Chokri Ben Lamine Explains Washed PRBCs!
Chokri Ben Lamine, Adult Hematology and SCT Assistant Consultant at Oncology Center of Excellence at King Faisal Specialist Hospital and Research Center, shared on X:
”Washed PRBC
What are washed PRBCs?
PRBCs washed with saline to remove:
- Plasma proteins
- Residual platelets and leukocytes
- Cytokines / IgA / allergens
Main Indications (Adults):
- Severe allergic / anaphylactic transfusion reactions (esp. recurrent)
- IgA deficiency with anti-IgA antibodies
- History of plasma-mediated reactions despite premedication
- Selected neonates (context-specific)
NOT routinely indicated for:
– FNHTR (use leukoreduced blood instead)
– TRALI prevention
– Infection risk reduction
– GVHD prevention (need irradiated blood, not washed)
Practical Limitations / Pearls:
- Short shelf life after washing (≤24 hours at 1–6°C)
- Lower RBC recovery → slightly less hematocrit increment
- Higher contamination risk → use promptly
- Requires coordination with blood bank
Compare Quickly:
Washed PRBC → removes plasma proteins
Leukoreduced PRBC → removes WBCs (default standard)
Irradiated PRBC → prevents TA-GVHD
MCQ (Perfect Answer)
Q: Best blood product for a patient with IgA deficiency and prior anaphylaxis to transfusion?
A. Standard PRBC
B. Leukoreduced PRBC
C. Irradiated PRBC
D. Washed PRBC
Correct answer: D
OSCE Pearl
Adult with repeated urticaria + hypotension during PRBC transfusion despite antihistamines:
- Switch to washed PRBC
- Premedication alone is insufficient
Take-Home:
– Use only when clearly indicated
– Key role in severe allergic reactions and IgA deficiency
– Not a substitute for leukoreduction or irradiation
Reputable Sources:
• AABB Standards for Blood Banks and Transfusion Services
• British Society for Haematology (BSH) Transfusion Guidelines
• UpToDate – Indications for washed red blood cells”
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