Article by Specialist 2 Nguyen Thi Tuyet Mai – Hematmatistry-Blood Transfusion – Laboratory Department – Share99 Ha Long International Health Hub
Cubic red blood cells are prepared from whole blood by centrifugal and separate 80-90% of plasma, then add a dextrose, adenine and mannitol nourishing solution that allows for 42 days of storage. Accordingly, the infusion of cubic red blood cells will be used to replace the amount of blood lost in the recipient and correct abnormalities in the blood without any alternative solution.
1. What is cubic red blood cells?
Cubic red blood cells are prepared from whole blood by centrifugal and separate 80-90% of plasma, then add a dextrose, adenine and mannitol nourishing solution that allows for 42 days of storage. Cubic red blood cells are preserved at 40C. There are types of red blood cells: dense red blood cells, preserved red blood cells, washing red blood cells, irradiation red blood cells, diukocycemia red blood cells.
Each unit of cubic red blood cells with a preserved solution, volume 250 mL, with Hct from 0.50 – 0.70 L /L, will increase by 10 g/L Hemoglobine. Cubic red blood cells do not contain blood clots, so after a lot of infusion, fresh frozen plasma must be transmitted. The advantage of cubic red blood cells over whole blood is to reduce the risk of volume overload, reduce the amount of citrate, ammonia and organic acids, reduce the risk of immuno-diseases (allo immunization) thanks to containing less antigen. Cubic red blood cells rapidly increase oxygen transport in patients with emergency or chronic blood loss.
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Blood and blood products derived from humans, will be used as substitutes for the amount of blood lost in the recipient and correct the abnormalities in the blood without any alternative solution.
Currently, blood and blood products are widely used in the treatment of Active Resuscitation, Emergency, Internal Medicine, Surgery, Obstetrics, Pediatrics, Organ Transplantation … and other specialties for the purpose of reimbursing the volume of blood circulation and the lacking composition of blood or to help patients resenter when taking chemotherapy drugs that affect the bone marrow. In particular, in Obstetrics and Gynecology, bleeding during labor, at birth is a dangerous complications, if not treated in time and resucked well, it can be fatal.
3. Which patients need to transmit red blood cells?
Patients with chronic or chronic anemia, causes of anemia, clinical manifestations of oxygen deficiency, patient clearing for blood loss and blood transfusions.
Patients with chronic anemia and at risk of circulation overload, need more Hemoglobin to transport oxygen but do not want to increase the volume of circulation in: Elderly people, young children, people with heart disease, surgery, digestive hemorrhages lose about 15 to 25% of the body's blood volume. Kidney disease and cases of chronic anemia that cannot be treated with hemodialysis substances such as iron, vitamin B12, folic acid, re-combined erythroprotein, cases of severe bleeding due to injury….
- Severe blood loss due to surgery or by accident,
- Digestive bleeding,
- Emergency Maternity – Women with a lot of blood loss,
- Chronic anemia,
- Supporting the treatment of a number of diseases with anemia …
Emergency blood transfusion: In an emergency situation, O/group dysbemia is the only blood product used even though it has not yet been used as a cross reaction/blood type has been able to save the patient's life.
Emergency bleeding in trauma, digestive hemorrhage or rupture of abdominal aortic aneurysm. In healthy patients < 1500 mL máu (25-30% thể tích máu của người 70 kg) có thể được bù hoàn toàn bằng dịch. If this amount is lost, cubic red blood cells should be transmitted to increase oxygen and body volume transport capacity to compensate for the volume of reglys.
Vascular blood loss: Hb < 70 g/L hay cuộc mổ mất máu nhiều.
Chronic anemia requires emia if Hb < 70 g/L hay nếu người bệnh có triệu chứng hay bệnh lý tim phổi.
In addition to cubic red blood cells, there are other products such as poor white blood cells, frozen red blood cells, washing red blood cells for some special patients.
4. Undesirable accidents when transmiting blood/red blood cells
Undesirable accidents or blood transfusion reactions are reactions, manifestations that occur in patients that are associated with blood transfusions and blood products.
Blood transfusions/blood products are a matter of necessity to ensure the patient's life. However, blood transfusions/blood products can cause undesirable accidents, which can be dangerous to the patient's life if not done properly and controlled in a timely manner.
Accordingly, accidents caused by blood transfusions/blood products may occur sooner or later. So only transfusions of blood when very necessary.
Early accidents such as hemalysis due to the wrong blood type of ABO, Rh, hypothermia, tremors, allergies, acute pulmonary edema during transmission … Late accidents occur when blood transfusions include: infection, infection of blood-fecting viruses such as hepatitis B, C, HIV, late hematoma …
When an accident occurs, it is necessary to handle it promptly and in accordance with the regimen to ensure the safety of patients.
5. Classification of accidents when transmiting cubic red blood cells
Categorised by mechanism
- Immune disagreements
- be infected
- High volume blood transfusions.
Categorised by degree:
Classification over time:
- Emergency: An emergency blood transfusion occurs from the beginning of the blood transfusion and within 24 hours after the blood transfusion.
- Late: A slow blood transfusion occurs after 24 hours to days after the blood transfusion.
5.2. Urgent unwanted accidents
- Allergic reactions – urticaria
- Fever reaction after non-hemorrhaular blood transfusion
- Bacterial infections
- Anaphylactic shock
- Acute lung damage caused by blood transfusion (TRALI)
5.3. Late unwanted accidents caused by blood transfusions
- Transmission of blood-transmitted diseases: HIV-1 and HIV-2, HTLV-1 and II, Hepatitis B and C, Syphilis, Malaria, Cytomegalovirus infection …
- Anti-master transplant disease due to blood transfusion (GvHD).
- Hemorrhage after blood transfusion
- Complications caused by large blood transfusions: Hemolysis, Citrate intoxication, Hypothermia, Iron infection due to blood transfusion …
5.4. Early detection signs and clinical symptoms
- Restlessness, anxiety, discomfort, neglect, loss of sense;
- Back pain, abdominal pain, headache;
- Fever or malaria tremor;
- Snoring, itching, urticaria;
- Rapid pulse, hypotension, vascular failure, shortness of breath, respiratory failure;
- Nausea, vomiting,
- Sudden bleeding in pre-held wounds, failure to heal new wounds, blood flowing out of non-freezing,
- Hemochromatic hematemia…
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- Ministry of Health (2013). Circular No. 26/2013/TT-BYT of September 16, 2013 "Guidance on blood transfusion activities".
- Department of Hematological-Blood Transfusion, Hanoi Medical University (2014). Lecture on Hematological-Blood Transfusion (Post-University). Medical Publishing House…
- Blood production and preservation processes and blood products
- The role of blood
- Blood production process, blood products to replace blood