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Expediting red blood cell transfusions by syringing causes significant hemolysis
Author(s) -
De Villiers Willem Lambertus,
Murray Adriaan Albertus,
Levin Andrew Ian
Publication year - 2017
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.14283
Subject(s) - hemolysis , medicine , hemoglobin , red blood cell , anesthesia , surgery
BACKGROUND Techniques commonly used to expedite blood transfusions include pneumatically pressurizing red blood cell (RBC) bags or manual syringing its contents. We compared these techniques on RBC hemolysis using a simulated transfusion model. STUDY DESIGN AND METHODS Fifteen warmed RBC units that were 12.3 ± 4.3 (95% confidence interval [CI], 10.1‐14.5) days old were each subjected to two experimental rapid transfusion techniques. RBCs from each technique were directed through 18‐ and 22‐gauge cannulas attached to blood administration sets. One technique involved RBC bag pressurization to 300 mmHg. The other employed a 20‐mL syringe to effect forceful, manual aspiration from the RBC bag followed by forceful, manual RBC injection. The control group was gravity driven without cannulas. Free hemoglobin (Hb) concentrations were measured and percent hemolysis was calculated. RESULTS Free Hb concentrations and percent hemolysis (median [95% CI]) were similar in the control (0.05 [0.03‐0.08] g/dL and 0.13% [0.09%‐0.17%], respectively) and pressurized experiments (0.06 [0.05‐0.09] g/dL; 0.14% [0.12%‐0.22%]), respectively. Syringing resulted in 10‐fold higher free Hb concentrations (0.55 [0.38‐0.92] g/dL) and percent hemolysis (1.28% [1.03%‐2.15%]) than when employing the control (p < 0.0001) or pressurization (p < 0.0001) techniques. Cannula sizes studied did not affect hemolysis. CONCLUSION 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.