Transfusing red cells to a patient with corresponding antibodies can result in a severe or fatal reaction.

Just a few millilitres can trigger an immediate immune response leading to shock and disseminated intravascular coagulation, which can result in severe bleeding, or renal failure.

The red cell components routinely available are as follows:

• Red cells in additive solution (the usual red cells provided for the majority of patients);
• Washed red cells;
• Phenotype (Rh and K) matched red cells;
• Red cells for intrauterine transfusion (IUT);
• Red cells in additive solution for neonatal use;
• Red cells in additive solution for neonates and infants (known as large volume transfusion [LVT]);
• Red cells for neonatal exchange transfusion.

Units for IUT and LVTs must be <5 days old (following donation) to minimise the risk of hyperkalaemia.

1. Red cells have a shelf life of 35 days (unless irradiated) and must be stored at 2° - 6°C in an authorised blood fridge with an audible alarm system and functional temperature recorder - never in a domestic / drug fridge.
2. Current recommendations advise that each unit of red cells should be transfused within 4 hours of removal from 2 - 6°C temperature controlled 4°C storage (TCS).
3. Red cells that have been taken out of the blood fridge but not transfused, must be returned to the Hospital Transfusion Laboratory (HTL) with clear documentation confirming the length of time out of TCS. It may be possible to re-issue any returned units, which will be guided by the Hospital Transfusion Laboratory (HTL).

Unused red cells can be returned to a blood issue fridge within 30 minutes of removal from temperature controlled storage (TCS). Red cells not being used that have been out of TCS for longer than 30 minutes must be returned to staff in the Hospital Transfusion Laboratory to be quarantined in a secure fridge.

Below is the red cell guidance for children and infants: