Expediting red blood cell transfusions by syringing causes significant hemolysis

Villiers, Willem Lambertus De; Murray, Adriaan Albertus; Levin, Andrew

doi:10.1111/trf.14283

Cited by 8 publications

(12 citation statements)

References 25 publications

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“…Neither veterinary study reported any adverse effects in the transfused patients. The present study did not show significant damage to the RBCs even after forceful aspiration of blood through the microaggregate 18‐μ filter followed by rapid infusion at a rate over 8,000 mL/h, contradicting findings of a similar human study 10 . Without reported adverse effects in vivo or significant hemolysis in vitro, rapid administration of blood via syringe bolus may represent an acceptable method of rapid transfusion in dogs, but in vivo studies are needed.…”

Section: Discussioncontrasting

confidence: 99%

“…Overzealous crystalloid administration may also lead to dilutional coagulopathy and worsening acidosis 3 . Massive transfusion protocols that ensure use of sufficient blood products are part of a multimodal approach to damage control resuscitation, which decrease mortality in hemorrhaging human trauma patients 4 There are numerous studies assessing different methods of rapid transfusion 5–10 and associated RBC damage. However, rapid infusion techniques have not yet been compared in veterinary medicine, so the comparable risk factors for hemorrhaging veterinary patients are unknown.…”

Section: Introductionmentioning

confidence: 99%

“…Commonly used infusion methods in veterinary medicine include shuttle‐ and piston‐type infusion pumps, pressure bags, rapid syringing, and manual compression. Although vigorous syringe infusion, 10 and shuttle‐ and piston‐type infusion pumps result in significant iatrogenic hemolysis, 12 neither pressure bags 5,6,10 nor peristaltic‐type infusion pumps 12 cause substantial RBC damage. Currently, there is no consensus in veterinary medicine regarding optimal rapid transfusion delivery method.…”

Section: Introductionmentioning

confidence: 99%

“…Over time, RBC fragility leads to hemolysis and release of plasma free hemoglobin (fHb) and formation of microparticles 13–18 . The biochemical and biomechanical changes that occur over time are known as the RBC storage lesion, which is characterized by increasing concentrations of plasma fHb, microparticles, % hemolysis, osmotic fragility, serum potassium, total bilirubin, and lactate dehydrogenase and decreased nitric oxide availability, hematocrit, average corpuscular volume, total hemoglobin, and number of erythrocytes 5–7,9,10,12–18 . Hemolysis of blood products that occurs during the storage or transfusion process is a known risk factor for adverse transfusion‐related patient outcomes in people 13,14,19,20 .…”

Section: Introductionmentioning

confidence: 99%

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In vitro iatrogenic hemolysis of canine packed red blood cells during various rapid transfusion techniques

Weeks¹,

Motsinger‐Reif

Reems³

2020

J Vet Emergen Crit Care

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Objective To evaluate which rapid blood administration technique causes the least iatrogenic hemolysis in canine packed red blood cells (pRBCs) as determined by plasma free hemoglobin (fHb) and percent hemolysis (% hemolysis). Design Prospective in vitro randomized study. Setting Private referral center. Animals None. Interventions Thirteen units of canine pRBCs were divided equally into 5 aliquots, resulting in 65 trials. The aliquots of each unit were subjected to the following administration techniques: gravity‐driven (control), an infusion pump at maximal rate, application of a pressure bag, manual compression, and syringe bolus. Plasma fHb and % hemolysis were recorded before and after each trial. Rate of administration (mL/s) was calculated for each method. Measurements and main results Compared to the control, there were no significant increases in % hemolysis or plasma fHb noted among any of the trial methods. The manual compression and syringe bolus methods resulted in the fastest transfusion rates, whereas the infusion pump was not faster than the gravity‐driven method. Despite a storage time of ≤14 days, 15% of pRBC units had unsuitable (>0.8%) hemolysis before even being subjected to the trials. Conclusions Commonly used rapid infusion techniques in small animal transfusion medicine do not cause significant iatrogenic hemolysis of canine pRBCs in vitro, although a significant risk is present in stored blood. This suggests that if an expedited transfusion is needed, any method described in this study could be considered, although stored pRBCs should be tested for unsuitable levels of hemolysis prior to transfusion.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

In vitro iatrogenic hemolysis of canine packed red blood cells during various rapid transfusion techniques

Weeks¹,

Motsinger‐Reif

Reems³

2020

J Vet Emergen Crit Care

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“…Previous reports of ex vivo hemolysis have implicated irradiation, catheter gauge, RBC washing, Cell Saver device suction, and high rate of infusion. [3][4][5][6][7][8][9][10] In addition, the one-way valve recently introduced into the operating room was suspected as a potential contributing factor. A series of in vitro experiments were performed to test the potential contribution of these factors.…”

Section: Resultsmentioning

confidence: 99%

Mechanical hemolysis in pediatric patients associated with rapid transfusion and one‐way valve

et al. 2018

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Investigating non‐immune haemolytic transfusion reactions in surgical patients

Chand

Amita

Gupta

2022

Transfusion Medicine

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Objective: To perform a Root Cause Analysis (RCA) to identify the cause for Acute Haemolytic Transfusion Reaction (AHTR) in five patients who received red cell transfusions.Background: The occurrence of red coloured urine following blood transfusion carries the possibility of an immune or non-immune mediated haemolytic transfusion reaction (HTR). Non-immune haemolysis can be due to thermal, osmotic, or mechanical injury to red blood cells. The authors report five cases of non-immune HTR that occurred in surgical patients in the peri-operative period.Methods: AHTR was reported to the Transfusion Medicine Department, in five patients who underwent surgery and received a blood transfusion in the peri-operative period. Transfusion reaction workup and RCA were performed to identify the cause for AHTR. Results:The initial presentation was red coloured urine and suspicion of an immune HTR. Immunohaematology workup ruled out an immune mediated haemolysis and further analysis revealed the possibility of mechanical red cell destruction in all these cases. Conclusion:Multiple factors can result in non-immune destruction of red cells. Possibility of non-immune haemolysis should be considered while evaluating haemolytic transfusion reactions.

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Expediting red blood cell transfusions by syringing causes significant hemolysis

Abstract: Forceful manual syringing caused significant hemolysis and high free Hb concentrations. Pressurizing RBC bags induced no more hemolysis than after gravity-facilitated transfusions. Syringing to expedite RBC transfusions should be avoided in favor of pneumatic RBC bag pressurization.

Cited by 8 publications

References 25 publications

In vitro iatrogenic hemolysis of canine packed red blood cells during various rapid transfusion techniques

In vitro iatrogenic hemolysis of canine packed red blood cells during various rapid transfusion techniques

Mechanical hemolysis in pediatric patients associated with rapid transfusion and one‐way valve

Investigating non‐immune haemolytic transfusion reactions in surgical patients

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