Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Division of Transfusion Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Transfusion. 2024 Feb;64(2):216-222. doi: 10.1111/trf.17690. Epub 2023 Dec 21.
Washing red blood cell (RBC) units mitigates severe allergic transfusion reactions. However, washing reduces the time to expiration and the effective dose. Automated washing is time- and labor-intensive. A shortage of cell processor tubing sets prompted review of medical necessity for washed RBC for patients previously thought to require washing.
A single-center, retrospective study investigated discontinuing wash RBC protocols in chronically transfused adults. In select patients with prior requirements for washing, due to a history of allergic transfusion reactions, trials of unwashed transfusions were performed. Patient demographic, clinical, laboratory, and transfusion data were compiled. The per-unit washing cost was the sum of the tubing set, saline, and technical labor costs.
Fifteen patients (median age 34 years interquartile range [IQR] 23-53 years, 46.7% female) were evaluated. These patients had been transfused with a median of 531 washed RBC units (IQR 244-1066) per patient over 12 years (IQR 5-18 years), most commonly for recurrent, non-severe allergic reactions. There were no transfusion reactions with unwashed RBCs aside from one patient with one episode of pruritus and another with recurrent pruritus, which was typical even with washed RBC. We decreased the mean number of washed RBC units per month by 72.9% (104 ± 10 vs. 28.2 ± 25.2; p < .0001) and saved US $100.25 per RBC unit.
Washing of RBCs may be safely reconsidered in chronically transfused patients without a history of anaphylaxis. Washing should be implemented judiciously due to potential lack of necessity and logistical/operational challenges.
洗涤红细胞（RBC）单位可减轻严重过敏输血反应。然而，洗涤会减少过期时间和有效剂量。自动化洗涤既耗时又耗力。细胞处理器管套件短缺促使我们重新考虑先前认为需要洗涤的患者使用洗涤 RBC 的医学必要性。
一项单中心回顾性研究调查了在慢性输血的成年人中停止洗涤 RBC 方案的情况。在由于过敏输血反应史而之前需要洗涤的选择患者中，进行了未洗涤输血的试验。收集患者的人口统计学、临床、实验室和输血数据。每个单位洗涤的成本是管套件、生理盐水和技术劳动力成本的总和。
评估了 15 名患者（中位数年龄 34 岁，四分位距 [IQR] 23-53 岁，46.7%为女性）。这些患者在 12 年（IQR 5-18 年）中每人平均输注了 531 个洗涤 RBC 单位（IQR 244-1066），最常见的是复发性非严重过敏反应。除了一名患者出现瘙痒和另一名患者出现反复瘙痒（即使是洗涤 RBC 也很常见）外，未洗涤 RBC 没有发生输血反应。我们每月平均洗涤 RBC 单位数减少了 72.9%（104 ± 10 与 28.2 ± 25.2；p < 0.0001），每单位 RBC 节省 100.25 美元。
在没有过敏反应史的慢性输血患者中，可以安全地重新考虑洗涤 RBC。由于潜在的必要性和后勤/运营挑战，应审慎实施洗涤。
