whole blood (Blood Component)

Action and Spectrum

Actions and spectrum: 

Red Blood Cells (RBCs): 

• Action: Red blood cells are responsible for transporting oxygen from lungs to tissues & carrying the carbon dioxide back to lungs for excretion. 
• Spectrum: Primarily involved in oxygen transport. 

White Blood Cells (WBCs): 

• Action: White blood cells, or leukocytes, play a crucial role in the immune system. They defend the body against infections and foreign invaders. 
• Spectrum: Involved in the immune response and defense against pathogens. 

Platelets: 

• Action: Platelets are essential for blood clotting and wound healing. They help prevent excessive bleeding by forming clots at the site of injury. 
• Spectrum: Involved in hemostasis and clot formation. 

Plasma: 

• Action: Plasma is the liquid component of blood, containing water, electrolytes, proteins, hormones, and waste products. It serves as a transport for nutrients, hormones, and waste products. 
• Spectrum: Carries various substances, including nutrients, hormones, and waste products. 

Other Substances: 

• Action: Whole blood also contains other components such as electrolytes, nutrients, hormones, and waste products. 
• Spectrum: These substances contribute to the overall homeostasis and function of the body. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Febrile Non-Hemolytic Reactions 

Septic Reactions 

Circulatory Overload 

Postransfusion Purpura 

Hemolytic Transfusion Reactions 

Allergic Reactions from urticaria to anaphylaxis 

Transfusion related to Acute Lung Injury (TRALI) 

Transfusion Graft Versus Host Disease 

Black Box Warning

Black Box Warning: 

There is no specific black box warning associated with whole blood transfusions. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

• Allergic or Anaphylactic Reactions: Individuals with a known severe allergy or anaphylactic reaction to components of blood (such as plasma proteins) may be considered at risk for adverse reactions. 
• Iron Overload Disorders: In conditions associated with iron overload, such as hemochromatosis, repeated blood transfusions may exacerbate iron accumulation. In such cases, other blood products or iron-chelating therapies might be considered. 
• Severe Congestive Heart Failure: In individuals with severe congestive heart failure, the additional volume from a blood transfusion may exacerbate the condition. 
• Severe Coagulopathy or Bleeding Disorders: In certain bleeding disorders or coagulopathies, whole blood transfusion might not be the preferred option. Instead, specific blood components such as platelets, plasma, or clotting factor concentrates may be used based on the underlying condition.

Caution: 

• Immunological Reactions: Transfusion reactions can occur due to immune responses to components in the donor’s blood. Fever, chills, and allergic reactions are potential manifestations of immunological responses. 
• Volume Overload: Whole blood transfusions involve the infusion of a significant volume of fluid into the recipient’s circulatory system. In individuals with compromised cardiac function or congestive heart failure, the additional volume may contribute to fluid overload. 
• Infection Risk: Although extensive screening is conducted, there is always a minimal risk of transmitting infections through blood transfusions. Stringent donor screening and testing protocols are in place to minimize this risk. 
• Iron Overload: Repeated blood transfusions, as seen in certain medical conditions, can lead to iron overload in the body. This may necessitate monitoring and, in some cases, the use of iron-chelating agents to manage excess iron. 
• Transfusion-Associated Circulatory Overload (TACO): TACO is a condition characterized by volume overload that can occur after blood transfusions. It is more common in individuals with compromised cardiac function. 
• Transfusion-Related Acute Lung Injury (TRALI): TRALI is a rare but serious complication characterized by acute respiratory distress following a blood transfusion. It is associated with the transfusion of antibodies that can cause inflammation in the lungs. 

Comorbidities: 

• Hemorrhagic Disorders: Patients with bleeding disorders, such as hemophilia or von Willebrand disease, may require blood transfusions to replace clotting factors. However, the specific blood components needed (e.g., fresh frozen plasma or platelets) might be more tailored to address their condition. 
• Anemia: Anemia itself is not a comorbidity, but rather a condition indicating a reduced number of red blood cells or hemoglobin levels. Whole blood transfusions are often considered in cases of severe anemia due to conditions such as trauma, surgery, or certain medical illnesses. 
• Cardiovascular Disease: Individuals with cardiovascular diseases, such as congestive heart failure, may be at risk of volume overload from whole blood transfusions. Careful monitoring and consideration of alternative blood components may be necessary. 
• Severe Trauma or Surgery: Patients who have experienced severe trauma or undergone extensive surgeries may require blood transfusions to address acute blood loss. 

