Packed red blood cells
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Packed blood cells (pRBC) can be used to increase the body's oxygen carrying capacity in the setting of anemia or hemorrhagic shock. Transfusion is indicated in patients with HGB level <7.0 g/dL. Some studies suggest transfusing to a HGB of 8.0 g/dL in patients with cardiac disease. Typically a unit of pRBC will increase an adult HGB level by 1 g/dL.
Patient refusal. Some patients have religious objections to receiving a blood transfusion. It is important to clarify which blood products patients accept before anesthetizing them. Some institutions may have patients sign a blood product refusal form as well.
Transfusing packed red blood cells may lead to a transfusion reaction.
Hemolytic transfusion reactions can be divided into acute and delayed. Acute hemolytic transfusion reactions are due to ABO incompatibility. Delayed hemolytic transfusion reactions are due to alloantibodies to minor red blood cell antigens such as Rh, Kell, Kidd, and Duffy.
Febrile transfusion reactions are due to antibodies formed against donor leukocytes.
Anaphylactic transfusion reactions occur in recipients with IgA deficiency.
Contaminated blood products can lead to bacterial or viral infection.
Transfusion associated circulatory overload (TACO) and transfusion related acute lung injury (TRALI) are other possible reactions.