Blood Products

  • Kurt F. Heim


Blood components, commonly transfused in the intensive care unit (ICU), include packed red blood cells, platelets, plasma, and cryoprecipitate. The indications, dosing, and expectations for each will be discussed, in turn. Components occasionally transfused include albumin and factor concentrates. Although some indications of the latter are controversial and extensive discussions are beyond the scope of this chapter, a brief mention of their use is warranted.


Human Leukocyte Antigen International Normalize Ratio West Nile Virus Blood Product Blood Bank 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP. Transfusion medicine. First of two parts – blood transfusion. N Engl J Med. 1999;340:438–447.PubMedCrossRefGoogle Scholar
  2. 2.
    Anonymous. Practice guidelines for blood component therapy: a report by the American Society of Anesthesiologists Task Force on Blood Component Therapy. Anesthesiology. 1996;84:732–747.Google Scholar
  3. 3.
    Anonymous. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology. 2006;105:198–208.Google Scholar
  4. 4.
    Hebert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340:409–417.PubMedCrossRefGoogle Scholar
  5. 5.
    Napolitano LM. Current status of blood component therapy in surgical critical care. Curr Opin Crit Care. 2004;10:311–317.PubMedCrossRefGoogle Scholar
  6. 6.
    Vincent JL, Piagnerelli M. Transfusion in the intensive care unit. Crit Care Med. 2006;34(Suppl):S96–S101.PubMedCrossRefGoogle Scholar
  7. 7.
    Vallet B, Adamczyk S, Barreau O, Lebuffe G. Physiologic transfusion triggers. Best Pract Res Clin Anaesthesiol. 2007;21:173–181.PubMedCrossRefGoogle Scholar
  8. 8.
    Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP. Transfusion medicine. Second of two parts – blood conservation. N Engl J Med. 1999;340:525–533.PubMedCrossRefGoogle Scholar
  9. 9.
    Reid TJ. Hb-based oxygen carriers: are we there yet? Transfusion. 2003;43:280–287.PubMedCrossRefGoogle Scholar
  10. 10.
    Natanson C, Kern SJ, Lurie P, Banks SM, Wolfe SM. Cell-free hemoglobin based blood substitutes and risk of myocardial infarction and death: meta-analysis. JAMA. 2008;299:2304–2312.PubMedCrossRefGoogle Scholar
  11. 11.
    Anonymous. Practice parameter for the use of fresh-frozen plasma, cryoprecipitate, and platelets. Fresh-Frozen Plasma, Cryoprecipitate, and Platelets Administration Practice Guidelines Development Task Force of the College of American Pathologists. JAMA 1994;271:777–781.Google Scholar
  12. 12.
    Dzik WH. Component therapy before bedside procedures. In: Mintz PD, editor. Transfusion therapy: clinical principles and practice. 2nd ed. Bethesda, MD: AABB Press; 2005. p. 1–26.Google Scholar
  13. 13.
    O’Shaughnessy DF, Atterbury C, Bolton Maggs P, et al. British Committee for Standards in Haematology, Blood Transfusion Task Force. Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant. Br J Haematol. 2004;126:11–28.Google Scholar
  14. 14.
    Segal JB, Dzik WH. Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: an evidence-based review. Transfusion. 2005;45:1413–1425.PubMedCrossRefGoogle Scholar
  15. 15.
    Erstad BL, Gales BJ, Rappaport WD. The use of albumin in clinical practice. Arch Intern Med. 1991;151:901–911.PubMedCrossRefGoogle Scholar
  16. 16.
    Vermeulen LC, Ratko TA, Erstad BL, Brecher ME, Matuszewski KA. A paradigm for consensus. The University Hospital Consortium guidelines for the use of albumin, nonprotein colloid, and crystalloid solutions. Arch Intern Med. 1995;155:373–379.PubMedCrossRefGoogle Scholar
  17. 17.
    Anonymous. Human albumin administration in critically ill patients: a systematic review of randomized controlled trials. Cochrane Injuries Group Albumin Reviewers. Br Med J. 1998;317:235–240.Google Scholar
  18. 18.
    Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R. SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350:2247–2256.PubMedCrossRefGoogle Scholar
  19. 19.
    Lusher JM. Congenital disorders of clotting proteins and their management. In: Simon TL, Dzik WH, Snyder EL, Stowell CP, Strauss RG, editors. Rossi’s principles of transfusion medicine. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 2002. p. 448–462.Google Scholar
  20. 20.
    Mannucci PM. Treatment of von Willebrand’s disease. N Engl J Med. 2004;351:683–694.PubMedCrossRefGoogle Scholar
  21. 21.
    Lane TA, Anderson KC, Goodnough LT, et al. Leukocyte reduction in blood component therapy. Ann Intern Med. 1992;117:151–162.PubMedCrossRefGoogle Scholar
  22. 22.
    Laupacis A, Brown J, Costello B, et al. Prevention of posttransfusion CMV in the era of universal WBC reduction: a consensus statement. Transfusion. 2001;41:560–569.PubMedCrossRefGoogle Scholar
  23. 23.
