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Wang Y, Rao Q, Li X. Adverse transfusion reactions and what we can do. Expert Rev Hematol 2022; 15:711-726. [PMID: 35950450 DOI: 10.1080/17474086.2022.2112564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Transfusions of blood and blood components have inherent risks and the ensuing adverse reactions. It is very important to understand the adverse reactions of blood transfusion comprehensively for ensuring the safety of any future transfusions. AREAS COVERED According to the time of onset, adverse reactions of blood transfusion are divided into immediate and delayed transfusion reactions. In acute transfusion reactions, timely identification and immediate cessation of transfusion is critical. Vigilance is required to distinguish delayed responses or reactions that present non-specific signs and symptoms. In this review, we present the progress of mechanism, clinical characteristics and management of commonly encountered transfusion reactions. EXPERT OPINION The incidence of many transfusion-related adverse events is decreasing, but threats to transfusion safety are always emerging. It is particularly important for clinicians and blood transfusion staff to recognize the causes, symptoms and treatment methods of adverse blood transfusion reactions to improve the safety. In the future, at-risk patients will be better identified and can benefit from more closely matched blood components.
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Affiliation(s)
- Yajie Wang
- Department of Blood Transfusion, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Quan Rao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xiaofei Li
- Department of Blood Transfusion, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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2
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Wolf J, Geneen LJ, Meli A, Doree C, Cardigan R, New HV. Hyperkalaemia Following Blood Transfusion–a Systematic Review Assessing Evidence and Risks. Transfus Med Rev 2022; 36:133-142. [DOI: 10.1016/j.tmrv.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
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3
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Nollet KE, Ngoma AM, Ohto H. Transfusion-associated graft-versus-host disease, transfusion-associated hyperkalemia, and potassium filtration: Advancing safety and sufficiency of the blood supply. Transfus Apher Sci 2022; 61:103408. [DOI: 10.1016/j.transci.2022.103408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Burke M, Sinha P, Luban NLC, Posnack NG. Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients. Front Pediatr 2021; 9:765306. [PMID: 34778153 PMCID: PMC8586075 DOI: 10.3389/fped.2021.765306] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/29/2021] [Indexed: 01/05/2023] Open
Abstract
Red blood cell (RBC) transfusions are a life-saving intervention, with nearly 14 million RBC units transfused in the United States each year. However, the safety and efficacy of this procedure can be influenced by variations in the collection, processing, and administration of RBCs. Procedures or manipulations that increase potassium (K+) levels in stored blood products can also predispose patients to hyperkalemia and transfusion-associated hyperkalemic cardiac arrest (TAHCA). In this mini review, we aimed to provide a brief overview of blood storage, the red cell storage lesion, and variables that increase extracellular [K+]. We also summarize cases of TAHCA and identify potential mitigation strategies. Hyperkalemia and cardiac arrhythmias can occur in pediatric patients when RBCs are transfused quickly, delivered directly to the heart without time for electrolyte equilibration, or accumulate extracellular K+ due to storage time or irradiation. Advances in blood banking have improved the availability and quality of RBCs, yet, some patient populations are sensitive to transfusion-associated hyperkalemia. Future research studies should further investigate potential mitigation strategies to reduce the risk of TAHCA, which may include using fresh RBCs, reducing storage time after irradiation, transfusing at slower rates, implementing manipulations that wash or remove excess extracellular K+, and implementing restrictive transfusion strategies.
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Affiliation(s)
- Morgan Burke
- School of Medicine, George Washington University, Washington, DC, United States
| | - Pranava Sinha
- Department of Pediatrics, School of Medicine, George Washington University, Washington, DC, United States.,Division of Cardiac Surgery, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States
| | - Naomi L C Luban
- Department of Pediatrics, School of Medicine, George Washington University, Washington, DC, United States.,Department of Pathology, School of Medicine, George Washington University, Washington, DC, United States.,Division of Hematology and Laboratory Medicine, Children's National Hospital, Washington, DC, United States
| | - Nikki Gillum Posnack
- Department of Pediatrics, School of Medicine, George Washington University, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States.,Department of Pharmacology & Physiology, School of Medicine, George Washington University, Washington, DC, United States.,Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States
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5
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Fujita H, Teratani M, Hazama Y, Nakahara M, Asaka H, Nishimura S. Use of potassium adsorption filter for the removal of ammonia and potassium from red blood cell solution for neonates. Transfusion 2018; 58:2383-2387. [PMID: 30178874 DOI: 10.1111/trf.14897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/12/2018] [Accepted: 07/12/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Ammonia in the plasma usually does not pass through the blood-brain barrier (BBB). However, it can affect the brain as a neurotoxin in neonates with anemia of prematurity. Excess intake of ammonia should therefore be restricted in conditions involving BBB breakdown, such as in premature neonates. A potassium adsorption filter (PAF) can remove not only potassium, but also ammonia from red blood cell (RBC) solution. PAF for neonates (PAF-n) has been recently introduced using small satellite packs. We evaluated the effects of PAF-n on the removal of ammonia and potassium from RBC solution in small satellite packs. STUDY DESIGN AND METHODS RBC solutions were obtained from the Japanese Red Cross Society. Two units of RBC solution (280 mL) were divided into four satellite packs (70 mL/pack). The RBC solution was passed through PAF-n (Kawasumi Laboratories Inc.) that was primed with saline (100 mL) before use. The concentrations of ammonia and potassium were measured in the solution before and after filtration (four samples of 10 mL each of filtered RBC solution) by Biomedical Laboratories. RESULTS Approximately 47 to 82 and 84% to 93% of ammonia and potassium were removed from the RBC solution, respectively, without dilution with saline. CONCLUSION PAF-n can remove ammonia and potassium from RBC solution in small satellite packs. PAF-n could therefore improve the clinical prognosis of neonates with poorly developed BBB by limiting the delivery of excess ammonia found in the RBC solution.
