Whole blood

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Whole blood
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A Red Cross whole blood donation
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Whole blood (WB) is human blood from a standard blood donation. [1] It is used in the treatment of massive bleeding, in exchange transfusion, and when people donate blood to themselves. [1] [2] One unit of whole blood (~517 mls) brings up hemoglobin levels by about 10 g/L. [3] [4] Cross matching is typically done before the blood is given. [2] [5] It is given by injection into a vein. [6]

Contents

Side effects include red blood cell breakdown, high blood potassium, infection, volume overload, lung injury, and allergic reactions such as anaphylaxis. [2] [3] Whole blood is made up of red blood cells, white blood cells, platelets, and blood plasma. [3] It is best within a day of collection; however, can be used for up to three weeks. [3] [5] [7] The blood is typically combined with an anticoagulant and preservative during the collection process. [8]

The first transfusion of whole blood was in 1818; however, common use did not begin until the First and Second World Wars. [5] [9] It is on the World Health Organization's List of Essential Medicines. [10] [11] In the 1980s the cost of whole blood was about US$50 per unit in the United States. [12] Whole blood is not commonly used outside of the developing world and military. [2] It is used to make a number of blood products including packed red blood cells, platelet concentrate, cryoprecipitate, and fresh frozen plasma. [1]

Medical use

Whole blood has similar risks to a transfusion of red blood cells and must be cross-matched to avoid hemolytic transfusion reactions. Most of the reasons for use are the same as those for RBCs, and whole blood is not frequently used in high income countries where packed red blood cells are readily available. [13] [14] However, use of whole blood is much more common in low and middle income countries. Over 40% of blood collected in low-income countries is administered as whole blood, and approximately a third of all blood collected in middle-income countries is administered as whole blood. [15]

Whole blood is sometimes "recreated" from stored red blood cells and fresh frozen plasma (FFP) for neonatal transfusions. This is done to provide a final product with a very specific hematocrit (percentage of red cells) with type O red cells and type AB plasma to minimize the chance of complications. [16]

Transfusion of whole blood is being used in the military setting and is being studied in pre-hospital trauma care and in the setting of massive transfusion in the civilian setting. [13] [17] [18] [14] Whole blood can be ABO-type specific when the recipient blood type is known. For unknown recipient type, low-titer O universal donor whole blood (LTOWB) can be used; this requires that the donor plasma contains only low titers of anti-A and anti-B. [19]

Processing

Historically, blood was transfused as whole blood without further processing. Most blood banks now split the whole blood into two or more components, [20] typically red blood cells and a plasma component such as fresh frozen plasma. Platelets for transfusion can also be prepared from a unit of whole blood. Some blood banks have replaced this with platelets collected by plateletpheresis because whole blood platelets, sometimes called "random donor" platelets, must be pooled from multiple donors to get enough for an adult therapeutic dose. [21]

The collected blood is generally separated into components by one of three methods. A centrifuge can be used in a "hard spin" which separates whole blood into plasma and red cells or a "soft spin" which separates it into plasma, buffy coat (used to make platelets), and red blood cells. The third method is sedimentation: the blood simply sits overnight and the red cells and plasma are separated by gravitational interactions. Preparing a pooled buffy coat concentrate may provide additional advantages. [22]

Storage

Whole blood is typically stored under the same conditions as red blood cells and can be kept up to 35 days if collected with CPDA-1 storage solution or 21 days with other common storage solutions such as CPD.[ citation needed ]

If the blood is used to make platelets, it is kept at room temperature until the process is complete. This must be done quickly to minimize the warm storage of RBCs in the unit.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Blood transfusion</span> Intravenous transference of blood products

Blood transfusion is the process of transferring blood products into a person's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but modern medical practice commonly uses only components of the blood, such as red blood cells, plasma, platelets, and other clotting factors. White blood cells are transfused only in very rare circumstances, since granulocyte transfusion has limited applications. Whole blood has come back into use in the setting of trauma.

Transfusion medicine is the branch of medicine that encompasses all aspects of the transfusion of blood and blood components including aspects related to hemovigilance. It includes issues of blood donation, immunohematology and other laboratory testing for transfusion-transmitted diseases, management and monitoring of clinical transfusion practices, patient blood management, therapeutic apheresis, stem cell collections, cellular therapy, and coagulation. Laboratory management and understanding of state and federal regulations related to blood products are also a large part of the field.