Pregnancy / Lactation

Pregnancy consideration: US FDA pregnancy category: Not assigned 

Lactation: Excreted into human milk: Unknown 

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.   
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women. 
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

The pharmacology of whole blood involves the understanding of its components and their physiological roles. Whole blood is consisting of red blood cells, white blood cells, platelets, plasma, and various other substances. Red blood cells primarily transport oxygen, white blood cells contribute to the immune response, and platelets are crucial for blood clotting. Plasma serves as the liquid medium, carrying nutrients, hormones, and waste products.

Whole blood transfusions aim to restore or replace specific components in individuals with conditions such as anemia, bleeding disorders, or during surgical procedures. The pharmacological effects are diverse, encompassing oxygen delivery, immune support, hemostasis, and maintenance of homeostasis. The safety and efficacy of whole blood transfusions depend on careful donor screening, compatibility testing, and consideration of the recipient’s medical condition, emphasizing the need for individualized patient care in the administration of this blood component.  

Pharmacodynamics: 

• Red Blood Cells (RBCs): The primary pharmacodynamic effect of RBCs is the transport of oxygen from the lungs to tissues and the return of carbon dioxide to the lungs for elimination. This oxygen-carrying capacity is crucial for cellular metabolism and overall tissue oxygenation. 
• White Blood Cells (WBCs): WBCs play a key role in the immune response. The pharmacodynamics involve the surveillance, recognition, and elimination of pathogens, contributing to the body’s defense against infections. 
• Platelets: Platelets are essential for hemostasis and blood clotting. Their pharmacodynamic effect involves forming a plug at the site of vascular injury, preventing excessive bleeding. 
• Plasma: Plasma serves as a transport medium for various substances, including nutrients, hormones, electrolytes, and waste products. The pharmacodynamics of plasma involve maintaining homeostasis by supporting vital physiological functions.

Pharmacokinetics: 

Absorption 

Whole blood is administered through intravenous infusion. The absorption of blood components occurs through the recipient’s circulatory system, ensuring rapid distribution throughout the body. 

Distribution 

Once infused, the individual components of whole blood—red blood cells, white blood cells, platelets, and plasma—are distributed throughout the circulatory system. Red blood cells usually carries oxygen, white blood cells contribute to the immune response, platelets aid in clotting, and plasma transports various substances. 

Metabolism 

Blood components do not undergo traditional metabolic processes within the body. Red blood cells, for example, do not have a nucleus or mitochondria and rely on anaerobic metabolism for energy.  

Elimination and excretion 

Blood components do not undergo excretion in the way drugs are eliminated from the body. Red blood cells have a definite lifespan and are eventually removed from circulation by the spleen and liver. Some components may be recycled, while others are broken down and eliminated as waste products. 

Adminstartion

Administration: 

• Blood Typing and Crossmatching: Blood typing identifies the recipient’s blood type (A, B, AB, or O) and Rh factor (positive or negative). Crossmatching involves testing the compatibility between the recipient’s and donor’s blood to minimize the risk of transfusion reactions. 
• Preparation of Blood: The whole blood unit is carefully selected and screened for infectious diseases. It may be separated into individual components (red blood cells, plasma, platelets) based on the recipient’s needs. 
• IV Access: An intravenous (IV) line is established in the recipient’s vein. This provides direct access for the infusion of whole blood. 
• Transfusion Set-Up: The blood bag is hung on an IV pole, and the transfusion set is connected to the bag. The tubing contains a filter to remove clots or debris from the blood. 
• Transfusion Initiation: The transfusion is started at a slow rate, usually 1-2 milliliters per minute for the first 15 minutes. This allows for careful monitoring of the recipient’s response and the detection of any immediate adverse reactions. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: whole blood 

Pronounced: (Hohl bluhd)  

Why do we use whole blood? 

Whole blood transfusions are often employed in situations where an individual has experienced significant blood loss due to trauma, surgery, or childbirth. The transfusion helps restore the lost volume and maintains adequate oxygen-carrying capacity. Whole blood transfusions may be used to manage severe anemia caused by conditions such as hemolytic anemia, aplastic anemia, or complications of certain medical treatments. 

Certain blood disorders like sickle cell disease or thalassemia, may require whole blood transfusions to manage symptoms and complications associated with the underlying condition. Individuals with disorders affecting the production of blood cells in the bone marrow, such as myelodysplastic syndromes, may benefit from whole blood transfusions to alleviate symptoms.