Red Blood Cells

Red Cross RBC products utilize leukoreduction, which reduces the incidence of alloimmunization to foreign human leukocyte antigens (HLA) and febrile nonhemolytic transfusion reactions. Studies indicate that prestorage leukoreduction of RBCs is as effective in preventing transfusion-transmitted cytomegalovirus (CMV) as use of CMV seronegative (CMV antibody-negative) components.

Indications:

• RBCs are transfused to patients with inadequate circulating red cell mass; this results in reduced oxygen-carrying capacity, or tissue hypoxia.
  
• RBCs are also indicated for exchange transfusions (e.g., in hemolytic disease of the fetus or newborn, or for acute complications in sickle cell anemia).
  
• RBCs may be used for patients with acute blood loss.

The Red Cross’s network of more than 40 Immunohematology Reference Laboratories (IRL) can provide specific antigen-negative units for patients with known red cell antibodies and for patient populations where preventive antigen matching is performed, notably when managing sickle cell disease.

Indications:

• Patients at high risk for both long-term transfusion dependence and development of red cell antibodies (e.g. sickle cell disease, thalassemia major).
• Transfusion to individuals with known red cell antibodies.

Pediatric and neonatal patients may have additional specific blood modification requirements related to their unique physiology. To best serve this patient population, the Red Cross has developed a concise, but comprehensive pediatric offering to accommodate most transfusion practices while ensuring consistent availability.

Indications:

• Pediatric and neonatal transfusions as indicated within hospital protocols.

AS-1 Pediatric RBC

• Blood types:  All types
• Optional Attributes: CMV Negative, Hemoglobin S-negative, Irradiated, 5 days fresh, attached empty bags*

*  4 or 6 empty pediatric bags are sterile welded to the RBC unit, but RBCs are not aliquoted into the attached bags.

AS-3 Pediatric RBC

• Blood types:  O Neg, O Pos, A Neg and B Neg
• Optional Attributes: CMV Negative, Hemoglobin S-negative, Irradiated, 5 days fresh, attached bags*

*  4 or 6 empty pediatric bags are sterile welded to the RBC unit, but RBCs are not aliquoted into the attached bags.

Hemoglobin S is an abnormal hemoglobin present in the red blood cells of individuals with sickle cell trait or sickle cell disease and can cause sickling of the red cells under conditions of reduced oxygen concentration in the blood stream. Negative results indicate that the screening test did not detect the presence of Hemoglobin S or sickle hemoglobin.

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

• Patients with sickle cell disease.
• Infants ≤ four months old who require large volumes of blood, although some experts expand this to apply to any RBC transfusion given to an infant within this age range.
• All fetuses.

Irradiation by gamma or X-ray inactivates donor lymphocytes, the primary cause of transfusion-associated graft-vs-host disease (TA-GVHD).  Maximum shelf-life of RBCs post-irradiation is shortened to 28 days because of damage to red cells, reducing overall viability. Irradiated units can be safely transfused to all patients, even those who have no risk of TA-GVHD.

Indications:

• Prevention of  transfusion-associated GVHD in at-risk patients, including:
  • Patients receiving blood from relatives.
  • Fetuses receiving intrauterine transfusion.
  • Neonates, particularly those with low birth weight, requiring neonatal exchange transfusion, or having received intrauterine transfusions.
  • Hematopoietic stem cell transplant recipients.
  • Patients with Hodgkin Lymphoma or hematologic malignancies.
  • Patients with T-cell immune defects due to either congenital immunodeficiency or related to therapies.
  • Patients on purine analogs (e.g fludarabine).

CMV is an intracellular virus transmissible by cellular blood components which may have a detrimental effect on immunocompromised patients. Universal leukoreduction of red blood cell products has decreased the risk of transfusion-transmitted CMV infection. However, upon request, CMV-negative products can be provided.

Indications:

• Reduce risk of transfusion-transmitted CMV to high-risk patients, which may include:
  • Pregnant CMV-negative women.
  • Fetuses receiving intrauterine transfusions.
  • Neonates requiring neonatal whole blood exchange transfusion or who received intrauterine transfusion(s).
  • Very low birth weight premature infants.
  • CMV-negative recipients of organ or hematopoietic stem cell transplants from CMV-negative donors.
  • Other severely immunocompromised patient populations.