Blood Products

- Whole Blood (rarely used, may consider when there is massive bleeding and use of >5-7 units of packed RBCs)

- Packed RBCs (1 unit increases Hct by 3)

- CMV-Negative RBCs (and other blood products)

o Indicated for premature infants and infants less than 4 weeks of age, and immune compromised patients who are CMV seronegative

- Leukoreduced RBCs (and other blood products)

o Removes leukocytes, leukocyte debris, and leukocyte-generated cytokines

o Indicated for transplant patients, patients with previous febrile nonhemolytic transfusion reactions, and CMV seronegative at-risk patients for whom seronegative components are not available

- Irradiated RBCs (and other blood products)

o Indicated to avoid GVHD in immune compromised, transplant, and leukemia patients

- Washed RBCs

o Prevents complications associated with infusion of proteins present in small amount of residual plasma in RBC concentrates

o Indicated for patients with severe or recurrent allergic reactions associated with RBC transfusion, patients with IgA deficiency, and patients with complement mediated immune hemolysis

- Platelets (6 units increase platelets by 30,000/uL)

o Indicated for patients with bleeding due to either thrombocytopenia and/or platelet dysfunction (DIC, TTP, ITP, hypersplenism, AIDS, sepsis, aplasia)

o Whole Blood Platelets: each unit is pooled from 4-6 donors of the same blood type

o Apheresis Platelets: obtained from one donor with use of an apheresis machine

- Granulocytes (neutrophils)

o Always irradiated to prevent GVHD

o Indicated for patients with severe neutropenia and life-threatening bacterial or fungal infection not responsive to antibiotic therapy (ie Candida tropicalis fungemia, vancomycin-resistant Enterococcus faecalis, multidrug-resistant Pseudomonas aeruginosa, and invasive aspergillosis); also indicated for neonates with clinical sepsis and patients with chronic granulomatous disease

- Fresh Frozen Plasma (1 unit increases fibrinogen by 7-10mg/dL)

o Contains all clotting products but no platelets

o Indicated for multiple coagulation factor deficiencies (eg DIC, TTP/HUS, liver disease, warfarin overdose, vitamin K deficiency)

- Cryoprecipitate (10 bags increases fibrinogen by 70mg/dL)

o Contains fibrinogen, VWF, factors V, VIII, XIII

o Indicated for bleeding in VWD, factor XIII deficiency, or factor VIII deficiency

§ Recombinant factor VIII now available for factor VIII deficiency

§ Can be used to prepare fibrin glue

- Cryo-poor Plasma (FFP minus cryoprecipitate)

o Indicated for plasma replacement in TTP and HUS, can also be used in treatment of warfarin overdose and vitamin K deficiency