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Effect of incubation with crystalloid solutions or medications on packed red blood cells
Author(s) -
Mladinov Domagoj,
Yarnoff Kristine,
Nagababu Enika,
Berkowitz Daniel E.,
Lawrence Courtney,
Ness Paul M.,
Kickler Thomas,
Brunker Patricia A.,
Boyd Joan S.,
Doddo Jeffrey M.
Publication year - 2019
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.15353
Subject(s) - packed red blood cells , hemolysis , incubation , chemistry , hemoglobin , medicine , pharmacology , anesthesia , chromatography , biochemistry , surgery , blood transfusion
BACKGROUND American Association of Blood Banks (AABB) guidelines suggest that packed red blood cells (PRBCs) be administered through a dedicated intravenous (IV) catheter. Literature supporting this broad‐scope declaration are scarce. Obtaining additional IV access is painful, costly, and an infectious risk. We evaluated the effect of co‐incubating PRBCs with crystalloids and medications on PRBC hemolysis, membrane deformability, and aggregation, as well as medication concentration. METHODS PRBCs were co‐incubated 5 minutes with plasma, normal saline (NS), 5% dextrose in water (D5W), Plasmalyte, epinephrine (epi), norepinephrine (norepi), dopamine (dopa), or Propofol (prop). Samples were then assessed for hemolysis (free hemoglobin, serum potassium), membrane deformability (elongation index [EI]), aggregation (smear, critical shear stress [mPa]) and drug concentration (High Performance Liquid Chromatography/Tandem Mass Spectrometry [LCMS‐MS]). Significance (p ≤ 0.05) was determined by Wilcoxon‐paired comparisons or Wilcoxon/Kruskall Willis with post‐hoc Dunn's test. RESULTS Compared to co‐incubation with plasma: 1) co‐incubation resulted in significantly increased hemolysis only when D5W as used (free hemoglobin, increased potassium); 2) EI trended lower when co‐incubated with D5W and trended toward higher when co‐incubated with prop; 3) aggregation was significantly lower when PRBCs co‐incubated with NS, D5W, or Plasmalyte, and trended lower when co‐incubated with epi, norepi, or dopa. Medication concentrations were between those predicted by distribution only in plasma and distribution through the entire intra‐ and extracellular space. CONCLUSION Our data suggest that 5 minutes of PRBC incubation with isotonic crystalloids or catecholamines does not deleteriously alter PRBC hemolysis, membrane deformability, or aggregation. Co‐incubation with D5W likely increases hemolysis. Propofol may promote hemolysis.