Stored platelet number and viscoelastic maximum amplitude are not altered by warming or rapid infusion

Hess, Aaron S.; Ramamoorthy, Jagan; Raife, Thomas J.; Hess, John R.

doi:10.1111/trf.15446

Cited by 12 publications

(11 citation statements)

References 26 publications

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“…They found a significant reduction in platelet count at 70 mL/min and 100 mL/min and differences in thrombin generation, but no reduction in the MA on TEG. Hess et al [ 14 ] performed 10 iterations of infusing platelets stored in plasma through a Belmont RI-2 and samples were evaluated using platelet count and TEG. They did not find any significant differences between pre-infusate and post-infusate.…”

Section: Discussionmentioning

confidence: 99%

Effects of a Single Rapid Infusion System on Platelet Function in Stored Whole Blood: An Ex Vivo Study

Sappenfield¹,

White²,

Pelletier³

et al. 2021

Cureus

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IntroductionRapid infusion systems (RIS) are used to warm and rapidly infuse crystalloids and blood products. Current guidelines do not approve of platelet transfusion through a RIS, but data supporting these guidelines are scarce. Our hypothesis was that an infusion of whole blood through a RIS would degrade platelet quantity, impede viscoelastic clot strength, and inhibit platelet aggregation response to adenosine diphosphate pathway (ADP) activation. MethodsTen iterations of a simulated scenario of transfusing whole blood via a single brand and make of RIS (Belmont Fluid Management System 2000, Belmont Medical Technologies, Billerica, MA) were performed. Units of whole blood, which were two to nine days old, were leukoreduced prestorage. Blood was used to prime the RIS and then warmed and infused at 100 mL/min into a reservoir. Blood samples were collected before and immediately after infusion. Samples were tested for platelet count, size, and viscoelastic clot strength using thromboelastographic and aggregation assays. ResultsThe study sample (n = 10) included platelets with an average age of 5.3 days. The infusion through the RIS had a detrimental effect on all the maximal amplitudes (MA) of viscoelastic testing: MA ADP

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Section: Discussionmentioning

confidence: 99%

Effects of a Single Rapid Infusion System on Platelet Function in Stored Whole Blood: An Ex Vivo Study

Sappenfield¹,

White²,

Pelletier³

et al. 2021

Cureus

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show abstract

“…Specifically, we intent to monitor the hemolytic rate before and after unwarmed and warmed transfusions using the sensitive metric of end-tidal carbon monoxide. 17 Platelets could potentially be damaged by an inline warmer, but Hess et al 18 found no adverse effect of a warmer on PLT count or PLT function, using an in vitro simulation of adult-type transfusions. Similarly, we found no evidence of PLT damage using our NICU transfusion simulation.…”

Section: Discussionmentioning

confidence: 99%

Warming blood products for transfusion to neonates: In vitro assessments

et al. 2020

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Background Blood products may be transfused into neonates at temperatures at or below room temperature. The benefits and risks of warming blood to 37°C are not defined in this population or with the equipment used in neonates. Physiologic warming might enhance product effectiveness or decrease transfusion‐associated hypothermia. Study Design and Methods We utilized an in vitro model of neonatal transfusions, with a syringe pump, blood tubing, and 24‐gauge catheter and compared current practice (cold products) vs an inline blood warmer. Transfusions were performed rapidly (30 minutes) and slower (120 minutes) to model emergent vs routine situations. We tested red blood cells, fresh‐frozen plasma, apheresis platelets (PLTs), and cold‐stored low‐titer group O whole blood. We used infrared detectors and inline probes to measure temperatures at the origin and at the simulated patient. We assessed warmer‐induced damage by measuring plasma hemoglobin and hematocrit (seeking hemolysis), fibrinogen (seeking activation of coagulation), and PLT count and TEG‐MA (seeking PLT destruction or dysfunction). Results The cold‐stored products were 4.2 ± 1.0°C (mean ± SD) at the origin and 21.5 ± 0.1°C at the patient. With the inline warmer, products were 37.8 ± 0.6°C at the warmer and 32.6 ± 1.7°C at the patient during a 30‐minute infusion, but were 34.5 ± 2.1 with a foil sheath covering the terminal tubing. We found no warmer‐induced damage using any metric. Conclusion In simulated neonatal intensive care unit (NICU) transfusions, an inline blood warmer can deliver blood products at near‐physiologic temperatures with no detected damage. We suggest in vivo testing of warmed NICU transfusions, assessing product effectiveness and hypothermia risk reduction.

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“…Rapid infusion was studied using a 300 mm Hg pressure bag and was not shown to reduce aggregation. Hess and colleagues 8 infused (n = 10) 5‐ to 7‐day‐old apheresis PLT units through a Ranger blood warming device and found no decease in PLT count and TEG MA as a measure of PLT function. Rapid infusion of apheresis PLT units at 500 mL/min via a rapid infusion system (Belmont) also did not reduce PLT count or TEG MA.…”

Section: Discussionmentioning

confidence: 99%

“…Despite these guidelines, many anesthesia providers infuse PLT transfusions through warming devices in supplementary efforts to prevent perioperative hypothermia and its harsh complications 3,6 . There are now three small (each study n = 10) in vitro studies that show infusion of PLT units through blood warmers does not impair PLT function 6–8 …”

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confidence: 99%

Platelet transfusion: The effects of a fluid warmer on platelet function

et al. 2020

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Background Platelet (PLT) transfusions are an important component of hemostatic resuscitation. The AABB has published several guidelines recommending that PLT units should not be infused through blood warming devices. Study Design and Methods Thirty‐one units of hospital blood bank apheresis PLTs were obtained. PLT‐rich plasma (PRP) aggregometry and thromboelastography (TEG) were performed on the unit samples before and after the units were infused through a Ranger blood/fluid warming device. Results There were no differences in any of the aggregometry results before and after infusion of the PLTs through the blood warmer (all P > .32). There was a significant reduction in the TEG maximum amplitude (MA) of 69.8 ± 7.9 mm before and 66.0 ± 8.8 mm after (P < .001) infusion of the PLTs through the blood warmer and α angle 61.8 ± 9.4° before and 59.3 ± 8.2° after (P = .044) infusion of the PLTs through the blood warmer, although both mean values were within normal range for the TEG and not clinically significant. There were very good correlations of aggregometry and TEG results before and after infusion of the PLTs through the blood warmer device. Conclusion This study did not demonstrate significant deleterious effect on PLT function from infusing apheresis PLT units through a blood warming device by PRP aggregometry. We did detect a statistically significant—but not clinically significant—reduction in TEG MA and α angle. The prohibition of transfusing PLT units though the Ranger blood warming device is not indicated.

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Stored platelet number and viscoelastic maximum amplitude are not altered by warming or rapid infusion

Cited by 12 publications

References 26 publications

Effects of a Single Rapid Infusion System on Platelet Function in Stored Whole Blood: An Ex Vivo Study

Effects of a Single Rapid Infusion System on Platelet Function in Stored Whole Blood: An Ex Vivo Study

Warming blood products for transfusion to neonates: In vitro assessments

Platelet transfusion: The effects of a fluid warmer on platelet function

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