Dosing and uses of washed red blood cells
Recurrent Severe Allergic Transfusion Reactions
Please see specific component monograph (i.e., RBCs or Platelets) for dosing.
Washed RBC units may not provide full 1 g/dL increase in hemoglobin per unit because 10-20% of the RBCs are lost in the washing process.
Platelet products may lose up to 33% of the platelets in the washing process. The platelets functionality may also be altered providing a suboptimal response.
Other Indications & Uses
Recurrent severe allergic transfusion reactions such as anaphylaxis or severe urticarial reactions not prevented by pre-transfusion antihistamine and corticosteroid administration
Depletion of potassium and anticoagulants prior to transfusion to a fetus or to a neonate with renal failure or when large amount of RBC component needed for neonate (i.e., RBC exchange, dialysis, ECMO, etc.) when fresh RBCs are not available.
IgA deficiency with documented anti-IgA antibodies when IgA deficient donors are not available to prevent anaphylactic transfusion reactions
Maternal platelets collected for neonates with neonatal alloimmune thrombocytopenia (controversial)
Atypical HUS with T-antigen activation (controversial)
Recurrent febrile non-hemolytic transfusion reactions not prevented by leukocyte reduction and antipyretics Consult with your blood bank medical director for questions regarding indications of washed blood products
Pediatric dosage forms and strengths
Please see specific component monograph (i.e., RBCs or Platelets) for dosing, as there is no difference on dosing washed blood products from non-washed blood products.
Platelet products may lose up to 33% of the platelets in the washing process. The platelets functionality may also be altered providing a suboptimal response.
washed red blood cells adverse (side) effects
Frequency not defined
Hemolytic Transfusion Reactions
Febrile Non-Hemolytic Reactions
Allergic Reactions ranging from urticaria to anaphylaxis
Septic Reactions
Transfusion Related Acute Lung Injury (TRALI)
Circulatory Overload
Transfusion Associated Graft Versus Host Disease
Postransfusion Purpura
Warnings
Contraindications
Washing is NOT indicated for leukocyte reduction as this technique only reduces the leukocytes by approximately 85% and is insufficient to consider the product as leukocyte reduced.
Washing is NOT adequate for the prevention of TA-GVHD. Patients at risk of TA-GVHD should receive irradiated cellular components regardless of whether they are washed.
Cautions
Washing is a time consuming process that lowers yield of RBCs or platelets and may alter functionality of platelets. Additionally, washing requires “spiking” of the unit and loss of sterility requiring the unit’s storage time to be drastically reduced to prevent potential bacterial contamination and septic transfusion reactions. Therefore, washing should only be utilized in cases in which it is clearly indicated.
All transfusions must be given via blood administration sets containing 170- to 260-micron filters or 20- to 40-micron microaggregate filters unless transfusion is given via a bedside leukocyte reduction filter. No other medications or fluids other than normal saline should be simultaneously given through the same line without prior consultation with the medical director of the blood bank.
Patient’s should be monitored for signs of a transfusion reaction including vitals pre, during, and post transfusion.
Please see specific component monograph for full safety information.
Consult with blood bank medical director or hematologist if you have questions regarding special transfusion requirements.
Pregnancy and lactation
Please see specific component monograph for pregnancy/lactation information.
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of washed red blood cells
Please see specific component monograph.
Mechanism of action
Washing is performed using centrifugation separation. The plasma is removed and replaced with either normal saline or a plasma substitute depending upon the institution. Washing removes between 98-99% of plasma constituents.
