Introduction

This chapter is a guide for the physicians who selects, orders, or administers blood components. Blood component descriptions, alternative therapies, and general and specific product indications and contraindications are specifically addressed. Special surgical situations requiring blood components are covered, such as emergency release of blood units and massive transfusion. Technical considerations including pretransfusion evaluation, blood bank component inventory, and general aspects of transfusion are also discussed. Finally, adverse infectious and non-infectious complications are described in detail.

Whole blood and packed red blood cells

Description

Whole blood (WB) is the starting point for the manufacture of most of the components used in transfusion. Whole blood contains red blood cells, plasma, clotting factors, platelets, and approximately 109 white blood cells. However, packed red blood cells (pRBCs) are the most commonly transfused blood component. pRBCs are made from whole blood collections by centrifugation or by apheresis techniques. In the USA, over 12 million units of pRBCs are transfused each year. Table 20.1 provides important information on WB and pRBC products including approximate volumes, compositions, and storage periods.

Indications

Historically, WB was used to replace volume and red cell mass, usually during resuscitation of a patient when masssive transfusion was required. Availability of WB is dependent upon each institution and blood center. Its use is discouraged, however, as the use of specific blood components may be best tailored to the individual and unique needs of each patient.