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

Knichwitz, Gisbert; Zahl, M.; Aken, Hugo Van; Semjonow, Axel; Booke, Michael

doi:10.1213/00000539-200208000-00015

Cited by 27 publications

(11 citation statements)

References 3 publications

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“…This difference may be a result of differing IRC processing protocols between hospitals. Cell saver removal rates for [K + ] found in the literature of 97.3% [13] are comparable with our study. The higher [K + ] observed at our institution further supports the investigation of the benefits of cell saver washing in order to reduce the potential effects of IRC transfusions.…”

Section: Discussionsupporting

confidence: 91%

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Washing of irradiated red blood cells prevents hyperkalaemia during cardiopulmonary bypass in neonates and infants undergoing surgery for complex congenital heart disease

Swindell

Barker

McGuirk

et al. 2007

European Journal of Cardio-Thoracic Surgery

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Objective: High concentrations of potassium and lactate in irradiated red cells transfused during cardiopulmonary bypass may have detrimental effects on infants and neonates undergoing cardiac surgery. The effects of receiving washed and unwashed irradiated red cells from the cardiopulmonary circuit on serum potassium and lactate concentrations were compared. Methods: The study population included neonates and infants undergoing heart surgery for complex congenital heart disease. A control group (n = 11) received unwashed irradiated red cells and the study group (n = 11) received irradiated red cells washed in a cell saver (Dideco Electa) using 900 ml of 0.9% saline prior to pump priming. Potassium and lactate concentrations were compared before, during and after bypass. Results: Washing irradiated red cells reduced donor blood [potassium] from > 20 to 0.8 AE 0.1 mmol/l, and [lactate] from 13.7 AE 0.5 to 5.0 AE 0.3 mmol/l ( p < 0.001). The resulting prime had significantly lower [potassium] and [lactate] than the unwashed group (potassium 2.6 AE 0.1 vs 8.1 AE 0.4 mmol/l, p < 0.001; lactate 2.6 AE 0.2 vs 4.6 AE 0.3 mmol/l, p < 0.001). Peak [potassium] in the unwashed group occurred 3 minutes after going on bypass (4.9 AE 0.3 mmol/l) and during rewarming (4.9 AE 0.4 mmol/l). These were significantly higher than the washed group (3.1 AE 0.1, p < 0.001 and 3.0 AE 0.1 mmol/l, p < 0.001). The [potassium] was greater than 6.0 mmol/l for 4 out of these 11 unwashed patients compared with none of the washed group. Immediately postbypass the washed group had significantly lower serum [potassium] (3.2 AE 0.1 vs 4.2 AE 0.2 mmol/l, p = 0.002). There was no significant difference in [lactate] between groups during and after cardiopulmonary bypass. Conclusions: The washing of irradiated red cells reduces potassium and lactate loads and prevents hyperkalaemia during cardiopulmonary bypass. The washing of irradiated red cells should be considered in neonates and infants undergoing cardiac surgery for complex congenital heart disease. #

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Section: Discussionsupporting

confidence: 91%

“…A number of studies have used similar devices for the removal of K + and saline washing has been shown to produce an effective K + reduction in all cases [1,12,13]. Modern cell saver devices such as the Dideco Electa (Sorin Group, Italy) used in this study have been designed to minimise haemolysis.…”

Section: Introductionmentioning

confidence: 99%

Washing of irradiated red blood cells prevents hyperkalaemia during cardiopulmonary bypass in neonates and infants undergoing surgery for complex congenital heart disease

Swindell

Barker

McGuirk

et al. 2007

European Journal of Cardio-Thoracic Surgery

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“…It has been postulated that washing removes debris, nonviable cells and unspecified metabolic breakdown products, thereby reducing possible sources of toxicity by removing supernatant hemoglobin, leukocytes and plasma. [9][10][11] Also, when older units of blood are used in massive transfusions, saline washing has been employed in an effort to reduce the risk of hyperkalemia. This latter rationale has been challenged, particularly when applied to less-than-massive volumes of blood transfused, because when small volumes are transfused, the major consideration for the patient is the total amount of K þ transfused and the transfusion rate.…”