    Moroff G, Luban NL. The irradiation of blood and blood components to prevent graft-versus-host disease: technical issues and guidelines. Transfus Med Rev. 1997;11:15–26.PubMedCrossRefGoogle Scholar
  24. 24.
    Davenport RD, Burnie KL, Barr RM. Transfusion management of patients with IgA deficiency and anti-IgA during liver transplantation. Vox Sang. 1992;63:247–250.PubMedCrossRefGoogle Scholar
  25. 25.
    AuBuchon JP, Kruskall MS. Transfusion safety: realigning efforts with risks. Transfusion. 1997;37:1211–1216.PubMedCrossRefGoogle Scholar
  26. 26.
    Sazama K. Reports of 355 transfusion-associated deaths: 1976–1985. Transfusion. 1990;30:583–590.PubMedCrossRefGoogle Scholar
  27. 27.
    Boyan CP, Howland WS. Cardiac arrest and temperature of bank blood. JAMA. 1963;183:58–60.PubMedCrossRefGoogle Scholar
  28. 28.
    Ryden SE, Oberman HA. Compatibility of common intravenous solutions with CPD blood. Transfusion. 1975;15:250–255.PubMedCrossRefGoogle Scholar
  29. 29.
    Oberman HA, Barnes BA, Friedman BA. The risk of abbreviating the major crossmatch in urgent or massive transfusion. Transfusion. 1978;18:137–141.PubMedCrossRefGoogle Scholar
  30. 30.
    Winslow RM. New transfusion strategies: red cell substitutes. Annu Rev Med. 1999;50:337–353.PubMedCrossRefGoogle Scholar
  31. 31.
    Olsson ML, Clausen H. Modifying the red cell surface: towards an ABO-universal blood supply. Br J Haematol. 2008;140:3–12.PubMedGoogle Scholar
  32. 32.
    Collins JA. Problems associated with the massive transfusion of stored blood. Surgery. 1974;75:274–295.PubMedGoogle Scholar
  33. 33.
    Mannucci PM, Federici AB, Sirchia G. Hemostasis testing during massive blood replacement. A study of 172 cases. Vox Sang. 1982;42:113–123.PubMedCrossRefGoogle Scholar
  34. 34.
    Duchesne JC, Hunt JP, Wahl G, et al. Review of current blood transfusions strategies in a mature level I trauma center: were we wrong for the last 60 years? J Trauma. 2008;65:272–278.PubMedCrossRefGoogle Scholar
  35. 35.
    Gunter OL, Au BK, Isbell JM, Mowery NT, Young PP, Cotton BA. Optimizing outcomes in damage control resuscitation: identifying blood product ratios associated with improved survival. J Trauma. 2008;65:527–534.PubMedCrossRefGoogle Scholar
  36. 36.
    Hardy JF, DeMoerloose P, Samama M. Massive transfusion and coagulopathy: pathophysiology and implications for clinical management. Can J Anaesth. 2004;51:293–310.PubMedCrossRefGoogle Scholar
  37. 37.
    Ciavarella D, Reed RL, Counts RB, et al. Clotting factor levels and the risk of diffuse microvascular bleeding in the massively transfused patient. Br J Haematol. 1987;67:365–368.PubMedCrossRefGoogle Scholar
  38. 38.
    Roberts HR, Monroe DM, White GC. The use of recombinant factor VIIa in the treatment of bleeding disorders. Blood. 2004;104:3858–3864.PubMedCrossRefGoogle Scholar
  39. 39.
    Goodnough LT, Lublin DM, Zhang L, Despotis G, Eby C. Transfusion medicine service policies for recombinant factor VIIa administration. Transfusion. 2004;44:1325–1331.PubMedCrossRefGoogle Scholar
  40. 40.
    Dutton RP, McCunn M, Hyder M, et al. Factor VIIa for correction of traumatic coagulopathy. J Trauma. 2004;57:709–719.PubMedCrossRefGoogle Scholar
  41. 41.
    Boffard KD, Riou B, Warren B, et al. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials. J Trauma. 2005;59:8–18.PubMedCrossRefGoogle Scholar
  42. 42.
    O’Connell KA, Wood JJ, Wise RP, Lozier JN, Braun MM. Thromboembolic adverse events after use of recombinant human coagulation factor VIIa. JAMA. 2006;295:293–298.PubMedCrossRefGoogle Scholar
  43. 43.
    Bracey A, Harrison C, Weiskopf R, Sipherd B, Steiner EA. Guidelines for massive transfusion. Bethesda, MD: AABB; 2005.Google Scholar
  44. 44.
    Perkins HA, Payne R, Ferguson J, Wood M. Nonhemolytic febrile transfusion reactions. Quantitative effects of blood components with emphasis on isoantigenic incompatibility of leukocytes. Vox Sang. 1966;11:578–600.PubMedCrossRefGoogle Scholar
  45. 45.
