Whole Blood

Whole blood is used to treat acute hemorrhage, for blood transfusions, and use during cardiovascular surgery or hemodialysis.

Dosages of Whole Blood:

• Dosing is based on the patient's clinical condition, estimated blood loss, and other measures being used to maintain hemodynamic stability.

Dosage Considerations – Should be Given as Follows:

Acute Hemorrhage

• As whole blood transfusion is limited to acutely hemorrhaging individuals, dosing should be based on the patient’s clinical condition, estimated blood loss, and other measures being used to maintain hemodynamic stability.

Exchange Transfusions - Pediatric

• For dosing of reconstituted whole blood for exchange transfusions, please consult with your institution's blood bank medical director or hematologist.

Cardiovascular Surgery or Hemodialysis - Pediatric

• For dosing of reconstituted whole blood for use during cardiovascular surgery or hemodialysis, predefined dosing protocols should be set up by the institution depending on the type of procedure performed and the cardiopulmonary circuits used at the institution.

Other Information

• Whole blood is no longer commonly available or used in most of the United States.
• The most common use of whole blood in the United States is currently autologous donations for elective surgery.
• Whole blood, if available, may be indicated for large volume hemorrhaging, such as seen with major trauma, requiring massive transfusion and rapid correction of anemia, coagulopathy, acidosis, and hypothermia. Studies supporting this approach include military trauma where they can transfuse very fresh (less than 24 hours old) whole blood which is not currently routinely available in civilian institutions.
• Reconstituted whole blood is used for neonatal exchange transfusions, most commonly for hemolytic disease of the newborn. It is sometimes used during pediatric cardiovascular surgery as well as in neonatal hemodialysis.

Suspected adverse events after administration of any vaccine may be reported to Vaccine Adverse Events Reporting System (VAERS), 1-800-822-7967

Side effects of Whole Blood may include:

• Hemolytic transfusion reactions
• Febrile non-hemolytic reactions
• Allergic reactions ranging from urticaria to anaphylaxis
• Septic reactions
• Transfusion Related Acute Lung Injury (TRALI)
• Circulatory overload
• Transfusion-associated graft versus host disease
• Post-transfusion red and purple spots on the skin (purpura)

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Whole blood has no listed severe interactions with other drugs.
• Whole blood has no listed serious interactions with other drugs.
• Whole blood has no listed moderate interactions with other drugs.
• Whole blood has no listed mild interactions with other drugs.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

• This medication contains whole blood. Do not take whole blood if you are allergic to whole blood or any ingredients contained in this drug.
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Whole blood transfusions are not indicated when component-specific therapy is available (i.e., use RBCs to treat anemia or use FFP to treat coagulopathy). The use of whole blood when monocomponent therapy is indicated and available could lead to complications such as volume overload.

Effects of Drug Abuse

• No information is available.

Short-Term Effects

• See "What Are Side Effects Associated with Using Whole Blood?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Whole Blood?"

Cautions

• If a transfusion reaction is suspected, the transfusion should be stopped, the patient assessed and stabilized, the blood bank notified, and a transfusion reaction investigation initiated. Massive or rapid transfusion may lead to arrhythmias, hypothermia, hyperkalemia, hypocalcemia, metabolic alkalosis, and heart failure.
• Because whole blood contains both RBCs and plasma, only units that are ABO identical to the recipient can be transfused. If transfusion is needed emergently and the blood bank does not have a current patient sample, emergency release of type O RBC and/or type AB plasma units should be requested until ABO typing can be performed and type-specific blood products provided.
• Whole blood has a 21 to 35-day expiration depending on the anticoagulant solution used. Since the labile clotting factors V and VIII have short storage half-lives at 4 degrees C, these clotting factors may not be adequately restored with whole blood transfusion alone unless the units are fresh. The platelets contained in whole blood are unlikely to be beneficial since whole blood is stored at 4 degrees C.
• Reconstituting whole blood is a time-consuming process and transfusion should not be delayed waiting for reconstituted whole blood for emergency transfusions.
• All transfusions must be given via blood administration sets containing 170- to 260-micron filters or 20- to 40-micron micro aggregate filters unless transfusion is given via a bedside leukocyte reduction filter. No other medications or fluids other than normal saline should be simultaneously given through the same line without prior consultation with the medical director of the blood bank.
• The patient should be monitored for signs of a transfusion reaction including vitals pre, during, and post-transfusion.
• Non-septic infectious risks include transmission of HIV (approximately 1:2 mill), HCV (approximately 1:1.5 mill), HBV (1:300k), HTLV, WNV, CMV, parvovirus B19, Lyme disease, babesiosis, malaria, Chagas disease, vCJD.
• Iron overload in chronically transfused patients due to hemoglobinopathies or thalassemia.
• Consult with the blood bank medical director or hematologist if you have questions regarding special transfusion requirements.

Pregnancy and Lactation

• CMV-negative or CMV reduced risk (leukocyte reduced) RBCs should be used in pregnant women who are CMV-negative or whose CMV status is unknown. Consult your doctor.
• There is no information available about the use of whole blood while breastfeeding. Consult your doctor.