Medical Oncologist
Blood counts
Packed cells and whole blood
Whole blood is what was collected from the donor. Packed red cells are that same donation with most of the liquid plasma removed, leaving concentrated red cells. Almost every transfusion during chemotherapy uses packed cells, because someone with a low haemoglobin needs red cells rather than extra fluid.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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The short answer
What is the difference between packed cells and whole blood?
Whole blood is exactly what was collected from the donor. Packed red cells are that same donation with most of the liquid plasma removed, so what remains is concentrated red cells. Almost every transfusion given during chemotherapy uses packed cells, not whole blood.
The reason is simple. Someone with a low haemoglobin needs red cells, not extra fluid, and giving the fluid as well risks overloading the circulation. Removing it also allows the plasma and platelets from that donation to help other patients.
You will see these words on the requisition slip
Families are handed a form covered in abbreviations and asked to take it to the blood bank, with nobody explaining any of it. PRBC or packed cells is what will normally be written for a low haemoglobin.
Asking what is written is entirely reasonable
Ask the nurse to read the slip out and say what each item is. It takes a moment, and it means you can check at the blood bank counter that you have been given what was ordered.
Keep every transfusion slip in your file. You will be asked how many units have been given and when.The words on the slip
What each term actually means
- Whole blood
- The donation as collected, with all its components together. Rarely used during chemotherapy now, because separating it lets one donation treat several patients and avoids giving a patient what they do not need.
- Packed red cells, PRBC or PCV
- The concentrated red cells with most of the plasma removed. This is the normal product for a low haemoglobin, and it is what most transfusion slips in an oncology unit will say.
- Leucodepleted or leucoreduced
- White cells have been filtered out. This reduces the chance of a reaction and of fever during transfusion, and it is frequently preferred for patients having repeated transfusions. Ask whether yours is.
- Irradiated
- Treated with radiation to inactivate remaining white cells. Needed for certain patients and certain treatments. If it is on your slip there is a specific reason, and it is worth asking what that reason is.
- Platelet concentrate
- Platelets rather than red cells, given for a low platelet count. It comes as random donor platelets or single donor platelets, which differ in cost and in how they are arranged.
- Fresh frozen plasma
- The liquid part, containing clotting factors, given for particular clotting problems rather than for a low haemoglobin. Different indication entirely.
Not sure whether this applies to you?
Ask an oncologistWhat happens
How a red cell transfusion actually goes
Written for the family sitting beside the bed watching it.
The sample and the cross-match
A blood sample is taken to confirm the group and check compatibility against the unit. This laboratory work takes time and cannot be shortened, which is why a transfusion is rarely immediate.
Expect
- A wait of some hours before it starts
- Your identity checked repeatedly
The checks at the bedside
Two staff confirm your name, hospital number, blood group and the unit number against the bag and the paperwork. If they ask your name several times, that is the safety system working rather than disorganisation.
The transfusion itself
It runs slowly at first while you are watched closely, then at a steadier rate. Observations are taken before, shortly after starting, during and at the end. Most people feel nothing at all.
Tell the nurse if
- You feel hot, itchy or breathless
- You start shivering or feel very unwell
Afterwards
The haemoglobin is usually rechecked, sometimes the next day. Ask what the value was before and after, and write both in your file. That is how you learn your own pattern across a course.
!
Press the call bell at once during a transfusion for these
Shivering or feeling suddenly cold · a fever · breathlessness or a tight chest · itching, a rash or flushing · swelling of the face, lips or tongue · pain in the back, chest or at the drip site · dark or red-coloured urine · feeling suddenly very unwell or frightened without being able to say why. Do not wait to see whether it settles, and do not adjust the drip rate yourself. A reaction caught in the first minutes is straightforward; one caught late is not.
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Being straight with you
What this page cannot tell you
It cannot tell you how many units you will need or when. That depends on your haemoglobin, your symptoms, your treatment and how your marrow is recovering, and it is decided one transfusion at a time rather than planned in advance.
It also cannot tell you what your hospital will charge or what your slip will say, since terminology and abbreviations differ between blood banks. Ask the nurse to read your own slip out and explain each line.
Needing a transfusion is not a sign the cancer has worsened
A falling haemoglobin during chemotherapy usually reflects what the treatment is doing to the bone marrow. Families read a transfusion as bad news about the disease, and that is generally the wrong conclusion. Ask your team directly.
What to do next
Ask the nurse to read your requisition slip out to you. Ask whether your units are leucodepleted or irradiated and why. Note the haemoglobin before and after each transfusion in your file. Keep every slip. And report anything you feel during the transfusion straight away.
Commonly believed
Four things families misunderstand here
"Whole blood is better, because it is complete."
For a low haemoglobin it is worse, because the extra fluid risks overloading the circulation while adding nothing you need. Separating the donation also lets the plasma and platelets help other patients.
"They keep asking my name because they are confused."
Repeated identity checks are the main safety system preventing the wrong unit reaching the wrong patient. Two staff check name, hospital number, group and unit number. Answer every time, and be glad they asked.
"The transfusion should start as soon as it is ordered."
The sample has to be grouped and cross-matched against the unit in the laboratory, which takes real time. That wait is the safety work, not a delay. In a genuine emergency there are faster protocols.
"A transfusion means the cancer is getting worse."
A falling haemoglobin during chemotherapy usually reflects the effect of treatment on the bone marrow. It is expected, planned for and treatable. Ask your team what your own falling count means rather than assuming the worst.
Questions we are asked
Common questions about blood components
Which will my relative be given?
Almost certainly packed red cells if the haemoglobin is low. Whole blood is rarely used in oncology now. Read the requisition slip, which names the product, and ask the nurse to explain each line.
What does leucodepleted mean?
The white cells have been filtered out, which reduces the chance of fever and reactions during transfusion. It is often preferred for patients having repeated transfusions. Ask whether your units are.
Why does it take so long to start?
The sample has to be grouped and cross-matched against the unit in the laboratory, and that work cannot be rushed. Ask the unit for their usual timeframe so you can plan the day rather than waiting without knowing.
How long does one unit take to run?
Red cells run slowly, with observations throughout, so allow several hours for the visit including the cross-match. Platelets run considerably faster. Ask your unit for their expected times.
Will it make me feel better straight away?
Many people feel noticeably less tired and less breathless within a day or two. Others feel little difference. Tell your team either way, because it helps them judge when the next one is worth giving.
Is there a risk of infection from the blood?
Every unit is screened before use, and the risk is very small. The commoner problems are reactions such as fever, itching or breathlessness, which is why you are watched closely throughout.
Can I eat and drink during a transfusion?
Usually yes, and it helps during a long session. Ask your unit, since policies differ. Take water, dry snacks, something warm and something to pass the time, as you would for a treatment day.
Should I keep the slips?
Yes, all of them, in your file. You will be asked how many units you have had and when, by your own team and sometimes by an insurer. Note the haemoglobin before and after each one as well.
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Sources
- Cancer Research UK — Blood transfusions
- Macmillan Cancer Support — Blood transfusions
- National Cancer Institute — Chemotherapy and You
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