Posted in Fundamentals

Blood products refer to anything that is infused as a replacement for components of the hematologic system. 

Review the different types of blood products and prep for your blood transfusion check-off on the go in episode 253 of the Straight A Nursing podcast. Tune in wherever you listen to podcasts, or straight from the website here.

Whole blood – This is blood that has all the original elements present. It is not used as routinely as blood products that have been separated out into individual components. However, it may be administered in trauma situations or cases where patients have massive bleeding and will benefit from both the red blood cells and plasma. One unit of whole blood contains approximately 450 to 500 ml volume.

Packed red blood cells (PRBCs) – This is blood with 80% of the plasma removed and is generally used to restore oxygen carrying capacity and improve tissue perfusion when the hemoglobin is low. Typically, in the clinical setting, PRBCs are indicated when the hemoglobin is below 7 or below, though this may vary depending on the patient’s clinical presentation. One unit of PRBCs typically has between 250 to 300 ml volume.

Leukocyte-reduced RBCs – This is blood that has had the leukocytes (WBCs) removed. Each unit of whole blood or packed red blood cells contains between 2 and 5 billion white blood cells, which can cause a variety of adverse reactions including transmission of cytomegalovirus, human leukocyte alloimmunization, febrile nonhemolytic transfusion reactions, the transmission of bacteria, and other inflammatory reactions. 

Patients who are at high risk for experiencing one or more of these adverse effects will likely receive leukocyte-reduced blood. This includes:

  • Patients with leukemia
  • Patients who are severely immunocompromised, such as those going through chemotherapy 
  • Patients who have received a transplant, including a bone marrow transplant
  • Patients who receive chronic blood transfusions
  • Patients who have had previous febrile nonhemolytic transfusion reactions
  • Patients having cardiac surgery

Platelets – This blood product is pure platelets which have been separated from whole blood by apheresis. Platelets will be administered to patients who have thrombocytopenia and are at risk for bleeding or actively bleeding. Many times platelets will be administered to patients before having an invasive procedure to reduce the risk for bleeding. The threshold for when platelets are indicated will vary based on the procedure. For example: 

  • Bronchoscopy – less than 30,000
  • Central line placement – less than 20,000
  • Most surgeries – less than 50,000
  • Lumbar puncture – less than 50,000

If you work in an oncology department, you will be administering a lot of platelets! The volume of one unit of platelets is about 60 ml.

Fresh frozen plasma (FFP) – Plasma is the non-cellular component of the blood and it is removed from whole blood to create PRBCs and then frozen. The key component of plasma is coagulation factors, so we give FFP to prevent or control bleeding in patients with certain coagulopathies such as factor deficiencies and DIC. We can also administer FFP to help reverse the effects of warfarin, along with Vitamin K. One unit of FFP contains approximately 200 to 300 ml. You will often see “jumbo FFP” ordered which can be up to 600 ml in total volume.

Cryoprecipitate – Cryoprecipitate is an element of plasma and contains important clotting factors – factor VIII, factor XIII, fibronectin, von Willebrand factor and fibrinogen. It is used to control or prevent bleeding in patients who have a fibrinogen disorder (including DIC), von Willebrand disease and liver disease. One unit of “cryo” ranges from 15 to 20 ml in volume, and may be pooled into bags containing multiple units.

Granulocytes –  This is whole blood with the RBCs and most of the plasma removed (see leukocyte reduced RBCs above). Granulocytes are a type of WBC that may be transfused for patients who have overwhelming infection that is not responding well to medication. Note that granulocyte transfusion is not common due to the short viability of white blood cells. In order to be effective, granulocytes must be obtained and transfused within a few hours, making collection difficult. Granulocytes have a volume range of 150 to 300 ml per unit.

Because a granulocyte transfusion is more likely to cause a reaction than red blood cells, most patients will likely receive pre-transfusion acetaminophen and diphenhydramine. 

Albumin – Human-derived albumin is a protein component of plasma that is made in the liver. It is used as a volume expander in cases of hypovolemic shock, hypotension, or as a replacement after paracentesis. While some facilities may provide albumin from the blood bank, it is most often stored in a glass bottle and obtained as you would any other medication. Albumin comes in various concentrations, such as 5% , 20% and 25%, so always check you are pulling the correct bottle. Common volumes for albumin bottles are 50 and 100 ml.

Note that patients who traditionally decline whole blood products based on religious views, such as Jehovah’s Witness practitioners, may accept plasma derivatives including albumin, cryoprecipitate, immunoglobulins and clotting factors.

Want to learn about blood transfusion? Click here!

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