Red Blood Cells

(BAN, rINN)

💊 Chemical information

Eritrocitos.

Pharmacopoeias.

Many pharmacopoeias have monographs, including US.

USP 31

(Red Blood Cells). It is the portion of blood that contains haemoglobin and is derived from human whole blood (from which plasma and platelets are removed by centrifugation, sedimentation) or by apheresis. Red blood cells may be further processed by addition of red cell preservatives, irradiation to inactivate lymphocytes, filtration for removal of leucocytes, washing to remove proteins, freezing and thawing, or rejuvenation using validated and approved procedures. For preparations derived from whole blood, one unit (dose) of Red Blood Cells contains a minimum of 50 g of haemoglobin. One unit of Red Blood Cells, Leukocytes Reduced contains a minimum of 42.5 g of haemoglobin and has a residual leucocyte count of less than 5 × 10 6 . One unit of Red Blood Cells, Deglycerolized contains a minimum of 40 g of haemoglobin. One unit of Red Blood Cells, Leukocytes Reduced and Deglycerolized contains a minimum of 34 g of haemoglobin and has a residual leucocyte count of less than 5 × 10 6 . For preparations derived by apheresis, one unit (dose) of Red Blood Cells, Pheresis contains a mean haemoglobin content of 60 g of haemoglobin. One unit of Red Blood Cells, Pheresis, Leukocytes Reduced contains a mean haemoglobin content of 51 g of haemoglobin and has a residual leucocyte count of less than 5 × 10 6 . Red blood cells should be stored in the original container, or transferred to an equivalent container using a technique that does not compromise sterility. An approved additive solution may be added after removal of the plasma. Liquid red blood cells is stored at 1° to 6°. Frozen red blood cells is stored at or below −65°. Red blood cells in Anticoagulant Citrate Dextrose Solution, Anticoagulant Citrate Phosphate Dextrose Solution, or in Anticoagulant Citrate Phosphate Dextrose-Dextrose Solution may be stored for up to 21 days at 1° to 6° after the blood has been drawn. Red blood cells in Anticoagulant Citrate Dextrose Phosphate Adenine Solution may be stored for up to 35 days at 1° to 6°. Red blood cells may be stored in an approved additive solution for up to 42 days at 1° to 6°. Frozen red blood cells prepared with low glycerol content (20%) may be stored at or below −120° for not later than 10 years from years from the date of collection. Frozen red blood cells prepared with high glycerol content (40%) may be stored at or below −65° for not later than 10 years from years from the date of collection. If the frozen red blood cells is processed for freezing or for thawing, in an open system, the expiry date for the thawed red blood cells is 24 hours after removal from −65° storage, provided it is then stored at the temperature of unfrozen red blood cells. Dark red in colour when packed and may show a slight creamy layer on the surface and a small supernatant layer of yellow or opalescent plasma.

💊 Adverse Effects and Precautions

As for Blood.

Antibody formation.

Patients with sickle-cell anaemia frequently require repeated transfusions of red blood cells. Alloimmunisation is a common problem in these patients, and has the potential to cause haemolytic transfusion reactions.1 Alloantibodies were detected in 32 of 107 black patients with sickle-cell anaemia who had received red cell transfusions compared with 1 of 19 non-black patients who had received transfusions for other chronic anaemias.2 The incidence of antibody formation was related to the number of transfusions received. An analysis of the red cell phenotypes suggested that the high rate of alloimmunisation among patients with sickle-cell anaemia could be due to racial differences between donors and recipients. Alloimmunisation can also occur in thalassaemia patients who are given transfusions,3 and the incidence in these patients may also be affected by racial differences between donors and recipients.4Erythrocyte autoantibody formation has also been reported.1,3
1. Aygun B, et al. Clinical significance of RBC alloantibodies and autoantibodies in sickle cell patients who received transfusions. Transfusion 2002; 42: 37–43
2. Vichinsky EP, et al. Alloimmunization in sickle cell anemia and transfusion of racially unmatched blood. N Engl J Med 1990; 322: 1617–21
3. Singer ST, et al. Alloimmunization and erythrocyte autoimmunization in transfusion-dependent thalassemia patients of predominantly Asian descent. Blood 2000; 96: 3369–73
4. Ho H-K, et al. Alloimmunization in Hong Kong southern Chinese transfusion-dependent thalassemia patients. Blood 2001; 97: 3999–4000.

💊 Uses and Administration

Transfusions of red blood cells are given for the treatment of severe anaemia without hypovolaemia. Red blood cells are also used for exchange transfusion in babies with haemolytic disease of the newborn. Red cells may be used with volume expanders for acute blood loss of less than half of the blood volume; if more than half of the blood volume has been lost, whole blood should be used. Other red blood cell products are available. Concentrated red cells in an optimal additive solution containing sodium chloride, adenine, glucose, and mannitol has reduced viscosity and an extended shelf-life. Leucocyte-depleted red cells may be used in patients who have developed antibodies to previous transfusions or in whom development of antibodies is undesirable. Frozen, thawed, and washed red cell concentrates in which plasma proteins are removed in addition to leucocytes and platelets may be used in patients with rare antibodies.
1. Davies SC, Williamson LM. Transfusion of red cells. In: Contreras M, ed. ABC of transfusion. 3rd ed. London: BMJ Books, 1998: 10–16
2. British Committee for Standards in Haematology, Blood Transfusion Task Force. Guidelines on the clinical use of leucocytedepleted blood components. Transfus Med 1998; 8: 59–71. Also available at: http://www.bcshguidelines.com/pdf/trans129.pdf (accessed 27/10/05
3. British Committee for Standards in Haematology, Blood Transfusion Task Force. Guidelines for the clinical use of red cell transfusions. Br J Haematol 2001; 113: 24–31. Also available at: http://www.bcshguidelines.com/pdf/bjh2701.pdf (accessed 27/10/05
4. Hill SR, et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Available in The Cochrane Database of Systematic Reviews; Issu
1. Chichester: John Wiley; 2000 (accessed 16/06/05).

💊 Preparations

USP 31: Red Blood Cells. Proprietary PreparationsMulti-ingredient: Arg.: Vulnofilin Compuesto†.
Published December 21, 2018.