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blood is spun in a centrifuge to separate the red cells from plasma and
platelets. The plasma can be further prepared into cryoprecipitate. The
red cells are washed to remove remaining plasma proteins and an anticoagulant is added to the storage bag. Platelets are usually collected
separately. This results in a series of blood products with a very low
likelihood of causing transfusion reactions.
Once they’ve been prepared, red blood cells (RBCs) have a shelf life
of 42 days. Plasma and cryoprecipitate can be kept frozen for a year,
and once thawed will last for 24 hours. Platelets are normally kept at
room temperature for only five days and must be constantly agitated,
but they can also be stored frozen.
When administered to a significantly injured patient, they’re usually transfused in a 1:1: 1 ratio of RBC, FFP and platelets, depending
on availability and local trauma center protocol.
Whole blood is collected from donors and stored in a refrigerator as-is. The collection bag has the same type of anticoagulant as the
RBCs. The shelf life of whole blood is up to 35 days when collected
using citrate phosphate dextrose adenine solution (CPDA- 1) and must
be used within 24 hours once brought to room temperature. Currently,
most whole blood is collected using citrate phosphate dextrose (CPD)
with a shelf life of 21 days.
It should be noted that the functionality of cold-stored whole
blood decreases dramatically after 21 days. The process for preparing whole blood doesn’t require any special separation, washing or
storage equipment, and the unit of blood contains all the individual
Component therapy using a 1:1: 1 ratio has several other disadvantages compared to whole blood.
23 (See Table 1, p. 52.) Component therapy has significantly lower function, with decreases in the percentage
of useful red blood cells (hematocrit), platelets and coagulation factors.
Once all the components have been combined, they have three times
the volume of anticoagulant and additives as whole blood.
IS IT SAFE?
All medical procedures have an inherent level of risk if done carelessly or incorrectly. If done properly, whole blood transfusions have a
good risk-to-benefit ratio. The most concerning problem is transfusion reactions.
The most severe reactions come from the mismatch of antigens on
the surface of red blood cells. Group O blood cells lack anti-A and
anti-B antigens seen in all other blood types, which is why it’s considered the universal blood donor.
However, the plasma of group O whole blood has both anti-A and
anti-B antibodies in quantities that vary by person. Fortunately, plasma
transfusion reactions are both less common and less severe than blood
cell transfusion reactions.
The name “low titer” comes from the test to determine how many
antibodies are in the plasma. The test measures IgM anti-A and anti-B
antibodies. The military has had great success using titers < 256, but to
be FDA-approved in the U.S., EMS agencies must use a titer of < 150.
About 40% of the U.S. population has group O blood, with another
40% having group A. The rest are spread between groups B and AB. By
using LTOWB, we decrease the likelihood of human error, the possibility of severe blood cell related reactions and the potential for plasma-related reactions.