This study aimed to compare washed red blood cell (WRBC) transfusion versus nonwashed RBC (NWRBC) transfusion in terms of posttransfusion potassium levels in dialysis patients on a day when the patient did not receive dialysis.

The patients were randomly assigned into two groups, i.e. those receiving WRBCs (n = 21) and those receiving NWRBCs (n = 17). Both groups received one unit of RBCs. Serum potassium and sodium levels were measured before and at the 1st, 2nd, 3rd, 4th, and 6th hours after transfusion.

In the WRBC group, the changes in the serum potassium levels at the 3rd, 4th, and 6th hours after transfusion were significant compared with pretransfusion levels. In the serum potassium levels mean decreases by 0.38 ± 0.57 mEq/L at the 3rd hour (P = 0.006), by 0.32 ± 0.47 mEq/L at the 4th hour (P = 0.005), and by 0.32 ± 0.51 mEq/L at the 6th hour (P = 0.009) after transfusion were significant compared with the pretransfusion levels.

Although nonwashed RBC transfusion does not change serum potassium levels, washed RBC transfusion significantly reduces serum potassium levels. Washed RBC transfusion is considered to be safer in hemodialysis patients with hyperkalemia and anemia.

The irradiation of red blood cells (RBCs) causes damage of the RBC membrane with increased potassium (K) leak during storage compared with nonirradiated RBC units of similar age. A previous in vitro study showed a mean reduction of K of 94 ± 5% with a potassium adsorption filter (PAF).

A prospective, single-center, nonblinded, randomized controlled trial (RCT) was designed to evaluate the safety and efficacy of transfusing irradiated RBC units with the PAF. Patients 18 years of age or older who received irradiated RBC units due to chemotherapy-induced anemia were randomly assigned to receive irradiated RBC units with the PAF (PAF group) or with the standard blood infusion set (control group). Primary outcome measures were safety and efficacy of the PAF (absolute change in hemoglobin [Hb] and K, respectively, in patient's blood values after transfusing the irradiated RBC units with or without the PAF).

A total of 63 irradiated RBC units were transfused to 17 patients in the control group, and a total of 56 irradiated RBC units were transfused to 13 patients in the PAF group. The absolute change of Hb (9.3 ± 6.3 g/L vs. 8.1 ± 5.8 g/L; p = 0.3) and the absolute change of K (-0.01 ± 0.4 mmol/L vs. -0.01 ± 0.3 mmol/L; p = 0.2) were comparable between the two groups of the trial.

The transfusion of 1 irradiated RBC unit with the PAF was as safe and efficacious as the transfusion of 1 irradiated RBC unit with the standard blood infusion set in patients with chemotherapy-induced anemia.

A K(+) -adsorption filter was developed to exchange K(+) in the supernatant of stored irradiated red blood cells with Na(+) . To date, however, the filter's adsorption capacity for K(+) has not been fully evaluated. Therefore, we characterized the cation-binding capacity of this filter. Artificial solutions containing various cations were continuously passed through the filter in 30 mL of sodium polystyrene sulfonate at 10 mL/min using an infusion pump at room temperature. The cation concentrations were measured before and during filtration. When a single solution containing K(+) , Li(+) , H(+) , Mg(2+) , Ca(2+) , or Al(3+) was continuously passed through the filter, the filter adsorbed K(+) and the other cations in exchange for Na(+) in direct proportion to the valence number. The order of affinity for cation adsorption to the filter was Ca(2+) >Mg(2+) >K(+) >H(+) >Li(+) . In K(+) -saturated conditions, the filter also adsorbed Na(+) . After complete adsorption of these cations on the filter, their concentration in the effluent increased in a sigmoidal manner over time. Cations that were bound to the filter were released if a second cation was passed through the filter, despite the different affinities of the two cations. The ability of the filter to bind cations, especially K(+) , should be helpful when it is used for red blood cell transfusion at the bedside. The filter may also be useful to gain a better understanding of the pharmacological properties of sodium polystyrene sulfonate.

