MODIFIED BLOOD COMPONENTS

Leukocyte Reduction:United Blood Services routinely provides leukocyte-reduced RBC and platelet components. Leukocyte-reduced products decrease the risk of transfusion-transmitted CMV (cytomegalovirus) infection, the incidence of HLA alloimmunization, and the frequency of febrile nonhemolytic transfusion reactions (FNHTR). An occasional special unit (e.g., autologous unit imported from another center or a deglycerolized RBC) may not be leukocyte-reduced. If the unit is required to be transfused as leukocyte-reduced then the transfusion facility must use a leukocyte reduction filter.

Irradiation: Patients at risk for developing transfusion-associated graft-versus-host disease (TA-GVHD) should receive irradiated cellular components. Examples include but may not be limited to the following:

  • Congenital immunodeficiency
  • Hematopoetic cell transplant candidates and recipients
  • Intrauterine transfusions or neonatal exchange transfusions
  • Premature infants
  • Patients receiving components from blood relatives
  • Patients receiving HLA matched or crossmatched platelets
  • Patients receiving granulocytes
  • Patients on medications that increase the risk for TA-GVHD (e.g., fludarabine, alemtuzumab, clofarabine, etc.)

Irradiated RBCs have an expiration date of 28 days from irradiation. If the unit has an expiration date less than 28 days prior to irradiation the shorter date must be used.

Volume Reduction: Removal of excess donor plasma from cellular components may be indicated in patients who cannot tolerate the full volume and in certain other clinical scenarios. The extra centrifugation step will cause some platelet activation and loss of function. Volume-reduced platelets have a 4-hour expiration.

Washing:Certain clinical situations, including severe life-threatening allergies to elements in plasma, may require the use of washed RBCs and platelets. These cellular products are generally resuspended in saline, with very little plasma proteins remaining. Washed RBCs expire within either 24 hours (when prepared in an open system) or 2 weeks (when prepared in a closed system). The washing process leads to red cell loss and a corresponding (albeit relatively small) reduction in product efficacy. The recovery and function of platelets after washing are impaired and these products outdate in 4 hours.

Deglycerolized RBCs: RBCs may be frozen up to 10 years when their antigen makeup is considered ‘rare’ or for other special reasons. When a transfusion service requests antigen-negative blood not found in readily available liquid units, frozen units may be available. Through a process of deglycerolization, the cells are thawed and resuspended in saline. Deglycerolized RBCs have a 24 hour expiration date if prepared in an open system. If prepared in a closed system, deglycerolized RBCs have a 2-week expiration.

CMV-seronegative Cellular Components: CMV-seronegative cellular components are provided upon request. Both leukoreduced blood and CMV-seronegative blood have been shown to reduce the risk of transmitting CMV infection through transfusion. However, breakthrough cases have been reported using both methods.

Hemoglobin S-negative: Hemoglobin S-negative RBCs are indicated for the transfusion of:

  • Patients with sickle cell disease
  • Infants ≤ 4 months old who require large volumes of blood (Note: some experts expand this to apply to any RBC transfusion given to an infant of this age range)
  • All fetuses