RBC

Description
One unit of "packed" red blood cells (RBC) contains approximately 200 mL red blood cells, 100 mL Optisol AS-5® (a solution added to extend storage life) and ~30mL plasma. All red blood cell transfusions must be ABO/Rh compatible with the recipient, so, in dire emergency, type O negative can be used for all patients. RBC do not provide viable platelets, nor do they provide clinically significant amounts of coagulation factors. RBC must be stored between 1-6° C and have a shelf life of 42 days.

Indications
RBC are indicated for patients with symptomatic anemia who are not treatable, within a reasonable amount of time considering their symptoms, with specific therapy such as iron, vitamin B12 or folic acid.

Therapeutic Effect
In a 70 kilogram adult,  each unit should increase the hematocrit by 3-4%.

Pediatric guidelines:

• PRBC: 10 cc/kg, will raised Hb 3 g, Hct 10%. (1 cc/kg will raise Hct 1%). Try to limit to a single donor at a single time.

• 1 unit is approx 200-250 cc. Give over 3-4 hours, but can do as fast as 2 hours.

• In ss dz, don’t Xfuse over Hb 10 to avoid vessel plugging/stroke. In these pts, goal 8-10.

• Usually don’t pre-med, unless documented reaction. Tylenol is best pre-med (donor pyrogens can cause fever). A true reaction merits hydrocortisone. Benadryl is indicated for urticarial rash.

• Whole blood: not available per se, but can be reconstituted; use in massive bleed traumas, where factors are also lost, but give slowly to prevent heart failure. Give initially as much blood to raise Hb to 8, then proceed slowly. If chronic anemia, may transfuse more rapidly.