Effect of warming and flow rate conditions of blood warmers on red blood cell integrity

Abstract

The use of a blood warmer adjusted to 41·5°C is probably the best choice for reducing the risk of hypothermia for the patient without generating haemolysis. However, we should be cautious with the use of an infusion pump for RBC transfusion, particularly at high flow rates.

Quantitative assessment of haemolysis secondary to modern infusion pumps

“…As described by Parfitt et al [12], we found that the haemolysis level was lower with higher flow rates for the Infusomat â Space pump. This was not observed for the Plum A+ TM and Colleague â CXE pumps, similar to other pumps tested in other studies [9,10,13]. In addition, the flow rate had no impact on the potassium level, and blood type (A vs. O) had no impact on the levels of haemolysis and potassium.…”

“…Most of the infusion pumps previously tested with packed RBCs seemed to induce relatively low levels of haemolysis . However, there were some notable exceptions, including the pump that was previously used at our institution . Although the Infusomat ® Space pump produced significantly more haemolysis than the Colleague ® CXE and Plum A+™ pumps, the absolute level of haemolysis induced by all three of the most used pumps in Quebec hospitals was relatively low and probably clinically insignificant.…”

“…a Change in difference between sample before and after pump utilization: (S3 + S4 + S5)/3-(S1 + S2)/2. Values in bold are significant at <0.05. including the pump that was previously used at our institution [10]. Although the Infusomat â Space pump produced significantly more haemolysis than the Colleague â CXE and Plum A+ TM pumps, the absolute level of haemolysis induced by all three of the most used pumps in Quebec hospitals was relatively low and probably clinically insignificant.…”

“…For example, in a study by Poder et al . , a high increase in haemolysis was found following the use of an actuated piston diaphragm pump with RBC units aged 30–39 days. Thus, this area merits further research.…”

“…Previous studies have also noted that the age of packed RBCs has a major effect on pump-induced haemolysis [12]. The relation between haemolysis and flow rate was inconsistent between different pumps; however, in general, there was an expected increase in haemolysis, whether at very low or high rates [9,10,13,23,24].…”