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

Abstract

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.

Effect of microaggregate filter passage on feline whole blood stored for 35 days

“…Five samples on the day of collection and three samples at D35 had a haemolysis percentage that decreased between pre-and post-filter passage analysis. Similar results have been found in humans 25 and dogs, 43 and the reasons for this are unclear. Proposed mechanisms include the settling of blood during the transfusion and/or partial filter occlusion, leading to inconsistencies in HCT/PCV and plasma Hb results.…”

“…A recent canine study found no significant increase in haemolysis percentage in PRBCs stored for <14 days after passage through an 18 µm filter at maximal manual infusion rates. 43 The clinical significance of transfusing blood with >1% haemolysis has not been established in cats. Free haemoglobin induces oxidative stress, with potentially detrimental effects to renal, myocardial and vascular systems.…”

Association of Veterinary Hematology and Transfusion Medicine (AVHTM) Transfusion Reaction Small Animal Consensus Statement (TRACS) Part 2: Prevention and monitoring

“…Four studies in dogs (LOE 3, good) have looked at red blood cell viability using different infusion methods 161–164 . Only one (LOE 3, good) looked at in vivo red blood cell survival.…”

“…160,165 A recent study in dogs also showed minimal hemolysis using the same piston pump. 161 Further studies looking at red blood cell in vivo survival of different age products with different pumps are needed. In addition, including administration method in future transfusion studies in dogs looking at improvement in PCV after transfusion would be useful.…”

Current controversies in feline transfusion medicine

“…Research performed on blood being given to dogs identified that administration via a pump or syringe driver resulted in a decreased lifespan of transfused cells compared with administration under gravity (McDevitt and others 2011), and a reduced improvement in packed cell volume after transfusion (Weltman and others 2014). However, recent work evaluating the effect of rapid infusion of canine packed RBCs did not identify increased haemolysis associated with administration through a syringe driver or pump (Weeks and others 2021). There is no evidence that administration using a syringe driver through a microaggregate filter decreases RBC lifespan in cats (Heikes and Ruaux 2014).…”