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Packed red blood cells
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In transfusion medicine, packed red blood cells are red blood cells that have been separated
from whole blood for transfusion purposes. The product is typically abbreviated RBC or
PRBC, and sometimes LRBC for leukoreduced products. The name "Red Blood Cells" with
initial capitals indicates a standardized product in the United States.
[1]

RBCs are used to restore oxygen carrying capacity to the blood of a patient that is suffering
from anemia due to trauma or other medical problems, and are one of the most important
blood components used in transfusion medicine. Historically they were transfused as part of
whole blood, but in modern practice the RBCs and plasma components are transfused
separately. The process of identifying a compatible blood product for transfusion is
complicated and giving incompatible RBCs to a patient can be fatal.
[2]

The RBCs are mixed with an anticoagulant and usually a storage solution which provides
nutrients and preserves the functionality of the living cells, which are stored at refrigerated
temperatures. The cells are separated from the fluid portion of the blood either after it is
collected from a donor or during the collection process by apheresis. The product is
sometimes modified after collection to meet specific patient requirements.
Contents
1 Compatibility testing
2 Collection and processing
3 See also
4 References
Compatibility testing
To avoid transfusion reactions, the donor and recipient blood are tested, typically ordered as a
"type and screen" for the recipient. The "type" in this case is the ABO and Rh type,
specifically the phenotype, and the "screen" refers to testing for atypical antibodies that might
cause transfusion problems. The typing and screening are also performed on donor blood.
The blood groups represent antigens on the surface of the red blood cells which might react
with antibodies in the recipient.
The ABO blood group system has four basic phenotypes: O, A, B, and AB. In the former
Soviet Union these were called I, II, III, and IV, respectively. There are two important
antigens in the system: A and B. Red cells without A or B are called type O, and red cells
with both are called AB. Except in unusual cases like infants or seriously
immunocompromised individuals, all people will have antibodies to any ABO blood type that
isn't present on their own red blood cells, and will have an immediate hemolytic reaction to a
unit that is not compatible with their ABO type. In addition to the A and B antigens, there are
rare variations which can further complicate transfusions, such as the Bombay phenotype.
The Rh blood group system consists of nearly around 50 different antigens, but the one of the
greatest clinical interest is the "D" antigen, though it has other names and is commonly just
called "negative" or "positive." Unlike the ABO antigens, a recipient will not usually react to
the first incompatible transfusion because the adaptive immune system does not immediately
recognize it. After an incompatible transfusion the recipient may develop an antibody to the
antigen and will react to any further incompatible transfusions. This antibody is important
because it is the most frequent cause of hemolytic disease of the newborn. Incompatible red
blood cells are sometimes given to recipients who will never become pregnant, such as males
or postmenopausal women, as long as they do not have an antibody, since the greatest risk of
Rh incompatible blood is to current or future pregnancies.
[3]

For RBCs, type O negative blood is considered a "universal donor" as recipients with types
A, B, or AB can almost always receive O negative blood safely. Type AB positive is
considered a "universal recipient" because they can receive the other ABO/Rh types safely.
These are not truly universal, as other red cell antigens can further complicate transfusions.
There are many other human blood group systems and most of them are only rarely
associated with transfusion problems. A screening test is used to identify if the recipient has
any antibodies to any of these other blood group systems. If the screening test is positive, a
complex set of tests must follow to identify which antibody the recipient has by process of
elimination. Finding suitable blood for transfusion when a recipient has multiple antibodies
or antibodies to extremely common antigens can be very difficult and time consuming.
Because this testing can take time, doctors will sometimes order a unit of blood transfused
before it can be completed if the recipient is in critical condition. Typically two to four units
of O negative blood are used in these situations, since they are unlikely to cause a reaction.
[4]

A potentially fatal reaction is possible if the recipient has pre-existing antibodies, and
uncrossmatched blood is only used in dire circumstances. Since O negative blood is not
common, other blood types may be used if the situation is desperate.
Collection and processing
Most frequently, whole blood is collected from a blood donation and is spun in a centrifuge.
The red blood cells are denser and settle to the bottom, and the majority of the liquid blood
plasma remains on the top. The plasma is separated and the red blood cells are kept with a
minimal amount of fluid. Generally an additive solution of citrate, dextrose, and adenine is
mixed with the cells to keep them alive during storage. This process is sometimes done as
automated apheresis where the centrifuging and mixing take place at the donation site.
[5]

Red Blood Cells are sometimes modified to address specific patient needs. The most common
modification is leukoreduction, where the donor blood is filtered to remove white cells. The
blood may also be irradiated, which destroys the DNA in the white cells and prevents graft
versus host disease, which may happen if the blood donor and recipient are closely related.
Other modifications, such as washing the RBCs to remove any remaining plasma, are much
less common.
With additive solutions, RBCs are typically kept at refrigerated temperatures for up to 42
days.
[6]
In some patients, use of RBCs that are much fresher is important. With the addition of
glycerol or other cryoprotectants, RBCs can be frozen for much longer. Frozen RBCs are
typically assigned a ten year expiration date, though older units have been transfused
successfully. The freezing process is expensive and time-consuming and is generally reserved
for rare units such as ones that can be used in patients that have unusual antibodies. Since
frozen RBCs have glycerol added, the added glycerol must be removed by washing the red
blood cells using special equipment, such as the IBM 2991 cell processor in a similar manner
to washing RBCs.
See also
Blood bank
Blood donation
References
1. ^ "21 CFR 640.10". GPO. Retrieved 3 November 2011.
2. ^ "Complications of Transfusion: Transfusion Medicine: Merck Manual
Professional". Retrieved 3 November 2011.
3. ^ "Guidelines for Blood Component Substitution in Adults". Provincial Blood
Coordinating Program, Newfoundland and Labrador. Retrieved 3 November 2011.
4. ^ "The appropriate use of group O RhD negative red cells". National Health Service.
Retrieved 3 November 2011.
5. ^ "Circular of information for the use of human blood and blood components" (pdf).
AABB. p. 11. Retrieved 3 November 2011.
6. ^ "Circular of information for the use of human blood and blood components" (pdf).
AABB. p. 8. Retrieved 3 November 2011.
Categories:
Hematology
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