Washed Red Blood Cells

Washed red blood cells, also known as erythrocytes, are separated from whole blood and undergo a washing process before transfusion. Red blood cells give blood its characteristic red color and contain hemoglobin, an iron-rich protein that carries oxygen from the lungs to the tissues and carbon dioxide back to the lungs for elimination.

Patients with active bleeding or symptomatic anemia may receive red blood cell transfusions to increase their red blood cell count, hemoglobin level, and oxygen carrying capacity. In cases of severe allergic reactions to standard red blood cell transfusions, washed red blood cells are used because they remove 98-99% of the plasma constituents that can cause anaphylactic reactions.

To prepare washed red blood cells, centrifugation separates red blood cells from whole blood and removes plasma constituents, white cells, platelets, proteins, antibodies, and electrolytes. The washed red blood cells are suspended in a solution before transfusion and have a shelf-life of 4 hours at 20 to 24 degrees C or 24 hours at 1 to 6 C.

Washing red cells is performed only when necessary, as it reduces the quality and quantity of the final product. The washed red blood cells must also be matched for blood group compatibility with the recipient. In certain cases, additional processes such as filtering or irradiation may be required before transfusion.

Indications for washed red blood cell transfusion include patients with recurrent severe allergic reactions to standard red blood cell transfusions, immunoglobulin A (IgA) deficiency with anti-IgA antibodies, and those at risk for excessive increase in blood potassium levels (hyperkalemia).

Warnings

• Do not use red blood cell transfusion to treat anemia that can be corrected with non-transfusion treatments such as iron therapy, unless immediate correction is required.
• Do not administer RBC transfusion to merely increase blood volume and/or oncotic pressure, or to improve wound healing or to provide a sense of wellbeing.
• Washing RBCs reduces leukocytes by approximately 85% and is not adequate for patients who require leukocyte-reduced RBCs. Only irradiated RBCs should be used to prevent transfusion-associated graft-versus-host disease (TA-GVHD).
• Washing RBCs should be performed only when clearly needed, as it can take up to 2 hours and results in lower quality and quantity of RBCs. Additionally, it drastically reduces shelf life and should be administered promptly to prevent bacterial contamination and septic transfusion reactions.
• Use appropriate blood administration sets with filters when transfusing washed RBCs, and consult the blood bank before simultaneously administering other medications or fluids through the same line.
• Monitor patients for transfusion reactions and signs of iron overload in chronically transfused patients.
• RBC transfusions carry risks for non-septic infections including HIV, hepatitis B and C, HTLV, CMV, West Nile virus, parvovirus B19, Lyme disease, babesiosis, malaria, Chagas disease, and vCJD.
• Consult with the medical director or a hematologist regarding special transfusion requirements.

Side Effects

Common side effects of washed red blood cells include:

• Hemolytic transfusion reactions
• Febrile non-hemolytic reactions
• Post-transfusion bruising (purpura)
• Transfusion-associated circulatory overload (TACO)
• Transfusion-related acute lung injury (TRALI)
• Allergic reactions such as hives, itching, wheezing, shortness of breath, low blood pressure, swelling, respiratory distress, and shock

Seek immediate medical attention if you experience severe symptoms or serious side effects such as heart symptoms, severe headache, confusion, nervous system reaction, or serious eye symptoms.

Dosages

For recurrent severe allergic reactions to red cell transfusions:

• 1 unit increases hemoglobin by 1 g/dL in average-sized adults without active bleeding or hemolysis
• Transfusing to a hemoglobin over 10 g/dL is rarely necessary
• Dosing and rate of administration vary for actively bleeding patients and must be evaluated on a case-by-case basis
• Washed RBC units may not provide a full 1 g/dL increase in hemoglobin per unit due to loss during washing

Other indications and uses include severe allergic transfusion reactions, anticoagulant depletion, IgA deficiency with anti-IgA antibodies, atypical hemolytic-uremic syndrome, and febrile non-hemolytic reactions. Consult with the blood bank medical director for specific indications.

In pediatric patients, 10-15 mL/kg increases hemoglobin by 2-3 g/dL without active bleeding or hemolysis. Dosing and rate of administration depend on the rate of bleeding and must be evaluated individually.

Drug Interactions

Inform your doctor of all medications you are currently taking to check for possible drug interactions. Washed red blood cells have no known interactions with other drugs.

It is important to always inform your healthcare provider about all medications you use and follow their recommendations.

Pregnancy and Breastfeeding

Pregnant or breastfeeding women who are cytomegalovirus-seronegative or whose CMV status is unknown should receive CMV-seronegative or reduced risk red blood cells.

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Summary

Washed red blood cells are used for transfusion in patients with severe allergic reactions to standard red blood cell transfusions. Common side effects include hemolytic transfusion reactions, febrile non-hemolytic reactions, post-transfusion bruising, transfusion-associated circulatory overload, transfusion-related acute lung injury, allergic reactions, and transfusion-transmitted infections and septic reactions.