Section: Discussionmentioning

confidence: 99%

Increased hemolysis from saline pre-washing RBCs or centrifugal pumps in neonatal ECMO

et al. 2007

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Objectives: Hemolysis is a significant complication of extracorporeal membrane oxygenation (ECMO), with a reported incidence of 12.2%. The aims of this study were (1) to investigate hemolysis caused by saline-washed versus unwashed RBCs, (2) to determine in vitro the effects of saline washing on erythrocyte hemolytic markers and (3) to investigate hemolysis by centrifugal versus roller pumps.Study design: (1) To evaluate the effect of pre-transfusion saline-washing versus non-washing, the peak plasma-free hemoglobin (FHb) and total bilirubin in the first 3 days versus the next 4 days of ECMO were compared (2) Pre-and postsaline-washed RBCs were analyzed for K þ , hemoglobin, mean corpuscular volume, FHb and hemolysis at baseline and after 4 h of storage at 41C. (3) Over 10 000 neonatal ECMO cases were retrospectively reviewed to study the effect of pump type on hemolysis.Results: (1) The washed blood group had significantly more hemolysis within the first 3 days of ECMO. (2) Immediately after saline washing, the K þ and Hb concentrations were significantly decreased compared with unwashed blood, and these differences were maintained after 4 h. The osmotic fragility of washed RBCs after 4 h of storage at 41C was significantly higher than at baseline. (3) Hemolysis was reported more often in the centrifugal than in the roller pump group.Conclusions: (1) Using unwashed RBCs decreased hemolysis within the first 3 days of ECMO. (2) Saline washing, while decreasing the concentration of K þ in the plasma, significantly increases RBC membrane osmotic fragility. (3) Hemolysis is linked to the use of centrifugal pumps.

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“…Others have processed in-date RBCs with a cellsaver and demonstrated a reduction in the toxicity of the suspension fluid [1][2][3]. However, this has been shown to induce some haemolysis, both at the time of processing and (when stored in vitro) for some hours afterwards [13].…”

Section: Discussionmentioning

confidence: 99%

“…Even for in-date RBCs, some authors have expressed concerns about high concentrations of potassium ions in the suspension fluid [1][2][3], and concentrations of hydrogen ions, lactate ions and free haemoglobin are potentially also of concern as storage time increases. During storage, RBCs develop a 'storage lesion' during storage, the early stages of which include suboptimal oxygen carriage and red cell deformability, and effects on the recipient's vascular tone and on immune system [4,5].…”

Section: Introductionmentioning

confidence: 99%

Conditioning out‐of‐date bank‐stored red blood cells using a cell‐saver auto‐transfusion device: effects on numbers of red cells and quality of suspension fluid

et al. 2014

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SummaryWe investigated the utility of a cell-saver device for processing out-of-date red blood cells, by washing twenty bags of red blood cells that had been stored for between 36 and 55 days. The volume of recovered cells, and the characteristics of the suspension fluid, were measured before and after treatment. The ratio of free haemoglobin to total haemoglobin was up to 0.02 before processing, and up to 0.011 afterwards, changing by between À0.013 and +0.003. This ratio met the current standard for free haemoglobin (less than 0.008 in more than 75% of samples

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

Cited by 27 publications

References 3 publications

Washing of irradiated red blood cells prevents hyperkalaemia during cardiopulmonary bypass in neonates and infants undergoing surgery for complex congenital heart disease

Washing of irradiated red blood cells prevents hyperkalaemia during cardiopulmonary bypass in neonates and infants undergoing surgery for complex congenital heart disease

Increased hemolysis from saline pre-washing RBCs or centrifugal pumps in neonatal ECMO

Conditioning out‐of‐date bank‐stored red blood cells using a cell‐saver auto‐transfusion device: effects on numbers of red cells and quality of suspension fluid

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