Intraoperative Washing of Long-Stored Packed Red Blood Cells by Using an Autotransfusion Device Prevents Hyperkalemia

Abstract

Long-stored packed red blood cells (PRBCs) have a large potassium load. In patients with end-stage renal failure, the transfusion of such PRBCs may cause a critical increase in plasma potassium levels. Washing PRBCs with an autotransfusion device allows for a marked decrease in potassium load, thus preventing hyperkalemia.

Washing of stored red blood cells by an autotransfusion device before transfusion

“…This procedure could be extended to the washing of donor blood, which may be particularly useful for aged RBCs that contain high concentrations of free haemoglobin, potassium, lactate and other metabolites. Thus, washing aged packed RBCs with an autotransfusion device can prevent hyperkalaemia [7]. It is not known whether stored RBC can withstand the cell washing procedure, while keeping their primary functions intact.…”

Washing of banked blood by three different blood salvage devices

“…Besides infections and immunological hazards, transfusion of banked red blood cells (RBC) is associated with an increased risk of cardiovascular events and multiple organ failure that arises from cell lesions and contaminants accumulating during storage. Morbidity and mortality are particularly increased in neonates and children, 1‐4 adults with renal or hepatic insufficiency, 5,6 and patients with massive hemorrhage 7‐9 . Transfusion‐associated hyperkalemia was identified as a major cause of cardiac arrest in neonates, children, trauma patients, and patients with massive transfusions.…”

“…In addition, washing also eliminates other products of storage lesions with high clinical relevance like fHb and potassium, but it is time‐ and cost‐consuming and not widely established. Instead, blood salvage devices with cell washing capabilities have been proposed for intraoperative application 2,5,14,16,17,23 . However, only limited data on their performance with RBCs are available, and concerns about this indication expansion and about the consistency of RBC quality have been raised 24 …”

Application of the continuous autotransfusion system (CATS) to prevent transfusion-related hyperkalemia following hyperkalemic cardiac arrest in an infant -A case report-

“…Therefore, we did not know the exact value. Nevertheless, according to several previous studies, it is assumed that the K + level might be, on average, 40 mM/L in non-irradiated RBCs [9] and 60 mM/L in the irradiated units [11,12]. In our case, supposing pre-processing value of 60 mM/L, K + was reduced only 67% after processing.…”

“…Similarly, the washing of the RBCs results in very low levels of residual K + [8]. The CATS autotransfusion system has been documented for a mean K + elimination rate of 97.3% [9]. This rate may vary, depending on the washing devices and modes.…”