Reducing the risk of hyperammonemia from transfusion of stored red blood cells

Apushkin, Marsha A.; Das, Anne; Joseph, Cherilyn; Leung, Edward Ki Yun; Yeo, Kiang-Teck J.; Baron, Joseph M.; Baron, Beverly W.

doi:10.1016/j.transci.2013.05.002

Cited by 7 publications

(4 citation statements)

References 11 publications

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“…In canine pRBC units, ammonia concentration increased over 35 days of storage, but when units of pRBC with high ammonia concentrations were transfused to anemic dogs, the recipient's plasma ammonia concentrations remained within the reference range (1–35 μmol/L) . Feline patients with hepatic insufficiency may have impaired hepatic processing of excess ammonia; thus, in cats where hepatic encephalopathy due to hyperammonemia is of concern, it may be prudent to consider a fresher blood unit for transfusion or to employ other methods to decrease ammonia concentration in stored blood, such as RBC washing or supernatant removal . Further prospective studies are warranted to support these recommendations.…”

Section: Discussionmentioning

confidence: 99%

The effect of storage on ammonia, cytokine, and chemokine concentrations in feline whole blood

Cummings

Abelson

Rozanski

et al. 2016

J Vet Emergen Crit Care

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Ammonia concentration increases with storage time in feline SWB. The clinical significance of this finding is yet to be determined. The presence of the proinflammatory chemokine CXCL-8 in feline SWB warrants further research to determine whether it can incite an inflammatory response in the recipient. Further research evaluating the epidemiology of transfusion reactions in cats should evaluate the effect of unit age, and should include the possible impact of the presence of CXCL-8.

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Section: Discussionmentioning

confidence: 99%

The effect of storage on ammonia, cytokine, and chemokine concentrations in feline whole blood

Cummings

Abelson

Rozanski

et al. 2016

J Vet Emergen Crit Care

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“…Blood transfusions led to increased ammonia levels in recipients. Although washing has been shown to be the only method for removing ammonia from RBC solutions, it cannot be used for small satellite packs. In this study, we demonstrate that PAF‐n, a newly introduced PAF for neonates, may be useful for removing potassium and ammonia from RBC solutions in small satellite packs.…”

Section: Discussionmentioning

confidence: 99%

“…PAF‐n is a novel strategy to eliminate the unnecessary administration of potassium and ammonia through RBC solutions in small satellite packs and is easier to use at the bedside compared to blood washing. While washing could remove ammonia completely from RBC solutions, PAF‐n was not as effective. The reason for this difference remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Use of potassium adsorption filter for the removal of ammonia and potassium from red blood cell solution for neonates

et al. 2018

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“…Delays in blood centrifugation and room temperature storage can lead to increased ammonia due to in vitro generation by ␥-glutamyltransferase (GGT) activity (4,5 ). Traumatic blood collection and hemolysis can increase ammonia, as red blood cells contain a high concentration of ammonia compared to plasma (6 ). Excess muscle activity (e.g., seizures) or muscle activity under ischemia (e.g., fist clenching with tourniquet) increases ammonia generation via AMP-deaminase activity (7 ).…”

Section: Discussionmentioning

confidence: 99%

Critically High Plasma Ammonia in an Adolescent Girl

et al. 2016

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A 12-year-old female patient presented with nonspecific symptoms including fatigue, fever, and headache persisting for approximately 4 months. Plasma ammonia was 230 g/dL (135 mol/L) (critical value Ͼ187 g/dL or 110 mol/L). The patient was referred to a pediatric emergency center for urgent evaluation of hyperammonemia. Plasma and urine amino acid testing was performed to investigate the possibility of a urea cycle disorder; however, all results were normal. Over the following 2 weeks, the patient was treated with intravenous sodium benzoate/sodium phenylacetate and L-arginine to reduce the blood ammonia concentration. However, the patient's ammonia concentration never dropped below 94 g/dL (55 mol/L) (upper limit of reference interval, 80 g/dL or 47 mol/L), with concentrations as high as 296 g/dL (174 mol/L) with inconsistent associations between ammonia concentrations and headaches. During the course of treatment, the patient suffered substantial side effects of intravenous therapy and underwent numerous costly clinical and laboratory investigations. Amino acid investigations were repeated but results remained normal. Given the large fluctuations in blood ammonia concentrations with inconsistent response to intravenous medications, the metabolic service contacted the laboratory to inquire about a possible preanalytical or analytical cause. One week before this query, a community physician also contacted the laboratory regarding hyperammonemia in several patients. However, no obvious preanalytical or analytical errors were discovered despite numerous audits of preanalytical conditions and review of quality control data.

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Reducing the risk of hyperammonemia from transfusion of stored red blood cells

Cited by 7 publications

References 11 publications

The effect of storage on ammonia, cytokine, and chemokine concentrations in feline whole blood

The effect of storage on ammonia, cytokine, and chemokine concentrations in feline whole blood

Use of potassium adsorption filter for the removal of ammonia and potassium from red blood cell solution for neonates

Critically High Plasma Ammonia in an Adolescent Girl

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