Erythrocyte concentrate, infant, irradiated

Code 'Blood Service'

EZLR

Stem E5261V with various suffixes as a function of division into subproducts

E5261VB0

E5261VC0

E5261VD0

etc.

NIHDI Code

Hospitalized: 752 485

Non-hospitalized: 752 474

An erythrocyte concentrate type "infant" is separated from an erythrocyte concentrate type "adult" via a closed system. The content corresponds to 90 to 100 ml of whole blood. An erythrocyte concentrate is prepared from human blood by centrifugation and removal of most of the plasma. The leukocytes in the erythrocyte concentrate are removed by filtration. To the concentrated and filtered erythrocytes is added a nutritive preservative, specifically saline-adenine-glucose-mannitol (SAGM).

The volume of an erythrocyte concentrate type 'infant' is 40 to 60 ml, storage liquid (SAGM) and anticoagulant (CPD: citrate-phosphate-dextrose) included. Only erythrocyte concentrates with blood group O, Kell negative, are prepared as erythrocyte concentrate type 'infant'. The rhesus type is chosen according to compatibility with the recipient's rhesus subgroups. An erythrocyte concentrate type 'infant' has a hematocrit of 0.50 to 0.70. Hemolysis at expiration is less than 0.8% of the erythrocyte mass. An irradiated erythrocyte concentrate is obtained by ionizing irradiation (gamma rays or X-rays) of a de-ukocyzed erythrocyte concentrate. This selectively damages the remaining lymphocytes in the concentrate, preventing them from multiplying. The irradiation dose is not less than 25 Gray and not more than 50 Gray. Irradiation is performed within 14 days of blood collection.

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

-          Prematuren (< 32 weken, < 1500 gram)

- Autologous and allogeneic stem cell transplant patients

- Severe acquired or congenital immune deficiencies (Hodgkin's disease, intensive
chemotherapy, radiotherapy or immunosuppressive therapy...)

Dose

Transfusion of 10 ml of erythrocyte concentrate/kg body weight on average increases hemoglobin concentration by 3 g/dl.

Special precautions

In transfusion of an erythrocyte concentrate type "infant", compatibility between donor, recipient and mother (if the recipient is less than three months old) should be ensured by selecting an erythrocyte concentrate compatible with the ABO and rhesus D blood type of the recipient and of the mother and by performing a cross test between red blood cells of the donor and serum/plasma of the recipient or the mother (up to three months after delivery). After one transfusion, all subsequent concentrates should be cross tested with serum/plasma of the child. 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.

Delegated erythrocyte concentrate type 'infant' is suitable for top-up transfusions in neonates and young children. Delegated erythrocyte concentrate type 'adult' should be used for transfusion of larger volumes. Mass transfusion with replacement of the entire blood volume should be considered potassium-critical: because of the risk of hyperkalemia, erythrocyte concentrates should be administered within 6 hours of preparation or washing.
For exchange transfusion in newborns, specially prepared reconstituted whole blood is used.

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

User Manual

Aseptic technique should be used during the duration of the transfusion. Feeding sets and filters should be replaced in a timely manner in case of multi-unit transfusion. The erythrocyte concentrate is administered intravenously via an infusion pump with standard filter (170-260 µ), the first few minutes under close observation for any transfusion reaction. The infusion rate is determined according to clinical condition and patient weight: an infusion rate of 5 ml/kg/hr is considered safe. The average transfusion duration of an erythrocyte concentrate is 1 to 2 hours. It is recommended that the duration for transfusion 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.

chemical disruption At Mass transfusion can cause 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.

If there is 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.

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.

An erythrocyte concentrate type "infant" should be stored between + 2 °C and + 6 °C. The storage time of an irradiated erythrocyte concentrate differs from that of an ordinary erythrocyte concentrate: when irradiated, the membrane of the red blood cells is slightly damaged, causing an accelerated exit of potassium and hemoglobin. This phenomenon increases as the cells age. The storage time is 2 days after 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.