Levels of Hemolysis Markers in Erythrocyte Concentrates Administered Using a Syringe Infusion Pump

Abstract

Syringe infusion pumps (SIPs) led to major advances in infusion therapy and were gradually applied to the transfusion of packed red blood cells (RBCs), raising questions about possible cell damage. The objectives of this study were to determine levels of hematocrit (%), total hemoglobin (g/dL), free hemoglobin (g/dL), lactate dehydrogenase (units/L), potassium (mmol/L), the degree of hemolysis (%) of RBCs infused by an SIP, and to investigate the influence of the infusion rate. The experimental study comprised 14 RBCs, 3 SIPs, and infusion rates of 5, 10, and 20 mL/h. The results showed total hemoglobin reduction (P = .003), and increased free hemoglobin and hemolysis (P <.001) were identified. The conclusion reached was that RBCs presented changes in free hemoglobin and degree of hemolysis.

Effect of modern infusion pumps on RBC quality

“…An increase in hemolysis due to pumping has been reported to be higher in blood with higher Hct (higher viscosity) and higher initial hemolysis 3 . We did not observe such correlations, which might be due to our study design, where pooling units reduced the variation among Hct and hemolysis in the repeats.…”

“…Infusion pumps have been used for delivery of crystalloid solutions since the 1950s and then gradually merged into use for transfusing blood products. Compared to conventional gravity infusions, infusion pumps have the capacity to generate and monitor a consistent flow rate, ensure accuracy of infused volume, and decrease the chance of errors 1–4 . The pumps' built‐in safety features mitigate occlusion or change in rates for agitated patients and children.…”

“…conventional gravity infusions, infusion pumps have the capacity to generate and monitor a consistent flow rate, ensure accuracy of infused volume, and decrease the chance of errors. [1][2][3][4] The pumps' built-in safety features mitigate occlusion or change in rates for agitated patients and children. Flexibility of providing faster infusion rates compared to gravity, notably in units with higher hematocrit and thus viscosity, can lead to higher satisfaction in outpatient transfusions.…”

Impact of different syringe pumps on red cells during paediatric simulated transfusion

“…Despite their benefits, studies have shown that SIPs can cause red cell damage during blood administration, increasing the rate of haemolysis. 7 Haemolysis is defined as the rupture of the RBC membrane and can be classified as immune and non-immune. 8 Non-immune haemolysis occurs after manipulation and exposure of the cell by devices and equipment, which expose the components of the erythrocyte membrane to a shear stress, progressing to the loss of cell integrity and releasing haemoglobin and potassium into the plasma.…”

“…Despite their benefits, studies have shown that SIPs can cause red cell damage during blood administration, increasing the rate of haemolysis 7 …”