In a randomized controlled blinded trial, 2-year-old purpose-bred beagles (n = 24), with Staphylococcus aureus pneumonia, were exchanged-transfused with either 7- or 42-day-old washed or unwashed canine universal donor blood (80 mL/kg in 4 divided doses). Washing red cells (RBC) before transfusion had a significantly different effect on canine survival, multiple organ injury, plasma iron, and cell-free hemoglobin (CFH) levels depending on the age of stored blood (all, P < .05 for interactions). Washing older units of blood improved survival rates, shock score, lung injury, cardiac performance and liver function, and reduced levels of non-transferrin bound iron and plasma labile iron. In contrast, washing fresh blood worsened all these same clinical parameters and increased CFH levels. Our data indicate that transfusion of fresh blood, which results in less hemolysis, CFH, and iron release, is less toxic than transfusion of older blood in critically ill infected subjects. However, washing older blood prevented elevations in plasma circulating iron and improved survival and multiple organ injury in animals with an established pulmonary infection. Our data suggest that fresh blood should not be washed routinely because, in a setting of established infection, washed RBC are prone to release CFH and result in worsened clinical outcomes.

Pediatric patients who receive large volume blood transfusions are at risk for experiencing transfusion-related hyperkalemic cardiac arrest. Prebypass ultrafiltration of blood used to prime cardiopulmonary bypass circuits is commonly used in pediatric cardiac surgery to create a more physiologic and electrolyte balanced priming solution prior to initiation of cardiopulmonary bypass. This study was undertaken to determine the efficacy of prebypass ultrafiltration in normalizing extracorporeal life support circuit priming solution before initiating extracorporeal life support.

Prospective study.

PICU and neonatal ICU in a tertiary academic center.

Patients requiring venovenous extracorporeal life support.

Prebypass ultrafiltration of extracorporeal life support circuits.

Hematocrit, electrolyte, and lactate concentrations were measured in blood-primed extracorporeal life support circuits before and after ultrafiltration and in blood collected from patients before and after initiation of extracorporeal life support. Clinically significant elevation of K concentration was observed in all extracorporeal life support circuits prior to prebypass ultrafiltration, despite the fact that 93% of red blood cell units were collected ≤ 7 days prior to use. Prebypass ultrafiltration significantly reduced concentrations of K (10.9 vs 6.0 mEq/L, p = 0.001) and lactate (7.0 vs 3.6 mmol/L, p < 0.001) and increased hematocrit (37% vs 48%, p < 0.001) and concentrations of ionized calcium (0.64 vs 1.16 mg/dL, p < 0.001) and Na (129 vs 144 mEq/L, p < 0.001). Serum electrolyte concentrations remained within the normal physiologic range in all patients following initiation of venovenous extracorporeal life support with circuits that underwent prebypass ultrafiltration.

Prebypass ultrafiltration normalizes the electrolyte balance of blood-primed extracorporeal life support circuits. Prebypass ultrafiltration processing may reduce the risk of transfusion-related hyperkalemic cardiac arrest in small children who require venovenous extracorporeal life support.

Prevention of transfusion-associated graft versus host disease (TA-GVHD) by gamma irradiation is known to induce increased K+ in supernatant of packed red blood cells (PRBCs) stored in CPDA-1 and SAGM conservative solutions. However, no data exist for PRBCs in AS-3 medium which is considered safe for neonatal transfusion. We evaluated haemolysis and K+ release from irradiated AS-3 PRBCs and compared our results with reported data for SAGM and CPDA-1 PRBCs. Our results indicate that irradiated PRBCs stored in AS-3 after more than 7 days post-irradiation should not be used in massive and/or rapidly infused transfusions in neonates and infants.

Storage lesions in red blood cells (RBCs) lead to an accumulation of soluble contaminants that can compromise the patient. Organ failures, coagulopathies, and cardiovascular events including lethal cardiac arrest have been reported, especially with massive transfusion or in pediatric patients. Washing improves the quality of stored RBCs, and autotransfusion devices have been proposed for intraoperative processing, but these devices were designed for diluted wound blood, and limited data on their performance with RBCs are available.

Three autotransfusion devices (Electa, Sorin; CATS, Fresenius; OrthoPAT, Haemonetics) differing in function of their centrifugation chambers were evaluated with RBCs at the end of their shelf life and with dilutions thereof. Elimination rates of potassium, plasma free hemoglobin, total protein, citrate, acid equivalents, and iomeprol added as a marker substance were analyzed, in addition to RBC recoveries.

Product hematocrit (Hct) levels ranged between 54.8 and 72.6%. RBC recovery rates were between 62.7 and 95.0%, the lowest being with the OrthoPAT processing of undiluted RBCs. Plasma elimination rates increased with predilution and ranged from 46.6% to 99.5%, the lowest being with the CATS and undiluted RBCs. Washing did not change pH and buffering capacity of RBCs.

