of hemoglobin. Hemolysis at expiration is less than 0.8% of the erythrocyte mass.

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

An erythrocyte concentrate is used to increase oxygen transport in cases of blood loss and anemia. The transfusion threshold is between 7 and 10 g Hb per dl depending on other factors that determine oxygen transport capacity such as the patient's cardiopulmonary status

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

In transfusion of an erythrocyte concentrate, donor-recipient compatibility must be ensured by selection of an erythrocyte concentrate compatible with the ABO and rhesus D blood type of the recipient and by performance of a cross-test (indirect antiglobulin test) between donor red blood cells and recipient serum/plasma.

In patients in whom no irregular antibodies are found, the cross test can be replaced by a short cross test or an electronic cross test (Type and Screen method).

The compatibility study report should include the patient's identity, 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 women younger than 50 years, rhesus-compatible and Kell-negative blood products are preferably administered.

In rare cases of plasma intolerance, transfusion of an erythrocyte concentrate with residual plasma is not recommended. In these cases, the use of washed erythrocytes is indicated.

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

In neonati, a delegated erythrocyte concentrate type "infant" should be used. Mass transfusions in neonates and toddlers require vigilance regarding potassium levels. For exchange transfusion in newborns, specially prepared reconstituted whole blood is used. For intrauterine transfusion, an erythrocyte concentrate with specific characteristics is prepared.

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. In case of acute blood loss, the rate can be increased to 50 - 100 ml/min. The average transfusion duration of an erythrocyte concentrate is 1 - 2 hours. It is recommended to limit the duration for transfusion of one unit to a maximum of 4 hours.
Prevent backflow of blood from the patient into the transfusion set: always hang the blood bag higher than the patient's arm and close the roller clamp when moving patient and/or blood bag.

Any residues are disposed of as medical waste.

Warming the blood 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).

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 by removing 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.

No drugs or infusion fluids should be added to an erythrocyte concentrate. The hematocrit of an erythrocyte concentrate is such that dilution by the addition of isotonic saline is unnecessary. Calcium-containing and concentrated glucose solutions should not be administered through the same intravenous line as the erythrocyte concentrate.

Erythrocyte concentrates should be stored between + 2 °C and + 6 °C and should not be used after the expiration date indicated on the label. The maximum storage period is 42 days.

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.