Name of the Procedure:

Red Blood Cells, Leukocytes Reduced, Irradiated, Each Unit (HCPCS Code: P9040)

Common name(s): Leukocyte-Reduced Irradiated Red Blood Cells
Technical/Medical terms: Leukocyte-Reduced and Irradiated RBC Transfusion

Summary

This procedure involves the transfusion of red blood cells that have been specially treated to remove most white blood cells (leukocytes) and then irradiated to prevent certain complications. This type of blood product is used for patients requiring transfusions who may be at higher risk of complications from untreated red blood cells.

Purpose

This procedure addresses medical conditions that necessitate a blood transfusion while minimizing the risk of immune reactions and graft-versus-host disease. The goal is to provide the patient with safe and effective red blood cells to treat anemia, blood loss, or other conditions requiring increased oxygen-carrying capacity of the blood.

Indications

• Severe anemia
• Blood loss from surgery or trauma
• Bone marrow failure conditions
• Certain types of cancer treatments
• Patients with weakened immune systems who need transfusions

Patient criteria:

• Immune-compromised patients
• Newborns or pediatric patients
• Patients requiring frequent transfusions
• Patients with a history of febrile non-hemolytic transfusion reactions

Preparation

• Patients may need to have blood tests to determine blood type and the need for transfusion.
• Inform the healthcare provider about any medications or allergies.
• In some cases, fasting may be required.
• Pre-transfusion hemoglobin and hematocrit levels will be checked.

Procedure Description

1. Verification: Confirm patient identity and blood type.
2. Preparation: The irradiated and leukocyte-reduced red blood cells are prepared and verified.
3. Transfusion: The blood is transfused through an intravenous (IV) line. This may take several hours.
4. Monitoring: Vital signs are closely monitored before, during, and after the transfusion to detect any adverse reactions.

Tools/Equipment: Intravenous infusion setup, blood warmer (if needed), monitoring equipment.

Anesthesia/Sedation: None required; local anesthetic may be used for IV line insertion if necessary.

Duration

Typically takes 1 to 4 hours, depending on the volume of blood to be transfused and the patient's condition.

Setting

Performed in a hospital, outpatient clinic, or blood transfusion center.

Personnel

• Registered nurses (RNs)
• Medical technologists specializing in blood banking
• Physicians supervising the transfusion process

Risks and Complications

Common:

• Mild allergic reactions (rash, itching)
• Febrile reactions (fever)

Rare:

• Hemolytic transfusion reactions
• Infections
• Transfusion-associated graft-versus-host disease (mitigated by irradiation)

Possible Complications: Managed with medications like antihistamines, antipyretics, or steroids as prescribed.

Benefits

• Increased red blood cell count and improved oxygen delivery to tissues.
• Reduced risk of transfusion-related complications.
• Beneficial for patients who require frequent transfusions.

Recovery

• Patients will be monitored for a short period post-transfusion.
• Maintain hydration and report any symptoms such as fever, chills, or back pain.
• Follow-up appointments to monitor blood levels and health status.

Alternatives

• Erythropoiesis-stimulating agents (ESAs) for certain anemias.
• Autologous blood transfusion (patient's own blood collected before surgery).
• Non-irradiated or non-leukocyte-reduced red blood cells (with higher risk for certain patients).

Pros and Cons of Alternatives:

• ESAs: Effective but slow-acting and expensive; not suitable for severe, acute anemia.
• Autologous transfusion: Ideal for elective surgeries but not for emergency situations.

Patient Experience

During the procedure, patients may feel slight discomfort from the IV line. Generally, there should be minimal to no pain. After the procedure, the patient may feel tired and should rest. Pain management and comfort measures include ensuring the patient is warm and comfortable and providing pain relief if necessary.