Washed red blood cells: Difference between revisions
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'''Washed red blood cells''' are [[red blood cells]] which have had most of the [[Blood plasma|plasma]], [[platelets]] and [[white blood cells]] removed |
'''Washed red blood cells''' are [[red blood cells]] which have had most of the [[Blood plasma|plasma]], [[platelets]] and [[white blood cells]] removed and replaced with saline or another type of preservation solution.<ref>{{cite web|url=https://novascotia.ca/dhw/nspbcp/docs/Guideline-for-Washed-Red-Blood-Cells-in-Nova-Scotia.pdf|title=Guideline for Washed Red Blood Cells in Nova Scotia|date=October 2011|publisher=Nova Scotia|first1=Brigit |last1=Albiston|display-authors=etal}}</ref><ref name=":0">{{Cite web|url=https://www.dovepress.com/traditional-and-emerging-technologies-for-washing-and-volume-reducing--peer-reviewed-article-JBM|title=Traditional and emerging technologies for washing and volume reducing blood products|last=Shevkoplyas|first=Sergey S.|last2=Vörös|first2=Eszter|date=2019-01-03|website=Journal of Blood Medicine|language=English|doi=10.2147/jbm.s166316|pmc=PMC6322496|pmid=30655711|access-date=2019-01-25|last3=Lezzar|first3=Dalia L.|last4=Lu|first4=Madeleine}}</ref> The most common reason for using washed red blood cells in transfusion medicine is to prevent the recurrence of severe [[Allergic transfusion reaction|allergic transfusion reactions]] that do not respond to medical treatment. The usual cause of these allergic reactions is proteins in the donor plasma.<ref name=":1" /> These proteins are removed by the process of washing the red blood cells. |
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== Methods of washing red cells == |
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There are multiple methods of washing red cells.<ref name=":0" /> These can include automated or manual methods. They can use [[centrifugation]] or centrifugation-free methods.<ref name=":0" /> The red cells can be re-suspended in saline or other types of special preservative solutions for red cells e.g. SAG-M |
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== Medical Uses == |
== Medical Uses == |
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=== Prevention of recurrence of severe allergic reactions === |
=== Prevention of recurrence of severe allergic reactions === |
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The most common reason for using washed red blood cells in transfusion medicine is to prevent the recurrence of severe [[Allergic transfusion reaction|allergic transfusion reactions]]. The allergen is usually a protein in the plasma that is removed by the process of washing the red blood cells. Various proteins, such as antibodies directed against [[Immunoglobulin A|IgA]] or [[haptoglobin]] in people with IgA and haptoglobin deficiency have been suggested to have a causal relationship with the allergic reaction.<ref>{{Cite journal|last=Sandler|first=S. Gerald|last2=Eder|first2=Anne F.|last3=Goldman|first3=Mindy|last4=Winters|first4=Jeffrey L.|date=2015|title=The entity of immunoglobulin A–related anaphylactic transfusion reactions is not evidence based|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/trf.12796|journal=Transfusion|language=en|volume=55|issue=1|pages=199–204|doi=10.1111/trf.12796|issn=1537-2995}}</ref><ref>{{Cite journal|last=Hirayama|first=Fumiya|date=2013|title=Current understanding of allergic transfusion reactions: incidence, pathogenesis, laboratory tests, prevention and treatment|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/bjh.12150|journal=British Journal of Haematology|language=en|volume=160|issue=4|pages=434–444|doi=10.1111/bjh.12150|issn=1365-2141|pmc=PMC3594969|pmid=23215650}}</ref> [[Cytokine|Cytokines]] and [[Chemokine|chemokines]], which accumulate during the storage of blood components, have also been suggested as causative agents. However, the literature is scare and conflicting as passive infusion of anti-IgA antibodies in to recipients has not been found to cause an allergic reaction. |
The most common reason for using washed red blood cells in transfusion medicine is to prevent the recurrence of severe [[Allergic transfusion reaction|allergic transfusion reactions]]. The allergen is usually a protein in the plasma that is removed by the process of washing the red blood cells. Various proteins, such as antibodies directed against [[Immunoglobulin A|IgA]] or [[haptoglobin]] in people with IgA and haptoglobin deficiency have been suggested to have a causal relationship with the allergic reaction.<ref name=":2">{{Cite journal|last=Sandler|first=S. Gerald|last2=Eder|first2=Anne F.|last3=Goldman|first3=Mindy|last4=Winters|first4=Jeffrey L.