Autotransfusion devices offer a practical and obviously economical option to wash banked RBCs intraoperatively to prevent hyperkalemia and other disturbances in massive transfusion or pediatric patients. Predilution improves elimination rates, especially in devices that produce high product Hct levels. With a Y-tubing the RBCs should bypass reservoir and vacuum, and the procedure should be guarded by a policy and procedure manual and a quality management system.

Transfusion-induced hyperkalemia can lead to cardiac arrest, especially when the patient rapidly receives a large amount of red blood cells (RBCs), previously stored for a long period of time, irradiated or both. We report on a case of application of the Continuous AutoTransfusion System (CATS) to wash RBCs, in order to lower the high potassium (K(+)) level in the packed RBCs unit, during massive transfusion following transfusion-induced hyperkalemic cardiac arrest. After the washing process using CATS, there was no more electrocardiographic abnormality or cardiac arrest due to hyperkalemia. This case emphasizes the potential risk to develop transfusion-related hyperkalemic cardiac arrest, during massive transfusion of irradiated, pre-stored RBCs. CATS can be effectively used to lower the K(+) concentration in the packed RBCs unit, especially when the risk of transfusion-induced hyperkalemia is high.

During storage of red blood cells (RBC), these cells develop storage lesions. The clinical relevance of these storage lesions is heavily discussed in literature. In this review, different aspects of the storage lesion are shown and how these potentially affect posttransfusion performance of the RBC. An overview of the conflicting literature on the clinical relevance of prolonged storage is given, summarizing the evidence on associations with mortality, length of stay, (postoperative) infections and organ failure. Subsequently, possible explanations are given for the conflicting results in the clinical studies and suggestions on how to proceed.

In subsets of pediatric cardiac surgery patients, red blood cells (RBCs) are often washed to reduce extracellular potassium (K) to avoid hyperkalemia, but mechanical manipulation and time delay in issuing washed products may increase hemolysis and K. This study's purpose was to evaluate the quality of washed RBCs with regard to hemolysis and extracellular K using different cell washers as a function of postprocessing time.

Fresh (<4 days old) RBCs were washed on COBE 2991 blood cell processors (Model 1 and Model 2) or the Fresenius Continuous AutoTransfusion System (CATS), and K and hemolysis index (HI) were analyzed. Academic pediatric hospitals were surveyed to ascertain practice trends regarding indications for washing, washing device, and expiration time for washed RBCs.

K concentration at 24 hours for units washed with the COBE devices met or exceeded prewash values. At 12 hours, there was a significant difference (p < 0.001) in K concentration between all devices, with the CATS maintaining the lowest K concentration. HI increased immediately after wash on all devices and showed a significant difference between the COBE devices and CATS at times of more than 6 hours (p < 0.01). At storage times beyond 4 hours, hemoglobin exceeded 100 mg/dL on the COBE Model 1. Survey of pediatric hospitals indicated that COBE devices are commonly used, and storage time after washing was 12 hours or more in blood banks queried.

Hemolysis levels vary among different cell washers. Decreasing the expiration time of units after washing may be warranted.

Blood transfusion remains an essential treatment of acute anemia. Current storage processes allow the efficient administration of blood products. Erythrocytes undergo morphological and biochemical changes during storage that may affect outcomes after transfusion. A reliable small-animal model would be ideal to examine the effects of stored blood products after transfusion. The objective of this study was to characterize the storage of murine erythrocytes for future application to animal models of acute anemia. Blood samples were collected from male mice and human volunteers, separated into components, and stored. At intervals, morphological and biochemical analysis was performed. Lactate, potassium, hemoglobin, and hemolysis were determined, and cell morphology was evaluated with light microscopy. Murine packed red blood cells (pRBCs) aged more rapidly than human samples. Murine pRBCs exhibited higher lactate levels (34.9 +/- 1.3 mmol/L vs. 18.1 +/- 1.0 mmol/L, mouse vs. human) and more severe acidosis as indicated by pH (6.56 +/- 0.02 vs. 6.79 +/- 0.04, mouse vs. human). Murine pRBCs hemolyzed earlier (11.2 +/- 3.7 g vs. 0.7 +/- 0.3 g, mouse vs. human after 21 days of storage) and more rapidly than human pRBCs. Corpuscular changes consistent with red cell storage lesions appeared earlier in murine samples compared with human stored pRBCs. Compared with human pRBCs, murine pRBCs exhibit similar but more accelerated aging processes under standard storage conditions. Characterization of the murine red cell storage lesion will allow the application of stored blood components to future investigations into the treatment of acute anemia in experimental murine models.

