Feasibility of a new in vitro approach to evaluate cellular damage following co-infusion of red blood cell concentrates and intravenous drug solutions

Abstract

A novel in vitro dynamic infusion system appears to represent a useful technique to calculate possible damage to RBCs resulting from co-infused drug solutions. Co-infusion of the drug solutions tested with filtered and irradiated RBC concentrates did not produce fHb levels above the levels accepted by the Dutch national guidelines. Apart from haemolysis, other parameters reflecting RBC damage should be investigated in future studies.

Is it safe to co‐infuse dextrose‐containing fluids with red blood cells?

“…However, there remains no in vivo data available at present to support the findings by Stark et al . or others …”

“…Agglutination of red blood cells occurs when mixed with dextrose fluids and haemolysis is thought to occur due to osmotic lysis. Factors that may influence the degree of haemolytic damage include the infusion rate of the co‐infusate, contact time and flow rate of the PRBC transfusion as well as the composition of the solutions tested . Agglutination may be limited or completely avoided if saline is added to the dextrose co‐infusate …”

Coinfusion of dextrose‐containing fluids and red blood cells does not adversely affect in vitro red blood cell quality

“…Hemolytic damage is dependent on infusion rate, contact time as well as the composition of the solutions tested . In Phase 1, the contact time of the DW with RBCs was longer than would occur in clinical practice in the NICU.…”

Effects of Co-infusion of Plasma, Whole Blood and Anticogulants on Their Clotting Activities

“…Because of limited venous access, adherence to these guidelines may be compromised in certain clinical settings such as emergencies, bone marrow transplantation procedures and intravenous chemotherapy treatment in pediatrics as well as in patients receiving opioids such as morphine for intravenous analgesia [3][4][5]. Co-infusion of heparin as an anticoagulant with red cell concentrate (RCC) does not induce hemolysis [6]. However, co-infusion of RCC and other drugs results in unexpected adverse reactions in patients [7].…”