Dosing and uses of whole blood
Acute Hemorrhage
As whole blood transfusion is limited to acutely hemorrhaging individuals, dosing should be based on the patient’s clinical condition, estimated blood loss, and other measures being used to maintain hemodynamic stability.
Other Information
Whole blood is no longer commonly available or used in most of the United States.
The most common use of whole blood in the United States is currently autologous donations for elective surgery.
Whole blood, if available, may be indicated for large volume hemorrhaging, such as seen with major trauma, requiring massive transfusion and rapid correction of anemia, coagulopathy, acidosis, and hypothermia. Studies supporting this approach include military trauma where they are able to transfuse very fresh (<24 hours old) whole blood which is not currently routinely available in civilian institutions.
Reconstituted whole blood is used for neonatal exchange transfusions, most commonly for hemolytic disease of the newborn. It is sometimes used during pediatric cardiovascular surgery as well as in neonatal hemodialysis.
Pediatric dosage forms and strengths
Exchange Transfusions
For dosing of reconstituted whole blood for exchange transfusions, please consult with your institutions blood bank medical director or hematologist.
Cardiovascular Surgery or Hemodialysis
For dosing of reconstituted whole blood for use during cardiovascular surgery or hemodialysis, predefined dosing protocols should be setup by the institution depending on type of procedure performed and the cardiopulmonary circuits used at the institution.
whole blood 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
Whole blood transfusions are not indicated when component specific therapy is available (i.e., use RBCs to treat anemia or use FFP to treat coagulopathy). The use of whole blood when monocomponent therapy is indicated and available could lead to complications such as volume overload.
Cautions
If a transfusion reaction is suspected, the transfusion should be stopped, the patient assessed and stabilized, the blood bank notified, and a transfusion reaction investigation initiated. Massive or rapid transfusion may lead to arrhythmias, hypothermia, hyperkalemia, hypocalcemia, metabolic alkalosis, and heart failure.
Because whole blood contains both RBCs and plasma, only units that are ABO identical to the recipient can be transfused. If transfusion is needed emergently and the blood bank does not have a current patient sample, emergency release of type O RBC and/or type AB plasma units should be requested until ABO typing can be performed and type specific blood products provided.
Whole blood has a 21 to 35 day expiration depending on the anticoagulant solution used. Since the labile clotting factors V and VIII have short storage half-lives at 4 degrees C, these clotting factors may not be adequately restored with whole blood transfusion alone unless the units are fresh. The platelets contained in whole blood are unlikely to be beneficial since whole blood is stored at 4 degrees C.
Reconstituting whole blood is a time consuming process and transfusion should not be delayed waiting for reconstituted whole blood for emergency transfusions.
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 should be monitored for signs of a transfusion reaction including vitals pre, during, and post transfusion.
Non-septic infectious risks include transmission of HIV (~1:2 mill), HCV (~1:1.5 mill), HBV (1:300k), HTLV, WNV, CMV, parvovirus B19, Lyme disease, babesiosis, malaria, Chaga’s disease, vCJD.
Iron overload in chronically transfused patients due to hemoglobinopathies or thalassemia.
Consult with blood bank medical director or hematologist if you have questions regarding special transfusion requirements.
Pregnancy and lactation
CMV-negative or CMV reduced risk (leukocyte reduced) RBCs should be used in pregnant women who are CMV-negative or whose CMV status is unknown.
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 whole blood
Each unit (~450-500mL) provides the equivalent of one unit of RBCs and one unit of plasma. However, the plasma may be deficient in labile clotting factors (V & VIII) since these factors degrade rapidly during storage. The platelets undergo conformational changes even with short-term refrigerated storage that causes rapid removal of transfused platelets by the reticuloendothelial system and thus are unlikely to provide much improvement in hemostasis.
Mechanism of action
Whole blood provides red cells, stable clotting factors, and volume in each unit that make it potentially beneficial in rapidly hemorrhaging patients.
