Washing of irradiated red blood cells prevents hyperkalaemia during cardiopulmonary bypass in neonates and infants undergoing surgery for complex congenital heart disease

Abstract

Objective: High concentrations of potassium and lactate in irradiated red cells transfused during cardiopulmonary bypass may have detrimental effects on infants and neonates undergoing cardiac surgery. The effects of receiving washed and unwashed irradiated red cells from the cardiopulmonary circuit on serum potassium and lactate concentrations were compared. Methods: The study population included neonates and infants undergoing heart surgery for complex congenital heart disease. A control group (n = 11) received unwashed irradiated red cells and the study group (n = 11) received irradiated red cells washed in a cell saver (Dideco Electa) using 900 ml of 0.9% saline prior to pump priming. Potassium and lactate concentrations were compared before, during and after bypass. Results: Washing irradiated red cells reduced donor blood [potassium] from > 20 to 0.8 AE 0.1 mmol/l, and [lactate] from 13.7 AE 0.5 to 5.0 AE 0.3 mmol/l ( p < 0.001). The resulting prime had significantly lower [potassium] and [lactate] than the unwashed group (potassium 2.6 AE 0.1 vs 8.1 AE 0.4 mmol/l, p < 0.001; lactate 2.6 AE 0.2 vs 4.6 AE 0.3 mmol/l, p < 0.001). Peak [potassium] in the unwashed group occurred 3 minutes after going on bypass (4.9 AE 0.3 mmol/l) and during rewarming (4.9 AE 0.4 mmol/l). These were significantly higher than the washed group (3.1 AE 0.1, p < 0.001 and 3.0 AE 0.1 mmol/l, p < 0.001). The [potassium] was greater than 6.0 mmol/l for 4 out of these 11 unwashed patients compared with none of the washed group. Immediately postbypass the washed group had significantly lower serum [potassium] (3.2 AE 0.1 vs 4.2 AE 0.2 mmol/l, p = 0.002). There was no significant difference in [lactate] between groups during and after cardiopulmonary bypass. Conclusions: The washing of irradiated red cells reduces potassium and lactate loads and prevents hyperkalaemia during cardiopulmonary bypass. The washing of irradiated red cells should be considered in neonates and infants undergoing cardiac surgery for complex congenital heart disease. #

Anesthetic management of the first pediatric bilateral hand transplant

“…To counteract this occurrence, washing PRBCs is encouraged. 10 It is important to balance the need for improved oxygen delivery with increased viscosity secondary to higher hematocrit that could lead to a compromise in perfusion to the transplanted organ. 11 Optimizing hand blood flow requires maintenance of normothermia during the procedure as hypothermiaassociated vasoconstriction could reduce the blood supply to the graft.…”

“…In addition, his intravenous methylprednisolone was transitioned to oral prednisolone that was slowly tapered over three months to 0.2 mgÁkg -1 Áday -1 . He was restarted on his preoperative tacrolimus with a targeted level of [8][9][10][11][12] ngÁmL -1 , and his mycophenolate dose increased to 400 mg q 12 hr postoperatively. Cefazolin was continued postoperatively for antibiotic prophylaxis, and daily cotrimoxazole (trimethoprim/sulfamethoxazole) was administered for one year.…”

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

“…Low-birthweight neonates and small infants are susceptible to the high ion (free haemoglobin, potassium and calcium) concentrations that are present in older red cell units and it is standard practice in many centres to wash these red cells using cell salvage devices prior to administration. 47 However, a RCT of red cell washing in paediatric cardiac surgery patients failed to show a clinical benefit, although there was a reduction in a measure of inflammation (IL-6 : IL-10 ratio). 46 Importantly, no adverse effects of this technique were reported in recipients.…”

Effect of transfusion of washed red blood cells on serumpotassium level in hemodialysis patients

“…Potassium load can be minimized in washed RBC transfusions. When transfusion is necessary in hemodialysis patients, washed RBCs are recommended during dialysis-free intervals in order to avoid transfusion-associated hyperkalemia (8)(9)(10). Nevertheless, studies on the effects of washed RBCs on actual change in serum potassium concentration (in the receiver) are limited.…”

“…Preservatives, storage temperature, and duration have an effect on the potassium concentration of stored RBCs (7). Washing stored RBCs before transfusion is a recommended method to reduce the potassium load (8)(9)(10).…”