Hemolytic events during therapeutic plasma exchange: Root cause analysis

Hemolysis during therapeutic plasma exchange: A rare phenomena

“…Biochemistry analysis of 5% albumin (ALBUCEL, India; 5% albumin prepared by reconstituting 20% albumin in normal saline) used in prior three sessions was done and it met the quality control standards as per the guidelines 6 available, whereas the 5% albumin (ALBUPRIST, India) used for the first session post BMT‐revealed sodium concentration – 27 mmol/L, potassium concentration – 0, chloride concentration – 0, albumin content – 5 g/dL and a low osmolality – 29 mmol/kg, thus, confirming our hypothesis that hemolysis was seen due to hyposmolality of albumin solution. A similar case has been reported by Sachan et al 7 …”

“…Biochemistry analysis of 5% albumin (ALBUCEL, India; 5% albumin prepared by reconstituting 20% albumin in normal saline) used in prior three sessions was done and it met the quality control standards as per the guidelines 6 available, whereas the 5% albumin (ALBUPRIST, India) used for the first session post BMTrevealed sodium concentration -27 mmol/L, potassium concentration -0, chloride concentration -0, albumin content -5 g/dL and a low osmolality -29 mmol/kg, thus, confirming our hypothesis that hemolysis was seen due to hyposmolality of albumin solution. A similar case has been reported by Sachan et al 7 As per the guidelines available for quality control testing of human albumin solution by National Institute of Biologicals (NIB) 96% of the protein content should be albumin with sodium levels between 130 and 160 mmol/L. 6 The biochemical analysis performed of the albumin used failed the quality analysis as it showed low sodium content, however, the albumin content was adequate.…”

Pseudohemolysis during therapeutic plasma exchange due to IV iron dextran therapy

“…A blood warmer was being used as per protocol, however, the blood warmer was set at exactly 37°C, and passed all annual clinical engineering checks. “The Automated Interface Management” (AIM) system of the Terumo Optia 3,4 detected no interface abnormalities, there were no alarms involving the red blood cell indicator (which should alarm in the event of actual hemolysis), and the particular instrument being used for her procedure had received a routine preventive maintenance inspection earlier that week making mechanical hemolysis unlikely.…”