Management of red cell transfusion

Different red cell components are indicated under different circumstances. Red cell components available include the following. Whole blood

Storage at 4 °C is optimal for red cell viability, but leaves whole blood devoid of lasting functional platelets and certain coagulation factors (factor VIII levels decrease to 50 per cent after 1 day). Therefore whole blood is usually separated within hours of donation so that each component can be stored under optimal conditions. Red cell concentrate is stored at 4 °C, plasma is frozen quickly for storage as fresh frozen plasma or prior to fractionation for factors VIII and IX, and platelets are stored at 22 °C, with continuous agitation to maintain platelet function, for a maximum of 5 days.

The concept of fresh whole blood, only a few hours old and containing functional platelets and coagulation factors, is now obsolete, as testing to exclude viral infections takes 24 h. Consequently, it is preferable to use red cell concentrates and supplement with fresh frozen plasma or platelets for hemostatic problems, or with crystalloid or colloid solutions if volume expansion is required. Therefore whole blood is rarely indicated, except in massive transfusions.

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