red blood cells

Red blood cells (RBCs), also known as erythrocytes, are cellular components of blood that give blood its characteristic red color.

Red blood cells contain hemoglobin, an iron-rich protein that carries oxygen from the lungs to all the tissues, and carbon dioxide back to the lungs to be eliminated in exhalation. Red blood cells are used for transfusion in patients who have insufficient tissue oxygen because of active bleeding or symptomatic anemia, to increase the red blood cell count, hemoglobin level, and consequently, blood’s oxygen carrying capacity.

Red blood cells, also known as packed red blood cells, used for transfusion are separated by centrifugal process from whole blood collected from donors and screened for infectious diseases. Red blood cells may also be collected directly from donors by apheresis, a process in which the donor’s blood is passed through a medical device that selectively removes red blood cells and the plasma and other components are infused back into the donor.

Red blood cells may undergo further processes such as washing, special filtering or irradiation to remove other blood components before transfusion in certain patients with special requirements. Red blood cells are matched for blood group (ABO) compatibility with the recipient before transfusion.

• 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, improve wound healing or provide a sense of wellbeing.
• Monitor patients for signs of transfusion reaction, including vital signs, before, during, and after transfusion. If transfusion reaction is suspected, stop the transfusion, assess and stabilize the patient, and notify the blood bank to initiate an investigation.
• All RBC transfusions must be given using blood administration sets containing 170- to 260-micron filters or 20- to 40-micron microaggregate filters.
• RBC transfusion should be given through an exclusive venous port and no other medications or fluids other than normal saline should be simultaneously given through the same line without prior consultation with the medical director of the blood bank.
• Monitor for iron overload in patients chronically transfused with RBCs due to hemoglobinopathies such as sickle cell disease or thalassemia.
• RBC transfusions carry a risk for non-septic infections including human immunodeficiency virus (HIV) hepatitis B and C viruses (HBV and HCV), human T-lymphotropic virus (HTLV), cytomegalovirus (CMV), West Nile virus (WNV), parvovirus B19, Lyme disease, babesiosis, malaria, Chagas disease and variant Creutzfeldt-Jakob disease (vCJD).
• Consult with the blood bank medical director or a hematologist if you have questions regarding special transfusion requirements.

Common side effects of red blood cells include:

• Hemolytic transfusion reactions that destroy red blood cells 
• Feverish (febrile) non-hemolytic reactions
• Transfusion related acute lung injury (TRALI)
• Transfusion-associated circulatory overload (TACO)
• Allergic reactions such as:
  • Hives (urticaria)
  • Itching (pruritus)
  • Wheezing
  • Shortness of breath (dyspnea)
  • Low blood pressure (hypotension)
• Serious allergic (anaphylactic) reactions including:
  • Swelling under the skin and mucous membrane (angioedema)
  • Respiratory distress
  • Shock
• Transfusion-associated graft-versus-host disease (TA-GVHD)
• Transfusion-transmitted infections and septic reactions
• Post-transfusion bruising (purpura)

Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:

• Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
• Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
• Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
• Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Insufficient Tissue Oxygen Delivery Due to Active Bleeding or Symptomatic Anemia

• 1 unit increase hemoglobin 1 g/dL in average-sized adults without active bleeding or hemolysis; usually given over 1-2 hours but not longer than 4 hours
• Rarely necessary to transfuse to hemoglobin over 10 g/dL
• Actively bleeding patients dosing and rate of administration varies depending on rate of bleeding and must be evaluated on a case-by-case basis

Pediatric:

• 10-15 mL/kg increases hemoglobin 2-3 g/dL in patients without active bleeding or hemolysis
• Actively bleeding patients dosing and rate of administration varies depending on rate of bleeding and must be evaluated on a case-by-case basis

Other Information

• Usually, blood loss over 20% of estimated total blood volume

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Red blood cells have no known severe, serious, moderate, or mild interactions with other drugs.

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

• Cytomegalovirus-seronegative or CMV reduced risk (leukocyte reduced) red blood cells should be used in pregnant or breast-feeding women who are CMV-seronegative or whose CMV status is unknown.