|date=2015|title=The entity of immunoglobulin A–related anaphylactic transfusion reactions is not evidence based|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/trf.12796|journal=Transfusion|language=en|volume=55|issue=1|pages=199–204|doi=10.1111/trf.12796|issn=1537-2995}}</ref><ref name=":1">{{Cite journal|last=Hirayama|first=Fumiya|date=2013|title=Current understanding of allergic transfusion reactions: incidence, pathogenesis, laboratory tests, prevention and treatment|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/bjh.12150|journal=British Journal of Haematology|language=en|volume=160|issue=4|pages=434–444|doi=10.1111/bjh.12150|issn=1365-2141|pmc=PMC3594969|pmid=23215650}}</ref> [[Cytokine|Cytokines]] and [[Chemokine|chemokines]], which accumulate during the storage of blood components, have also been suggested as causative agents.<ref name=":1" /><ref name=":3">{{Cite web|url=https://www.dovepress.com/proven-and-potential-clinical-benefits-of-washing-red-blood-cells-befo-peer-reviewed-article-IJCTM|title=Proven and potential clinical benefits of washing red blood cells before transfusion: current perspectives|last=Blumberg|first=Neil|last2=Kirkley|first2=Scott A.|date=2016-08-22|website=International Journal of Clinical Transfusion Medicine|language=English|doi=10.2147/ijctm.s101401|access-date=2019-01-25|last3=Refaai|first3=Majed A.|last4=Schmidt|first4=Amy E.}}</ref> However, the literature is scare and conflicting as passive infusion of anti-IgA antibodies in to recipients has not been found to cause an allergic reaction.<ref name=":2" /><ref name=":1" /> |
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=== Reduction in transfusion-related complications === |
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In neonates transfusion has been associated with an increased risk of serious side-effects<ref name=":3" /><ref name=":4">{{Cite journal|last=Keir|first=Amy K|last2=Wilkinson|first2=Dominic|last3=Andersen|first3=Chad|last4=Stark|first4=Michael J|date=2016-01-20|title=Washed versus unwashed red blood cells for transfusion for the prevention of morbidity and mortality in preterm infants|url=http://dx.doi.org/10.1002/14651858.cd011484.pub2|journal=Cochrane Database of Systematic Reviews|doi=10.1002/14651858.cd011484.pub2|issn=1465-1858}}</ref> including: |
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* [[Necrotizing enterocolitis|Necrotising enterocolitis]] (NEC) |
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* [[Intraventricular hemorrhage|Intraventricular haemorrhage]] (IVH) |
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* [[Retinopathy of prematurity]] (ROP) |
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* Chronic lung disease (CLD) |
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* Death |
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[[Transfusion-related immunomodulation|Transfusion-related immune modulation]] has been thought to be the underlying mechanism.<ref name=":4" /> Washing red cells has been thought to be one way of potentially decreasing the risk of theses transfusion-related side-effects.<ref name=":4" /> However, in neonates, there is insufficient evidence to say whether washing red cells has any effect.<ref name=":4" /> |
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The term washed blood cells is used to indicate the process of centrifugation of blood cells to void the plasma and replace by an preservation solution. Washing of blood cells is used in case of red cells and sometimes for platelets. The most common reason for using washes blood cells in transfusion medicine is severe allergic transfusion reactions that do not respond to medical treatment. The cause of these allergic transfusion reactions is exposition to donor proteins in the donor plasma. These donor proteins can be removed by applying the washing of blood cells. Various proteins, such as IgA or haptoglobin, are suggested to have a causal relationship with the allergic reaction but literature is scare and conflicting |
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== Storage == |
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| ⚫ | Once red cells have been washed they can only be kept for up to a day.<ref name="Ha2003">{{cite book|last1=Handin|first1=Robert I.|last2=Lux|first2=Samuel E.|last3=Stossel|first3=Thomas P.|title=Blood: Principles and Practice of Hematology|date=2003|publisher=Lippincott Williams & Wilkins|isbn=9780781719933|page=2034|url=https://books.google.ca/books?id=H85dwxYTKLwC&pg=PA2034|language=en}}</ref> |
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==References== |
==References== |
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Revision as of 14:29, 25 January 2019
Washed red blood cells are red blood cells which have had most of the plasma, platelets and white blood cells removed and replaced with saline or another type of preservation solution.[1][2] The most common reason for using washed red blood cells in transfusion medicine is to prevent the recurrence of severe allergic transfusion reactions that do not respond to medical treatment. The usual cause of these allergic reactions is proteins in the donor plasma.[3] These proteins are removed by the process of washing the red blood cells.
