Utilising Technetium-99m Labelled Red Blood Cells (UltraTag) in Blood Pool Imaging and the Detection of Gastrointestinal Bleeding

Technetium-99m labelled red blood cells (RBCs), often known by the trade name UltraTag, are a pivotal component in the armamentarium of nuclear medicine, providing clinicians with a vital diagnostic tool for blood pool imaging and the detection of gastrointestinal bleeding. This sophisticated medical application harnesses the gamma-emitting properties of Technetium-99m (Tc-99m), a metastable nuclear isomer, and the biological distribution characteristics of RBCs to create detailed images of the vascular system and to locate sources of internal bleeding.

Blood Pool Imaging

Blood pool imaging is a nuclear medicine procedure that enables visualization of the vascular system, including the heart chambers and major vessels. It is particularly beneficial in assessing cardiac function, including ejection fraction, wall motion, and blood volume distribution. UltraTag RBCs play a critical role in such procedures.

The preparation of Tc-99m labelled RBCs involves the extraction of a patient’s blood, which is then labelled with Tc-99m using a variety of methods, including in vitro, in vivo, and modified in vivo techniques. Once the Tc-99m is bound to the RBCs, the labelled cells are reinjected into the patient. The gamma photons emitted by Tc-99m are detected by a gamma camera, which constructs an image of the organ or system under examination.

This technique allows for the dynamic assessment of blood flow and volume in real-time. The excellent tissue penetration of the gamma rays emitted by Tc-99m and the longevity of the isotope’s signal (with a half-life of about 6 hours) make it an ideal agent for prolonged imaging sessions necessary in some diagnostic evaluations, such as for complex cardiac conditions.

Gastrointestinal Bleeding

Gastrointestinal (GI) bleeding is a common medical emergency that can occur from multiple sources within the digestive tract, often requiring prompt diagnosis and treatment. Conventional methods such as endoscopy are typically employed first; however, in cases where the bleeding is intermittent or too slow to be detected by endoscopy, nuclear medicine techniques utilizing UltraTag RBCs become exceedingly valuable.

The process for imaging GI bleeding is similar to that of blood pool imaging. The Tc-99m labelled RBCs circulate throughout the bloodstream and pass through the gastrointestinal tract. In the event of bleeding, the tagged RBCs escape from the vascular system into the GI tract, concentrating at the bleeding site. The site of bleeding can be detected as an area of increased radioactivity when scanned with a gamma camera.

This nuclear scanning method is particularly sensitive and can detect bleeding rates as low as 0.1 mL/min, often below conventional endoscopic techniques’ detection threshold. Additionally, since the labelled RBCs remain in the vascular system until they bleed out or are metabolized (typically several hours), repeated scanning can be performed to monitor patients for intermittent bleeding, which is a common occurrence in GI haemorrhages.

Advantages of UltraTag RBCs

The use of Tc-99m labelled RBCs offers several advantages in clinical practice:

  • Safety and Efficacy: Tc-99m is a well-tolerated radioisotope with an excellent safety profile, and when combined with the patient’s own RBCs, it minimizes the risk of allergic reactions or immunologic complications.
  • Resolution and Accuracy: The imaging provides high-resolution visualization of blood pools and can precisely locate areas of bleeding within the GI tract, aiding in accurate diagnosis.
  • Non-Invasive: Unlike endoscopic procedures, UltraTag RBC imaging is non-invasive, which is particularly advantageous for patients who are not suitable for invasive procedures or when an endoscopic approach fails to localize the bleeding site.
  • Quantitative Analysis: Quantitative data about blood volume and circulatory dynamics can be extrapolated from the imaging, which can be critical in treatment planning.

Clinical Considerations

While the use of UltraTag RBCs for blood pool imaging and the detection of GI bleeding is invaluable, certain clinical considerations must be taken into account:

  • Technical Expertise: Labeling RBCs with Tc-99m and subsequent imaging requires specialized equipment and technical expertise.
  • Time Sensitivity: Given the half-life of Tc-99m, there is a finite window for optimal imaging, necessitating timely preparation and imaging procedures.
  • Physiological Factors: Patient-specific factors such as abnormal blood flow or severe anaemia can affect the distribution and imaging quality of the labelled RBCs.


Technetium-99m labelled red blood cells are a cornerstone in the field of nuclear medicine for blood pool imaging and the localization of gastrointestinal bleeding. UltraTag RBCs combine the physical and biochemical properties necessary for detailed and accurate diagnostic imaging, facilitating non-invasive diagnosis and enabling clinicians to tailor management strategies effectively. As medical technology advances, the integration of such specialized nuclear medicine techniques promises to enhance diagnostic accuracy and patient care in complex clinical scenarios involving blood pool dynamics and internal bleeding.

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