Red blood cell concentrates, also known as red cell concentrates or packed red blood cells, are red blood cells that have been separated for blood transfusion. A red blood cell concentrate typically has a haematocrit of 0.50 – 0.70 L/L and a volume between 250 and 320 mL. Transfusion of red blood cell concentrates is indicated to compensate for a deficit caused by critical bleeding or to correct anaemic conditions, in order to increase the oxygen-carrying capacity and avoid detrimental effects caused by oxygen debt. In adults, one unit brings up hemoglobin levels by about 10 g/L (1 g/dL). Repeated transfusions may be required in people receiving cancer chemotherapy or who have haemoglobin disorders. Cross-matching may be required before the blood is given. A red blood cell concentrate is given by injection into a vein. The widespread use of red blood cell concentrates as part of blood component therapy began in the middle of the 20th century, when polyvinyl chloride (PVC) blood bags were introduced as storage containers. The widespread use of packed red blood cells began in the 1960s. It is on the World Health Organization's List of Essential Medicines. A number of other versions also exist including whole blood, leukocyte reduced red blood cells, and washed red blood cells.
Clinical use of red blood cell concentrates
Red blood cells are used to restore oxygen-carrying capacity in people with anaemia due to trauma or other medical problems Whenever a red blood cell transfusion is being considered for a patient, it is good practice to consider not only the haemoglobin level, but also the overall clinical context, patient preferences, and whether there are alternative treatments. If a patient is stable and has a haematinic deficiency, they should be treated for the deficiency (iron deficiency, B12 deficiency, or folate deficiency) rather than being given a red blood cell transfusion. In adults, blood transfusion is typically recommended when hemoglobin levels are below 70 g/L (7 g/dL) in those who have stable vital signs, unless they have anemia due to a haematinic deficiency. Transfusing at a restrictive haemoglobin threshold of between 70 g/L to 80 g/L (7 to 8g/dL) decreased the proportion of people given a red blood cell transfusion by 41% across a broad range of clinical specialties, including those people who are critically ill. There is no evidence that a restrictive transfusion strategy are stronger associated with death or major adverse events (e.g. cardiac events, myocardial infarction, stroke, pneumonia, thromboembolism, infection) compared with a liberal transfusion strategy. There is not enough information in some patient groups to say whether a restrictive or liberal transfusion threshold is better.
Single unit transfusion This refers to transfusing a single unit or bag of red blood cells to a person who is not bleeding and haemodynamically stable followed by an assessment to see if further transfusion is required. The benefits of single unit transfusion include reduced exposure to blood products. Each unit transfused increases the associated risks of transfusion such as infection, transfusion associated circulatory overload and other side effects. Transfusion of a single unit also encourages less wastage of red blood cells.
Upper gastrointestinal bleeding In adults with upper gastrointestinal bleeding transfusing at a higher threshold caused harm (increased risk of death and bleeding).
Heart surgery A review established that in patients undergoing heart surgery a restrictive transfusion strategy of 70 to 80 g/L (7 to 8 g/dL) is safe and decreased red cell use by 24%.
Heart disease There is less evidence available for the optimal transfusion threshold for people with heart disease, including those who are having a heart attack. Guidelines recommend a higher threshold for people with heart disease of 80 g/L (8 g/dL) if they are not undergoing cardiac surgery.
Blood cancers There is insufficient evidence to suggest how to manage anemia in people with blood cancers in terms of transfusion thresholds.
Transfusion–dependent anemia People with thalassaemia who are transfusion dependent require a higher hemoglobin threshold to suppress their own red cell production. To do this their hemoglobin levels should not be allowed to drop below 90 to 105 g/L (9 to 10.5 g/dL). There is insufficient evidence to recommend a particular hemoglobin threshold in people with myelodysplasia or aplastic anemia, and guidelines recommend an individualized approach to transfusion.
Children There is less evidence for specific transfusion thresholds in children compared to adults. There has only been one randomized trial assessing different thresholds in children, and this showed no difference between a restrictive or liberal transfusion strategy. This trial used similar thresholds to the adult studies, and transfusing when the hemoglobin is less than 70 g/L is also recommended in children.
Neonates Neonatal red cell transfusion, and when it is appropriate depends on: the gestational age of the baby; how long since the baby had been born; and also on whether the baby is well or ill.
Compatibility testing
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