Whole blood has similar risks to a transfusion of red blood cells and must be cross-matched to avoid hemolytic transfusion reactions. Most of the indications for use are identical to those for RBCs, and whole blood is not used because the extra plasma can contribute to transfusion associated circulatory overload (TACO), a potentially dangerous complication.
Whole blood is sometimes
"recreated" from stored red blood cells and fresh frozen plasma (FFP)
for neonatal transfusions. This is done to provide a final product with a very
specific hematocrit (percentage of red cells) with type O red cells
and type AB plasma to minimize the chance of complications.
As whole blood transfusion is limited to acutely hemorrhaging individuals, dosing should be based on the patient’s clinical condition, estimated blood loss, and other measures being used to maintain hemodynamic stability.
Whole blood is no longer commonly available or used in most of the United States.
The most common use of whole blood in the United States is currently autologous donations for elective surgery.
Whole blood, if available, may be indicated for large volume hemorrhaging, such as seen with major trauma, requiring massive transfusion and rapid correction of anemia, coagulopathy, acidosis, and hypothermia. Studies supporting this approach include military trauma where they are able to transfuse very fresh (<24 hours old) whole blood which is not currently routinely available in civilian institutions.
Reconstituted whole blood is used for neonatal exchange transfusions, most commonly for hemolytic disease of the newborn. It is sometimes used during pediatric cardiovascular surgery as well as in neonatal hemodialysis.
For dosing of reconstituted whole blood for exchange transfusions, please consult with your institutions blood bank medical director or hematologist.
Cardiovascular Surgery or Hemodialysis
For dosing of reconstituted whole blood for use during
cardiovascular surgery or hemodialysis, predefined dosing protocols should be
setup by the institution depending on type of procedure performed and the
cardiopulmonary circuits used at the institution.
Whole blood transfusions are not indicated when component specific therapy is available (i.e., use RBCs to treat anemia or use FFP to treat coagulopathy). The use of whole blood when monocomponent therapy is indicated and available could lead to complications such as volume overload.
If a transfusion reaction is suspected, the transfusion should be stopped, the patient assessed and stabilized, the blood bank notified, and a transfusion reaction investigation initiated. Massive or rapid transfusion may lead to arrhythmias, hypothermia, hyperkalemia, hypocalcemia, metabolic alkalosis, and heart failure.
Because whole blood contains both RBCs and plasma, only units that are ABO identical to the recipient can be transfused. If transfusion is needed emergently and the blood bank does not have a current patient sample, emergency release of type O RBC and/or type AB plasma units should be requested until ABO typing can be performed and type specific blood products provided.
Whole blood has a 21 to 35 day expiration depending on the anticoagulant solution used. Since the labile clotting factors V and VIII have short storage half-lives at 4 degrees C, these clotting factors may not be adequately restored with whole blood transfusion alone unless the units are fresh. The platelets contained in whole blood are unlikely to be beneficial since whole blood is stored at 4 degrees C.
Reconstituting whole blood is a time consuming process and transfusion should not be delayed waiting for reconstituted whole blood for emergency transfusions.
All transfusions must be given via blood administration sets containing 170- to 260-micron filters or 20- to 40-micron microaggregate filters unless transfusion is given via a bedside leukocyte reduction filter. 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.
Patient should be monitored for signs of a transfusion reaction including vitals pre, during, and post transfusion.
Non-septic infectious risks include transmission of HIV (~1:2 mill), HCV (~1:1.5 mill), HBV (1:300k), HTLV, WNV, CMV, parvovirus B19, Lyme disease, babesiosis, malaria, Chaga’s disease, vCJD.
Iron overload in chronically transfused patients due to hemoglobinopathies or thalassemia.
Consult with blood bank medical
director or hematologist if you have questions regarding special transfusion