Whole Blood

The fluid that circulates through the heart, arteries, capillaries, and veins and is the chief means of transport within the body. Ittransports oxygen from the lungs to the body tissues, and carbon dioxide from the tissues to the lungs. It transports nutritivesubstances and metabolites to the tissues and removes waste products to the kidneys and other organs of excretion. It hasan essential role in the maintenance of fluid balance.

In an emergency, blood cells and antibodies carried in the blood are brought to a point of infection, or blood-clottingsubstances are carried to a break in a blood vessel. The blood distributes hormones from the endocrine glands to the organsthey influence. It also helps regulate body temperature by carrying excess heat from the interior of the body to the surfacelayers of the skin, where the heat is dissipated to the surrounding air.

Blood varies in color from a bright red in the arteries to a duller red in the veins. The total quantity of blood within anindividual depends upon body weight; a person weighing 70 kg (154 lb) has about 4.5 liters of blood in the body.

Blood is composed of two parts: the fluid portion is called plasma, and the solid portion or formed elements (suspended inthe fluid) consists of the blood cells (erythrocytes and leukocytes) and the platelets. Plasma accounts for about 55per cent of the volume and the formed elements account for about 45 per cent. ( and table.)

Chemical analyses of various substances in the blood are invaluable aids in (1) the prevention of disease by alerting thepatient and health care provider to potentially dangerous levels of blood constituents that could lead to more seriousconditions, (2) diagnosis of pathologic conditions already present, (3) assessment of the patient's progress when adisturbance in blood chemistry exists, and (4) assessment of the patient's status by establishing baseline or “normal” levelsfor each individual patient.

In recent years, with the increasing attention to preventive health care and rapid progress in technology and automation, theuse of a battery of screening tests performed by automated instruments has become quite common. These instruments arecapable of performing simultaneously a variety of blood chemistry tests. Some of the more common screening testsperformed on samples of blood include evaluation of electrolytealbumin, and bilirubin levels, blood urea nitrogen(BUN), cholesterol, total protein, and such enzymes as lactate dehydrogenase and aspartate transaminase.Other tests include electrophoresis for serum proteins, blood gas analysis, glucose tolerance tests, andmeasurement of iron levels.

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Dr. Anirban Deep Banerjee

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.

Adult

Acute Hemorrhage

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.

Other Information

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.

Pediatric

Exchange Transfusions

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.

  • Hemolytic Transfusion Reactions
  • Febrile Non-Hemolytic Reactions
  • Allergic Reactions ranging from urticaria to anaphylaxis
  • Septic Reactions
  • Transfusion Related Acute Lung Injury (TRALI)
  • Circulatory Overload
  • Transfusion Associated Graft Versus Host Disease
  • Postransfusion Purpura

Contraindications

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.

Cautions

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 requirements.

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