During storage, red blood cells intended for transfusion undergo progressive changes affecting survival and function. Some of these in vitro changes are partly restored in vivo after transfusion, and their clinical effects are largely unknown. We evaluated publications of clinical studies comparing storage times in connection with red blood cell transfusion using physiological or clinical outcomes. A few prospective randomised studies in humans investigated physiological outcomes or oxygen kinetics. Sixteen observational studies comparing clinical outcome yielded contradictory results regarding the effect of red cell storage on mortality, length of intensive care and hospital stay, infections, organ failure, and composite adverse effects. The use of different red blood cell products further obscures the issue. Available studies provide no evidence that longer stored red cells are more harmful than younger red cells. However, such an effect may occur under extreme clinical conditions of severe anaemia or septicaemia, but this can only be answered by randomised studies controlling for confounding factors.

Published analyses of clinical outcomes for patients requiring large-volume blood transfusion conflict with respect to the impact upon plasma potassium levels. We analyzed a cohort of trauma patients to ascertain the impact of component product transfusion upon plasma potassium values.

We performed an observational analysis of previously, prospectively collected clinical data on 131 noncrush trauma patients undergoing resuscitation during the initial 12 hours after admission to a combat support hospital. Comparisons were made between those who received packed red blood cell (PRBC) transfusion and those who did not. Primary outcome was hyperkalemia (plasma potassium level >5.5 mmol/L).

Ninety-six of one hundred thirty-one patients (73.3%) received PRBCs (mean number of PRBC units 11.2, range, 0-55.0). For transfusion versus nontransfusion patients, baseline plasma potassium value (3.7 +/- 0.57 mmol/L vs. 3.6 +/- 0.36 mmol/L, p = 0.22) rose significantly after transfusion (5.3 +/- 1.2 mmol/L, vs. 4.0 +/- 0.78 mmol/L, p < 0.001). During the study period, 38.5% of transfusion patients developed hyperkalemia, versus 2.9% of those who did not (p = 0.003). In multivariate logistic regression analysis, transfusion of greater than 7 units of PRBCs was independently associated with the development of hyperkalemia (RR 4.72, 95% CI 1.01-21.97, p = 0.048). Transfusion of other cell-based products, baseline base deficits, and plasma bicarbonate levels were not. Spearman's rank correlation coefficient for the relationship of number of transfused PRBC units to the highest recorded potassium value was 0.554 (p < 0.001). The predictive accuracy of the logistic regression model for hyperkalemia was 0.824 (95% CI 0.747-0.901, p < 0.001).

Hyperkalemia is common after PRBC transfusion, and often severe. PRBC transfusion is independently associated with the development of hyperkalemia. The findings suggest the need for interventional studies examining the impact of alternative resuscitative approaches after severe trauma.

This study compared the effect of unprocessed and processed packed red blood cells (PRBCs) with the continuous autotransfusion system (CATS) during neonate heart surgery. Sixteen neonatal patients undergoing cardiac surgery were randomly divided into two groups: unprocessed PRBC (C group, n = 8); processed PRBC (P group, n = 8). The CATS was employed perioperatively. Series laboratory and clinical parameters, including levels of hematocrit, blood potassium, blood glucose, blood lactate, acid-base, and total priming volume of PRBC, were used to compare the effect between the two groups. Before CPB, the hematocrit of processed PRBCs in P group was significantly higher than those in C group (p < 0.01), and the concentrations of potassium, blood glucose, and lactate of processed PRBCs in P group were significantly lower than those in C group (p < 0.01). At the beginning and the end of CPB, the hematocrit levels in P group were all higher than those in C group (p < 0.05); lactate levels in P group were significantly lower than those in C group at the beginning of CPB (p < 0.01), and lower than that of C group at the end of CPB (p < 0.05). The total priming of PRBCs in P group was significantly less than that in C group (p < 0.01). Perioperative processing with CATS provided a high-quality RBC concentration, decreased the total priming of PRBCs, providing increased high-quality blood salvage during neonatal CPB procedure.