Effects of rapid infusion with high pressure and large-bore IV tubing on red blood cell lysis and warming

Expediting red blood cell transfusions by syringing causes significant hemolysis

“…External pressurization of RBC bags appears safe. Mateer and colleagues observed no greater hemolysis when transfusing from RBC bags pneumatically pressurized to 600 mmHg compared to gravity‐driven transfusions. Similarly, Frelich and Ellis demonstrated that with respect to hemolysis, facilitating rapid transfusions by pneumatically pressurizing (150 to 300 mmHg) RBC bags was safe.…”

“…Blood transfusion services define significant hemolysis as being free Hb concentrations higher than 0.1 g/dL and hemolysis of 1% or more. At these levels, clinically significant adverse effects appear . Healthy individuals were asymptomatic after transfusion with blood having free Hb concentrations between 0.2 and 1.0 g/dL .…”

“…At these levels, clinically significant adverse effects appear. 4,10,24 Healthy individuals were asymptomatic after transfusion with blood having free Hb concentrations between 0.2 and 1.0 g/dL. 25 Free plasma Hb concentrations exceeding 0.064 g/dL have been associated with acute kidney injury after major surgery.…”

Pressure Infusion Cuff and Blood Warmer during Massive Transfusion: An Experimental Study About Hemolysis and Hypothermia

“…Actually, it is considered that the patient safety could be compromised with a percentage of hemolysis higher than 0.8% or 1% [ 16 , 17 ]. Considering that the fragility of the RBC membrane increase with temperature heating [ 18 ] and that any additional pressure exerted on it have the potential to generate hemolysis [ 19 ], it is important to examine whether to heat a blood product at a high temperature during massive transfusion with a compression sleeve can generate hemolysis at a percentage higher than those internationally admitted.…”

“…Later, Linko [ 21 ] indicated no hemolysis increase in pre-warmed blood at 37°C for different pressure rates, but did not clearly indicate these rates. From their side, Mateer et al [ 19 ] investigated the effect of pressure at 300 mmHg and 600 mmHg on various catheters with a blood warmer set at 36.7°C. They found a small increase (about 10%) in free hemoglobin between the two pressure tested for outdated blood, but it was not statistically significant.…”