Red blood cell (RBC) transfusions are given to raise the hemoglobin level in patients with anemia or to replace losses after acute bleeding episodes. Storage of red cells has been enhanced by the development of preservative solutions; in addition, several types of components are available for use in selected circumstances to minimize complications. This topic review will discuss the storage and use of these various preparations.
The administration of red blood cell transfusions in adults, including issues of storage, specialized modifications, and infusion, is discussed here. Indications for red blood cell transfusion, transfusion of red blood cells in infants and children, and transfusion complications are discussed separately.
COLLECTION AND STORAGE PROCEDURES
Blood collections are routinely separated into various components (ie, red cells, plasma, cryoprecipitate, platelets) and the RBC are stored for up to 42 days. These processes have markedly enhanced our ability to meet transfusion requirements and are due to two important developments, namely preservative solutions that allow for a long shelf-life of the red cells, and storage bags that permit separation of blood components and maintain sterility and viability of the contained red cells. These are discussed below. (See "Preparation of blood components".)
Preservative solutions — Preservative solutions are added to red blood cells to improve their shelf-life (eg, by maintaining pH and preventing coagulation). Although it was recognized since 1916 that red cells could be stored for brief periods of time in a citrate-glucose solution, it was not until the 1930s that blood was transfused after storage, and not until 1937 that the first blood "bank" was established at Cook County Hospital in Chicago . In the early 1940s, a major breakthrough came with the development of the first effective anticoagulant-preservative solution (A-P) ACD (acid citrate dextrose), which allowed blood to be stored for up to 21 days.