Erythrocyte concentrate, adult, irradiated

Code 'Blood Service'

E5261V00

E5261VA0

NIHDI Code

Hospitalized: 752 463

Non-hospitalized: 752 452

An erythrocyte concentrate is prepared from human blood by centrifugation followed by 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 at least 214 ml, anticoagulant (CPD: citrate-phosphate-dextrose) and 100 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 deukocyzed and contain less than 1 x¹⁰⁶ leukocytes per product. An irradiated erythrocyte concentrate is obtained by ionizing irradiation (gamma rays or X-rays) of a delegated erythrocyte concentrate. This damages the remaining lymphocytes in the concentrate, preventing them from multiplying. The irradiation dose is no less than 25 Gray and no more than 50 Gray. Irradiation is normally performed within 14 days of blood collection.

The use of irradiated erythrocyte concentrates is indicated for the treatment of blood loss and anemia in immunocompromised patients at risk of transfusion-associated graft versus host disease (TA-GVHD)

intra-uteriene transfusie en wisseltransfusie; daarna tot zes maanden na à terme datum (zie onder desbetreffende producten)
prematuren (< 32 weken, < 1500 gram)
autologe en allogene stamceltransplantatie-patiënten
ernstige verworven of aangeboren immuundeficiënties (ziekte van Hodgkin, intensieve
chemotherapie, radiotherapie of immunosuppressieve therapie…)

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 performing a cross test (indirect antiglobulin test) between red blood cells of the donor and serum/plasma of the recipient. In patients in whom no irregular antibodies are found, the cross test can be replaced by a short cross test or electronic cross test (Type and Screen method). The report of the compatibility study should include 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 women younger than 45 years, Kell-negative blood products are preferably administered.

In certain types of plasma intolerance, transfusion of an erythrocyte concentrate with residual amounts of plasma is not recommended. In these cases, the use of washed erythrocytes is indicated. For transfusion in neonati, a de-ukocyte erythrocyte concentrate type "infant" should be used.

For exchange transfusion in newborns, specially prepared reconstituted whole blood is used. For intrauterine transfusion, an erythrocyte concentrate with specific characteristics is prepared.

When using an erythrocyte concentrate adult, irradiated, for mass transfusion in neonati up to the age of 1 year, the erythrocyte concentrate should be maximum 5 days old and administered within 24 hours of irradiation.

An irradiated blood product is not radioactive and can be manipulated without danger by the nursing staff.

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 to 100 ml per minute. 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.

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 residue is 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).

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 must be stored between + 2 °C and + 6 °C and must not be used after the expiration date indicated on the label. The storage time of an irradiated erythrocyte concentrate differs from that of a normal erythrocyte concentrate: irradiation slightly damages the membrane of the red blood cells, causing an accelerated exit of potassium and hemoglobin. This phenomenon increases as the cells age. The storage time is 28 days from collection if irradiation was performed within 14 days of collection. With subsequent irradiation, the storage time is reduced to 24 hours from irradiation.

Other characteristics and storage conditions are not affected by irradiation.

A delegated erythrocyte concentrate, irradiated, should not be used after expiration date and 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.