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Washed Blood Products
Washing refers to a process that removes the noncellular fluid in red blood cell (RBC) and platelet products and replaces it, typically with saline. Usually, the process is performed in an open system where storage time is limited to 4–24 hours depending on the storage temperature. Washing removes >99% of plasma proteins (including antibodies) and original supernatant that may contain unwanted substances (e.g., anticoagulant-preservative solution, cytokines, electrolytes). Washing is indicated in a couple of clinical situations including recurrent severe allergic/anaphylactic reactions, and removal of potassium in large volume transfusion in pediatrics. Washing cellular products can take up to 2 hours and therefore limits its utility in emergent clinical situations.
Washed RBC Products
RBC products can be washed with 1–2 L of normal saline using a manual or automated method. The process can result in the loss of up to 20% of the RBC mass. If washing is performed in an open system, the unit can be stored for 24 hours at 1–6°C. More recently, closed system technology enables automated washing and extended storage of RBCs in additive solution for up to 14 days at 1–6°C. However, this technology has been limited mostly to cryopreserved RBCs after deglycerolization and is not FDA approved.
Washed Platelet Products
Platelets can be washed with normal saline, saline buffered with ACD-A or citrate, or platelet additive solutions (PAS) using a manual or automated method. Washing of platelets leads to platelet activation, loss of discoid shape, and reduced granule content. In addition, there is a significant loss of platelets (up to 30%) and reduced aggregation after washing. Recent studies have shown a difference in the functionality of washed platelets based on their storage time and suggest fresher platelets be selected for washing to improve their functionality, if possible. Washed platelets are stored at room temperature and must be used within 4 hours.
Possible Indications ( Table 46.1 )
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