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.[ citation needed ]

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] [16] [17] [14]

Processing

Historically, blood was transfused as whole blood without further processing. Most blood banks now split the whole blood into two or more components, [18] 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.[ citation needed ]

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.[ citation needed ]

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, white blood cells, plasma, clotting factors and platelets.

<span class="mw-page-title-main">Bleeding</span> Loss of blood escaping from the circulatory system

Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vagina or anus, or through a puncture in the skin. Hypovolemia is a massive decrease in blood volume, and death by excessive loss of blood is referred to as exsanguination. Typically, a healthy person can endure a loss of 10–15% of the total blood volume without serious medical difficulties. The stopping or controlling of bleeding is called hemostasis and is an important part of both first aid and surgery.

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

Platelets, also called thrombocytes, are a component of blood 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 that are 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 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">Complete blood count</span> Routine laboratory test of blood cells

A complete blood count (CBC), also known as a full blood count (FBC), is a set of medical laboratory tests that provide information about the cells in a person's blood. The CBC indicates the counts of white blood cells, red blood cells and platelets, the concentration of hemoglobin, and the hematocrit. The red blood cell indices, which indicate the average size and hemoglobin content of red blood cells, are also reported, and a white blood cell differential, which counts the different types of white blood cells, may be included.

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> Voluntary 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">Thrombocytopenia</span> Medical condition

Thrombocytopenia is a condition characterized by abnormally low levels of platelets, also known as thrombocytes, in the blood. It is the most common coagulation disorder among intensive care patients and is seen in a fifth of medical patients and a third of surgical patients.

<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">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>

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 given by slow injection into a vein.

Rho(D) immune globulin (RhIG) is a medication used to prevent RhD isoimmunization in mothers who are RhD negative and to treat idiopathic thrombocytopenic purpura (ITP) in people who are Rh positive. It is often given both during and following pregnancy. It may also be used when RhD-negative people are given RhD-positive blood. It is given by injection into muscle or a vein. A single dose lasts 12 weeks. It is made from human blood plasma.

<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.

<span class="mw-page-title-main">Factor VIII (medication)</span> Pharmaceutical drug

Factor VIII is a medication used to treat and prevent bleeding in people with hemophilia A and other causes of low factor VIII. Certain preparations may also be used in those with von Willebrand's disease. It is given by slow injection into a vein.

<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.

Patient Blood Management (PBM) is a set of medical practices designed to optimise the care of patients who might need a blood transfusion. Patient blood management programs use an organized framework to improve blood health, thus increasing patient safety and quality of life, reducing costs, and improving clinical outcomes. Some strategies to accomplish this include ensuring that anemia is treated prior to a surgical operation, using surgical techniques that limit blood loss, and returning blood lost during surgery to the patient via intraoperative blood salvage.

Single unit transfusion refers to transfusing a single unit or bag of blood product to a person who is not bleeding and haemodynamically stable followed by an assessment to see if further transfusion is required.. The benefits of single unit transfusion include reduced exposure to blood products. Each unit transfused increases the associated risks of transfusion such as infection, transfusion associated circulatory overload and other side effects. Transfusion of a single unit also encourages less wastage of blood products and can be cost-effective. Single unit transfusion can be as part of an institutional or national guidelines and instituted with the help of a transfusion committee or transfusion practitioner. Education of medical staff is important and catch phrases such as "Why use two when one will do", "every ONE matters" or "one bag is best - then reassess" have been used.

References

  1. 1 2 3 Hillyer, Christopher D. (2007). 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, Ada Lawrence (2007). Plumer's Principles and Practice of Intravenous Therapy. Lippincott Williams & Wilkins. p. 422. ISBN   9780781759441. Archived from the original on 2017-01-12.
  4. ↑ Herndon, David N. (2012). 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 (Oxford, England). 26 (6): 406–414. doi:10.1111/tme.12329. PMID   27357229. S2CID   24552025.
  6. ↑ Linton, Adrianne Dill (2015). Introduction to Medical-Surgical Nursing. Elsevier Health Sciences. p. 287. ISBN   9781455776412. Archived from the original on 2017-09-14.
  7. ↑ Marini, John J.; Wheeler, Arthur P. (2012). Critical Care Medicine: The Essentials (4 ed.). Lippincott Williams & Wilkins. p. 267. ISBN   9781451152845. Archived from the original on 2017-01-11.
  8. ↑ Rudmann, Sally V. (2005). Textbook of Blood Banking and Transfusion Medicine. Elsevier Health Sciences. p. 205. ISBN   072160384X. Archived from the original on 2017-01-12.
  9. ↑ Hemmings, Hugh C.; Egan, Talmage D. (2012). 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. ↑ Blood policy & technology. DIANE Publishing. 1985. p. 8. ISBN   9781428923331. Archived from the original on 2017-01-12.
  13. 1 2 Flint, AWJ; McQuilten, ZK; Wood, EM (April 2018). "Massive transfusions for critical bleeding: is everything old new again?". Transfusion Medicine (Oxford, England). 28 (2): 140–149. doi:10.1111/tme.12524. PMID   29607593. S2CID   4561424.
  14. 1 2 Pivalizza, Evan G.; Stephens, Christopher T.; Sridhar, Srikanth; Gumbert, Sam D.; Rossmann, Susan; Bertholf, Marsha F.; Bai, Yu; Cotton, Bryan A. (2018). "Whole Blood for Resuscitation in Adult Civilian Trauma in 2017: A Narrative Review". Anesthesia & Analgesia. 127 (1): 157–162. doi: 10.1213/ANE.0000000000003427 . ISSN   0003-2999. PMID   29771715. S2CID   21697290.
  15. ↑ "Blood safety and availability". www.who.int. Retrieved 2019-06-22.
  16. ↑ "Blood Far Forward". THOR. Retrieved 2019-06-22.
  17. ↑ Goforth, C. W.; Tranberg, J. W.; Boyer, P.; Silvestri, P. J. (2016-06-01). "Fresh Whole Blood Transfusion: Military and Civilian Implications". Critical Care Nurse. 36 (3): 50–57. doi:10.4037/ccn2016780. ISSN   0279-5442. PMID   27252101.
  18. ↑ Christopher D. Hillyer; Beth H. Shaz; James C. Zimring; Thomas C. Abshire (17 June 2009). 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.
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