<span class="mw-page-title-main">Platelet</span> Component of blood aiding in coagulation

Platelets or thrombocytes are a blood component whose function is to react to bleeding from blood vessel injury by clumping, thereby initiating a blood clot. Platelets have no cell nucleus; they are fragments of cytoplasm derived from the megakaryocytes of the bone marrow or lung, which then enter the circulation. Platelets are found only in mammals, whereas in other vertebrates, thrombocytes circulate as intact mononuclear cells.

<span class="mw-page-title-main">Blood plasma</span> Liquid component of blood

Blood plasma is a light amber-colored liquid component of blood in which blood cells are absent, but which contains proteins and other constituents of whole blood in suspension. It makes up about 55% of the body's total blood volume. It is the intravascular part of extracellular fluid. It is mostly water, and contains important dissolved proteins, glucose, clotting factors, electrolytes, hormones, carbon dioxide, and oxygen. It plays a vital role in an intravascular osmotic effect that keeps electrolyte concentration balanced and protects the body from infection and other blood-related disorders.

<span class="mw-page-title-main">Blood bank</span> Place where blood donations are collected

A blood bank is a center where blood gathered as a result of blood donation is stored and preserved for later use in blood transfusion. The term "blood bank" typically refers to a department of a hospital usually within a clinical pathology laboratory where the storage of blood product occurs and where pre-transfusion and blood compatibility testing is performed. However, it sometimes refers to a collection center, and some hospitals also perform collection. Blood banking includes tasks related to blood collection, processing, testing, separation, and storage.

<span class="mw-page-title-main">Blood donation</span> Blood withdrawal for use by another person via transfusion

A blood donation occurs when a person voluntarily has blood drawn and used for transfusions and/or made into biopharmaceutical medications by a process called fractionation. Donation may be of whole blood, or of specific components directly (apheresis). Blood banks often participate in the collection process as well as the procedures that follow it.

<span class="mw-page-title-main">Apheresis</span> Medical techniques to separate one or more components of blood

Apheresis is a medical technology in which the blood of a person is passed through an apparatus that separates out one particular constituent and returns the remainder to the circulation. It is thus an extracorporeal therapy.

<span class="mw-page-title-main">Plasmapheresis</span> Removal, treatment and return of blood plasma

Plasmapheresis is the removal, treatment, and return or exchange of blood plasma or components thereof from and to the blood circulation. It is thus an extracorporeal therapy, a medical procedure performed outside the body.

<span class="mw-page-title-main">Plateletpheresis</span> Method of collecting platelets from blood

Plateletpheresis is the process of collecting thrombocytes, more commonly called platelets, a component of blood involved in blood clotting. The term specifically refers to the method of collecting the platelets, which is performed by a device used in blood donation that separates the platelets and returns other portions of the blood to the donor. Platelet transfusion can be a life-saving procedure in preventing or treating serious complications from bleeding and hemorrhage in patients who have disorders manifesting as thrombocytopenia or platelet dysfunction. This process may also be used therapeutically to treat disorders resulting in extraordinarily high platelet counts such as essential thrombocytosis.

<span class="mw-page-title-main">Fresh frozen plasma</span> Liquid portion of whole blood

Fresh frozen plasma (FFP) is a blood product made from the liquid portion of whole blood. It is used to treat conditions in which there are low blood clotting factors or low levels of other blood proteins. It may also be used as the replacement fluid in plasma exchange. Using ABO compatible plasma, while not required, may be recommended. Use as a volume expander is not recommended. It is administered by slow injection into a vein.

Intraoperative blood salvage (IOS), also known as cell salvage, is a specific type of autologous blood transfusion. Specifically IOS is a medical procedure involving recovering blood lost during surgery and re-infusing it into the patient. It is a major form of autotransfusion.

<span class="mw-page-title-main">Transfusion-related acute lung injury</span> Medical condition

Transfusion-related acute lung injury (TRALI) is the serious complication of transfusion of blood products that is characterized by the rapid onset of excess fluid in the lungs. It can cause dangerous drops in the supply of oxygen to body tissues. Although changes in transfusion practices have reduced the incidence of TRALI, it was the leading cause of transfusion-related deaths in the United States from fiscal year 2008 through fiscal year 2012.

<span class="mw-page-title-main">Platelet transfusion</span> Treatment for bleeding irregularities

Platelet transfusion, also known as platelet concentrate, is used to prevent or treat bleeding in people with either a low platelet count or poor platelet function. Often this occurs in people receiving cancer chemotherapy. Preventive transfusion is often done in those with platelet levels of less than 10 x 109/L. In those who are bleeding transfusion is usually carried out at less than 50 x 109/L. Blood group matching (ABO, RhD) is typically recommended before platelets are given. Unmatched platelets, however, are often used due to the unavailability of matched platelets. They are given by injection into a vein.

