Red cell concentrate

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Red cell concentrate

An erythrocyte concentrate ( EK ) is a “blood reserve” made up of red blood cells ( erythrocytes ). When the colloquial term “ blood transfusion ” is used, then red cell concentrates are usually meant as standard preparations.

Recovery of red blood cell concentrates

Whole blood donation

The donation of blood for transfusion medical purposes is subject to very precise legal regulations in German-speaking countries. First, 450 ml of whole blood in a special, specially authorized and certified plastic bag of about 63-70 ml CPD-stabilizer solution are using venous blood, obtained (CPD = citrate - buffer , sodium dihydrogen phosphate , glucose , adenine ). The CPD stabilizer solution stabilizes the pH value at 7.1–7.2, which is of decisive importance for the shelf life and quality of the blood products. After the whole blood has been donated, the blood obtained is separated into its individual components. The transfusion of whole blood nowadays practically does not take place at all (except for autologous blood donation), but only the transfusion of the individual blood components (erythrocyte concentrates, platelet concentrates , plasma etc.). The main reason for this is that whole blood has a shorter shelf life. However, thanks to new bag systems, a shelf life of six weeks with acceptable quality is now achieved even with whole blood as part of autologous blood donation. On the other hand, erythrocyte concentrates have a shelf life of up to seven weeks.

Erythrocyte apheresis

In the apheresis process, no whole blood, but only the "red blood components", i.e. H. the erythrocytes recovered. A dialysis- like device separates the erythrocytes from the donor blood in a flow process and guides the remaining blood components back into the donor circuit.

Red cell concentrate preparations

White blood cell depleted red cell concentrates

Since October 1, 2001, these have been the standard erythrocyte concentrates. The leukocyte depletion (as far as possible separation of the donor leukocytes) is required by law for all blood products in Germany. After the donation, the blood is first centrifuged. The supernatant, which contains plasma and the so-called buffy coat , consisting of platelets and leukocytes , is separated off and the remaining erythrocytes are suspended in a little stabilizer solution.

Red cell concentrate for autologous blood donations

Before planned ( elective ) operations, which u. If this entails greater blood loss and the need for intraoperative EK transfusions, an autologous blood donation can be made. The patient can thus create a supply of his own erythrocyte concentrates, which can then be administered during an operation. The autologous blood donation takes place like a normal whole blood donation or as a double donation in the apheresis procedure.

Washed red cell concentrates

A leukocyte-depleted erythrocyte concentrate is once again suspended in a nutrient solution, centrifuged again and separated again so that the remainder of the donor blood plasma is replaced by the nutrient solution. Washed erythrocyte concentrates are useful or necessary in the case of intolerance to previous transfusions (e.g. allergic reactions to proteins in the donor plasma, e.g. in patients with IgA deficiency ).

Irradiated red cell concentrates

To kill all living cells containing DNA , especially leukocytes , red cell concentrates can be irradiated. This method is used in particular in patients who have had a bone marrow or blood stem cell transplant behind them or who are about to do so. The aim of the irradiation is to prevent the transfer of immunocompetent cells from the donor and the triggering of a graft-versus-host reaction .

Radiation is useful and necessary for:

Situation in Germany

The need for erythrocyte concentrates per 1,000 insured persons fell from 55.3 EC in 2009 to 43.2 EC in 2016 (minus 22 percent). With a simultaneous increase in inpatient treatment cases, consumption per 1,000 insured persons fell from 1 EC per 3.7 inpatient treatment cases in 2009 to 1 EC per 5.0 inpatient treatment cases in 2016. This corresponds to a reduction of 25 percent.

literature

  • Reinhold Eckstein: Immunohematology and transfusion medicine. 5th, revised and expanded edition. Elsevier - Urban and Fischer, Munich et al. 2005, ISBN 3-437-21032-7 .

Individual evidence

  1. ↑ Guidelines for the collection of blood and blood components and for the use of blood products (haemotherapy) Compiled according to §§ 12a u. 18 Transfusion Act by the German Medical Association in agreement with the Paul Ehrlich Institute Second guideline amendment 2010 in the version approved by the Board of Directors of the German Medical Association on April 16, 2010. The agreement of the Paul Ehrlich Institute was made on May 4, 2010. The amendment to the guidelines was announced in the Federal Gazette No. 101a on July 9, 2010 and came into force the following day. A new edition of the guidelines in the German Medical Association is in preparation ( ISBN 978-3-7691-1294-8 ). Archive link ( Memento of the original from May 19, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.bundesaerztekammer.de
  2. ↑ Consolidated federal law: Entire legal provision for Blood Donor Ordinance, version of March 29, 2017 [1]
  3. ↑ Acid-base balance in the blood of the human organism should be 7.4 ± 0.05 (corresponding to an H⁺ concentration around 40 nmol / l).
  4. ↑ Jörg Braun: Blood, blood products and coagulation disorders. In: Jörg Braun, Roland Preuss (Ed.): Clinic Guide Intensive Care Medicine. 9th edition. Elsevier, Munich 2016, ISBN 978-3-437-23763-8 , pp. 539-579, here: p. 566.
  5. ↑ http://dipbt.bundestag.de/dip21/btd/19/035/1903509.pdf