    Heddle NM, Kelton JG. Febrile nonhemolytic transfusion reactions. In: Popovsky MA, editor. Transfusion reactions. 2nd ed. Bethesda, MD: AABB Press; 2001. p. 45–82.Google Scholar
  46. 46.
    Vamvakas EC, Pineda AA. Allergic and anaphylactic reactions. In: Popovsky MA, editor. Transfusion reactions. 2nd ed. Bethesda, MD: AABB Press; 2001. p. 83–127.Google Scholar
  47. 47.
    Sandler SG, Mallory D, Malamut D, Eckrich R. IgA anaphylactic transfusion reactions. Transfus Med Rev. 1995;9:1–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Silliman CC. The two-event model of transfusion-related acute lung injury. Crit Care Med. 2006;34(Suppl):S124–S131.PubMedCrossRefGoogle Scholar
  49. 49.
    Davenport RD. Hemolytic transfusion reactions. In: Popovsky MA, editor. Transfusion reactions. 2nd ed. Bethesda, MD: AABB Press; 2001. p. 1–44.Google Scholar
  50. 50.
    Perez P, Salmi LR, Follea G, et al. Determinants of transfusion-associated bacterial contamination: results of the French BACTHEM Case-Control Study. Transfusion. 2001;41:862–872.PubMedCrossRefGoogle Scholar
  51. 51.
    Kuehnert MJ, Roth VR, Haley NR, et al. Transfusion-transmitted bacterial infection in the United States, 1998 through 2000. Transfusion. 2001;41:1493–1499.PubMedCrossRefGoogle Scholar
  52. 52.
    Popovsky MA, Audet AM, Andrzejewski C. Transfusion-associated circulatory overload in orthopedic surgery patients: a multi-institutional study. Immunohematology. 1996;12:87–89.PubMedGoogle Scholar
  53. 53.
    Ness PM, Shirey RS, Thoman SK, Buck SA. The differentiation of delayed serologic and delayed hemolytic transfusion reactions: incidence, long-term serologic findings, and clinical significance. Transfusion. 1990;30:688–693.PubMedCrossRefGoogle Scholar
  54. 54.
    Heddle NM, Soutar RL, O’Hoski PL, et al. A prospective study to determine the frequency and clinical significance of alloimmunization post-transfusion. Br J Haematol. 1995;91:1000–1005.PubMedCrossRefGoogle Scholar
  55. 55.
    Petz LD, Garratty G, Calhoun L, et al. Selecting donors of platelets for refractory patients on the basis of HLA antibody specificity. Transfusion. 2000;40:1446–1456.PubMedCrossRefGoogle Scholar
  56. 56.
    O’Connell BA, Schiffer CA. Donor selection for alloimmunized patients by platelet crossmatching of random-donor platelet concentrates. Transfusion. 1990;30:314–317.PubMedCrossRefGoogle Scholar
  57. 57.
    Anonymous. Leukocyte reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusions. The Trial to Reduce Alloimmunization to Platelets Study Group. N Engl J Med. 1997;337:1861–1869.Google Scholar
  58. 58.
    Anderson KC, Weinstein HJ. Transfusion-associated graft-versus-host disease. N Engl J Med. 1990;323:315–321.PubMedCrossRefGoogle Scholar
  59. 59.
    Linden JV, Pisciotto PT. Transfusion-associated graft-versus-host disease and blood irradiation. Transfus Med Rev. 1992;6:116–123.PubMedCrossRefGoogle Scholar
  60. 60.
    Raghavan M, Marik PE. Anemia, allogenic blood transfusion, and immunomodulation in the critically ill. Chest. 2005;127:295–307.PubMedCrossRefGoogle Scholar
  61. 61.
    Busch MP, Kleinman SH, Nemo GJ. Current and emerging infectious risks of blood transfusions. JAMA. 2003;289:959–962.PubMedCrossRefGoogle Scholar
  62. 62.
    Busch MP, Caglioti S, Robertson EF, et al. Screening the blood supply for West Nile virus RNA by nucleic acid amplification testing. N Engl J Med. 2005;353:460–467.PubMedCrossRefGoogle Scholar
  63. 63.
    Fiebig EW, Busch MP. Infectious disease screening. In: Roback JD, Combs MR, Grossman BJ, Hillyer CD, editors. Technical manual. 16th ed. Bethesda, MD: AABB; 2008. p. 241–282.Google Scholar
  64. 64.
    Becker J, Blackall D, Evans C, et al. Guidelines for blood utilization review. Bethesda, MD: AABB; 2001.Google Scholar
  65. 65.
    Mintz PD. Quality assessment and improvement of blood transfusion practices. In: Mintz PD, editor. Transfusion therapy: clinical principles and practice. 2nd ed. Bethesda, MD: AABB Press; 2005. p. 609–629.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Kurt F. Heim
    • 1
  1. 1.Transfusion Medicine, Department of Laboratory MedicineLahey Clinic Medical CenterBurlingtonUSA

Personalised recommendations