Erythrocytapheresis is an apheresis procedure by which erythrocytes are separated from whole blood. It is an extracorporeal blood separation method whereby whole blood is extracted from a donor or patient, the red blood cells are separated, and the remaining blood is returned to circulation.

<span class="mw-page-title-main">Packed red blood cells</span> Red blood cells separated for blood transfusion

Packed red blood cells, also known as packed cells, are red blood cells that have been separated for blood transfusion. The packed cells are typically used in anemia that is either causing symptoms or when the hemoglobin is less than usually 70–80 g/L. In adults, one unit brings up hemoglobin levels by about 10 g/L. Repeated transfusions may be required in people receiving cancer chemotherapy or who have hemoglobin disorders. Cross-matching is typically required before the blood is given. It is given by injection into a vein.

Autotransfusion is a process wherein a person receives their own blood for a transfusion, instead of banked allogenic (separate-donor) blood. There are two main kinds of autotransfusion: Blood can be autologously "pre-donated" before a surgery, or alternatively, it can be collected during and after the surgery using an intraoperative blood salvage device. The latter form of autotransfusion is utilized in surgeries where there is expected a large volume blood loss – e.g. aneurysm, total joint replacement, and spinal surgeries. The effectiveness, safety, and cost-savings of intraoperative cell salvage in people who are undergoing thoracic or abdominal surgery following trauma is not known.

A blood product is any therapeutic substance prepared from human blood. This includes whole blood; blood components; and plasma derivatives. Whole blood is not commonly used in transfusion medicine. Blood components include: red blood cell concentrates or suspensions; platelets produced from whole blood or via apheresis; plasma; and cryoprecipitate. Plasma derivatives are plasma proteins prepared under pharmaceutical manufacturing conditions, these include: albumin; coagulation factor concentrates; and immunoglobulins.

Febrile non-hemolytic transfusion reaction (FNHTR) is the most common type of transfusion reaction. It is a benign occurrence with symptoms that include fever but not directly related with hemolysis. It is caused by cytokine release from leukocytes within the donor product as a consequence of white blood cell breakdown .These inflammatory mediators accumulate during the storage of the donated blood, and so the frequency of this reaction increases with the storage length of donated blood. This is in contrast to transfusion-associated acute lung injury, in which the donor plasma has antibodies directed against the recipient HLA antigens, mediating the characteristic lung damage.

Pathogen reduction using riboflavin and UV light is a method by which infectious pathogens in blood for transfusion are inactivated by adding riboflavin and irradiating with UV light. This method reduces the infectious levels of disease-causing agents that may be found in donated blood components, while still maintaining good quality blood components for transfusion. This type of approach to increase blood safety is also known as “pathogen inactivation” in the industry.

A granulocyte transfusion is a medical procedure in which granulocytes are infused into a person's blood. Granulocyte transfusions were historically used to prevent and treat infections in people with neutropenia, but the practice declined in popularity in the 1980s. Interest in the procedure increased in the 1990s due to the development of more effective methods for harvesting granulocytes and a growing population of people with severe neutropenia from chemotherapy. However, the treatment's efficacy remains poorly understood and its use is controversial.

