Clinical Indications for Use

Each unit of DRBCs:

- Should be considered equivalent to a fresh unit of RBCs since they are frozen within 6 days of collection, washed during processing, and have a 14-day shelf-life upon deglycerolization.1
- Contains at least 80% of the RBCs present in the original unit of blood.
- Provides the same physiologic benefits as liquid RBCs.
- Carries the same expectation for post-transfusion survival as liquid-stored RBCs.
- Contains significantly lower concentrations of proteins associated with non-hemolytic transfusion reactions.
- The primary indication for use of frozen and deglycerolized RBCs is as a supplement to LTOWB, fresh whole blood and liquid RBCs during surge periods of increased transfusion requirements in order to decrease hemorrhagic morbidity and mortality.

DRBCs may be used in lieu of liquid-stored RBCs for all RBC transfusion requirements including massive transfusions. The Joint Trauma System (JTS) Performance Improvement Branch analyzed data from the DoD Trauma Registry (DoDTR) and Massive Transfusion database and found no statistically significant difference in outcomes or transfusion-related complications between patients who received at least 1 unit of DRBCs as part of their massive transfusion and those who received only liquid-stored RBCs (See Appendix A). A single center prospective randomized trial comparing DRBCs to liquid-stored RBCs in stable trauma patients revealed decreased cytokines and D-dimer levels and increased tissue oxygenation measured by near infrared spectroscopy in patients transfused DRBCs. There were no differences in clinical outcomes. 2,4

- Transfusion monitoring:
  - Clinical: Treat as a routine liquid-stored RBC transfusion before, during, and after transfusion, and for a suspected or actual adverse event.
  - Laboratory: Consider obtaining pre- and post-transfusion Hemoglobin/Hematocrit and Base Excess/Deficit or lactate levels.