Methods of washing red cells
There are multiple methods of washing red cells.[2] These can include automated or manual methods. They can use centrifugation or centrifugation-free methods.[2] The red cells can be re-suspended in saline or other types of special preservative solutions for red cells e.g. SAG-M
Medical Uses
Prevention of recurrence of severe allergic reactions
The most common reason for using washed red blood cells in transfusion medicine is to prevent the recurrence of severe allergic transfusion reactions. The allergen is usually a protein in the plasma that is removed by the process of washing the red blood cells. Various proteins, such as antibodies directed against IgA or haptoglobin in people with IgA and haptoglobin deficiency have been suggested to have a causal relationship with the allergic reaction.[4][3] Cytokines and chemokines, which accumulate during the storage of blood components, have also been suggested as causative agents.[3][5] However, the literature is scare and conflicting as passive infusion of anti-IgA antibodies in to recipients has not been found to cause an allergic reaction.[4][3]
In neonates transfusion has been associated with an increased risk of serious side-effects[5][6] including:
- Necrotising enterocolitis (NEC)
- Intraventricular haemorrhage (IVH)
- Retinopathy of prematurity (ROP)
- Chronic lung disease (CLD)
- Death
Transfusion-related immune modulation has been thought to be the underlying mechanism.[6] Washing red cells has been thought to be one way of potentially decreasing the risk of theses transfusion-related side-effects.[6] However, in neonates, there is insufficient evidence to say whether washing red cells has any effect.[6]
Storage
Once red cells have been washed they can only be kept for up to a day.[7]
References
- ^ Albiston, Brigit; et al. (October 2011). "Guideline for Washed Red Blood Cells in Nova Scotia" (PDF). Nova Scotia.
- ^ a b c Shevkoplyas, Sergey S.; Vörös, Eszter; Lezzar, Dalia L.; Lu, Madeleine (2019-01-03). "Traditional and emerging technologies for washing and volume reducing blood products". Journal of Blood Medicine. doi:10.2147/jbm.s166316. PMC 6322496. PMID 30655711. Retrieved 2019-01-25.
{{cite web}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link) - ^ a b c d Hirayama, Fumiya (2013). "Current understanding of allergic transfusion reactions: incidence, pathogenesis, laboratory tests, prevention and treatment". British Journal of Haematology. 160 (4): 434–444. doi:10.1111/bjh.12150. ISSN 1365-2141. PMC 3594969. PMID 23215650.
{{cite journal}}: CS1 maint: PMC format (link) - ^ a b Sandler, S. Gerald; Eder, Anne F.; Goldman, Mindy; Winters, Jeffrey L. (2015). "The entity of immunoglobulin A–related anaphylactic transfusion reactions is not evidence based". Transfusion. 55 (1): 199–204. doi:10.1111/trf.12796. ISSN 1537-2995.
- ^ a b Blumberg, Neil; Kirkley, Scott A.; Refaai, Majed A.; Schmidt, Amy E. (2016-08-22). "Proven and potential clinical benefits of washing red blood cells before transfusion: current perspectives". International Journal of Clinical Transfusion Medicine. doi:10.2147/ijctm.s101401. Retrieved 2019-01-25.
{{cite web}}: CS1 maint: unflagged free DOI (link) - ^ a b c d Keir, Amy K; Wilkinson, Dominic; Andersen, Chad; Stark, Michael J (2016-01-20). "Washed versus unwashed red blood cells for transfusion for the prevention of morbidity and mortality in preterm infants". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd011484.pub2. ISSN 1465-1858.
- ^ Handin, Robert I.; Lux, Samuel E.; Stossel, Thomas P. (2003). Blood: Principles and Practice of Hematology. Lippincott Williams & Wilkins. p. 2034. ISBN 9780781719933.
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