References

  1. 1 2 3 Hess JR, Beyer GM (2007). "Red Blood Cell Metabolism During Storage: Basic Principles and Practical Aspects". In Hillyer CD (ed.). Blood Banking and Transfusion Medicine: Basic Principles & Practice. Elsevier Health Sciences. p. 190. ISBN   978-0443069819. Archived from the original on 2017-01-12.
  2. 1 2 3 4 Connell NT (December 2016). "Transfusion Medicine". Primary Care. 43 (4): 651–659. doi:10.1016/j.pop.2016.07.004. PMID   27866583.
  3. 1 2 3 4 Plumer AL (2007). "Transfusion Therapy". Plumer's Principles and Practice of Intravenous Therapy. Lippincott Williams & Wilkins. p. 422. ISBN   9780781759441. Archived from the original on 2017-01-12.
  4. ↑ Woodson LC, Sherwood ER, Kinsky MP, Talon M, Martinello C, Woodson SM (2012). "Anesthesia for burned patients". In Herndon DN (ed.). Total Burn Care: Expert Consult - Online and Print. Elsevier Health Sciences. p. 194. ISBN   9781455737970.
  5. 1 2 3 Bahr MP, Yazer MH, Triulzi DJ, Collins RA (December 2016). "Whole blood for the acutely haemorrhaging civilian trauma patient: a novel idea or rediscovery?". Transfusion Medicine. 26 (6): 406–414. doi:10.1111/tme.12329. PMID   27357229. S2CID   24552025.
  6. ↑ Flagg C (2015). "Intravenous Therapy". In Linton AD (ed.). Introduction to Medical-Surgical Nursing. Elsevier Health Sciences. p. 287. ISBN   9781455776412. Archived from the original on 2017-09-14.
  7. ↑ Marini JF, Wheeler AP (2012). "Blood Conservation and Transfusion". Critical Care Medicine: The Essentials (4th ed.). Lippincott Williams & Wilkins. p. 267. ISBN   9781451152845. Archived from the original on 2017-01-11.
  8. ↑ Rudmann SV, ed. (2005). "Donor Screening and Blood Collection". Textbook of Blood Banking and Transfusion Medicine. Elsevier Health Sciences. p. 205. ISBN   072160384X. Archived from the original on 2017-01-12.
  9. ↑ Tanaka K (2012). "Transfusion and Coagulation Therapy". In Hemmings HC, Egan TD (eds.). Pharmacology and Physiology for Anesthesia: Foundations and Clinical Application. Elsevier Health Sciences. p. 628. ISBN   978-1455737932. Archived from the original on 2017-01-11.
  10. ↑ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl: 10665/325771 . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  11. ↑ World Health Organization (2021). World Health Organization model list of essential medicines: 22nd list (2021). Geneva: World Health Organization. hdl: 10665/345533 . WHO/MHP/HPS/EML/2021.02.
  12. ↑ "Introduction and Summary". Blood policy & technology. DIANE Publishing. 1985. p. 8. ISBN   9781428923331. Archived from the original on 2017-01-12.
  13. 1 2 Flint AW, McQuilten ZK, Wood EM (April 2018). "Massive transfusions for critical bleeding: is everything old new again?". Transfusion Medicine. 28 (2): 140–149. doi:10.1111/tme.12524. PMID   29607593. S2CID   4561424.
  14. 1 2 Pivalizza EG, Stephens CT, Sridhar S, Gumbert SD, Rossmann S, Bertholf MF, et al. (July 2018). "Whole Blood for Resuscitation in Adult Civilian Trauma in 2017: A Narrative Review". Anesthesia and Analgesia. 127 (1): 157–162. doi: 10.1213/ANE.0000000000003427 . PMID   29771715. S2CID   21697290.
  15. ↑ "Blood safety and availability". www.who.int. Retrieved 2019-06-22.
  16. ↑ Sharma DC, Rai S, Mehra A, Kaur MM, Sao S, Gaur A, Sapra R. Study of 25 cases of exchange transfusion by reconstituted blood in hemolytic disease of newborn. Asian J Transfus Sci. 2007 Jul;1(2):56-8. doi: 10.4103/0973-6247.33448. PMID: 21938234; PMCID: PMC3168121.
  17. ↑ "Blood Far Forward". THOR. Retrieved 2019-06-22.
  18. ↑ Goforth CW, Tranberg JW, Boyer P, Silvestri PJ (June 2016). "Fresh Whole Blood Transfusion: Military and Civilian Implications". Critical Care Nurse. 36 (3): 50–57. doi:10.4037/ccn2016780. PMID   27252101.
  19. ↑ Milford EM, Gurney JM, Beckett A, Strandenes G, Reade MC. Type-specific whole blood still has a role in the era of low titer O universal donor transfusion for severe trauma hemorrhage. J Trauma Acute Care Surg. 2024 May 20. doi: 10.1097/TA.0000000000004369. Epub ahead of print. PMID: 38764142.
  20. ↑ Greene CE, Hillyer CD (17 June 2009). "Component preparation and manufacturing". In Hillyer CD, Shaz BH, Zimring JC, Abshire TC (eds.). Transfusion Medicine and Hemostasis: Clinical and Laboratory Aspects. Elsevier. pp. 45–. ISBN   978-0-12-374432-6. Archived from the original on 23 September 2017. Retrieved 16 November 2010.
  21. ↑ Chu YH, Rose WN, Nawrot W, Raife TJ. Pooled platelet concentrates provide a small benefit over single-donor platelets for patients with platelet refractoriness of any etiology. J Int Med Res. 2021 May;49(5):3000605211016748. doi: 10.1177/03000605211016748. PMID: 34013757; PMCID: PMC8142527.
  22. ↑ Kumar R, Dhawan HK, Sharma RR, Kaur J. Buffy coat pooled platelet concentrate: A new age platelet component. Asian J Transfus Sci. 2021 Jul-Dec;15(2):125-132. doi: 10.4103/ajts.AJTS_72_19. Epub 2021 Nov 1. PMID: 34908742; PMCID: PMC8628246.
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