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Affiliation(s)
- Hiroshi Fujita
- Department of Transfusion Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Miyuki Teratani
- Clinical Laboratory, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yuki Hazama
- Clinical Laboratory, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Michiyo Nakahara
- Clinical Laboratory, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Hiroyuki Asaka
- Clinical Laboratory, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Shigeko Nishimura
- Department of Transfusion Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
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6
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Effects of potassium adsorption filters on the removal of ammonia from blood products. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 16:173-177. [PMID: 28287384 DOI: 10.2450/2017.0231-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/09/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although ammonia in plasma does not usually pass through the blood-brain barrier (BBB), in cases of traumatic brain injury it may do so, acting as a neurotoxin on the brain. Excess intake of ammonia should be restricted in conditions involving BBB breakdown, such as traumatic brain injury. Washing is a method to remove ammonia from blood products, but fresh-frozen plasma and albumin products cannot be washed. A potassium adsorption filter (PAF) can remove not only potassium, but also ammonia from red blood cell solutions. We, therefore, examined the effects of a PAF on the removal of ammonia from a range of blood products. MATERIALS AND METHODS Ammonia concentrations were measured in expired red blood cell solutions, fresh-frozen plasma, and platelet concentrates and purchased albumin products before and after filtration through a PAF. The PAF was primed with saline, which was removed before the filter was used. RESULTS The percentages of ammonia removal from the red blood cell solutions, fresh-frozen plasma, plasma concentrates, 20% albumin and 5% albumin were approximately 76-87%, 21-31%, 53%, 77-92% and 49-63%, respectively. DISCUSSION A PAF appears capable of removing ammonia from a range of blood products, although the reason for the lesser effect on the ammonia concentration in fresh-frozen plasma compared to other blood products remains unknown. We hypothesise that, by lowering ammonia levels in blood products, the PAF could improve the clinical prognosis of neonates with an underdeveloped BBB or patients with BBB breakdown following traumatic brain injury.
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Delaney M, Wendel S, Bercovitz RS, Cid J, Cohn C, Dunbar NM, Apelseth TO, Popovsky M, Stanworth SJ, Tinmouth A, Van De Watering L, Waters JH, Yazer M, Ziman A. Transfusion reactions: prevention, diagnosis, and treatment. Lancet 2016; 388:2825-2836. [PMID: 27083327 DOI: 10.1016/s0140-6736(15)01313-6] [Citation(s) in RCA: 244] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Blood transfusion is one of the most common procedures in patients in hospital so it is imperative that clinicians are knowledgeable about appropriate blood product administration, as well as the signs, symptoms, and management of transfusion reactions. In this Review, we, an international panel, provide a synopsis of the pathophysiology, treatment, and management of each diagnostic category of transfusion reaction using evidence-based recommendations whenever available.
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Affiliation(s)
- Meghan Delaney
- Bloodworks NW, Seattle, WA, USA; University of Washington, Department of Laboratory Medicine, Seattle, WA, USA.
| | | | | | - Joan Cid
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clínic, UB, Barcelona, Spain
| | - Claudia Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Nancy M Dunbar
- Department of Pathology and Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Torunn O Apelseth
- Laboratory of Clinical Biochemistry and Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Simon J Stanworth
- NHS Blood and Transplant/Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK; Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alan Tinmouth
- Department of Medicine and Department of Laboratory Medicine & Pathology, University of Ottawa, Ottawa, ON, Canada; University of Ottawa Centre for Transfusion Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Jonathan H Waters
- Department of Anesthesiology & Bioengineering, University of Pittsburgh & McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA
| | - Mark Yazer
- Division of Transfusion Medicine, Department of Pathology, University of Pittsburgh, Institute for Transfusion Medicine, Pittsburgh, PA, USA
| | - Alyssa Ziman
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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8
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Cid J, Villegas V, Carbassé G, Alba C, Perea D, Lozano M. Transfusion of irradiated red blood cell units with a potassium adsorption filter: A randomized controlled trial. Transfusion 2016; 56:1046-51. [PMID: 26923301 DOI: 10.1111/trf.13536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/16/2016] [Accepted: 01/18/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND 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). STUDY DESIGN AND METHODS 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). RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Joan Cid
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clínic, University de Barcelona, Barcelona, Spain
| | - Vanessa Villegas
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clínic, University de Barcelona, Barcelona, Spain
| | - Gloria Carbassé
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clínic, University de Barcelona, Barcelona, Spain
| | - Cristina Alba
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clínic, University de Barcelona, Barcelona, Spain
| | - Dolores Perea
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clínic, University de Barcelona, Barcelona, Spain
| | - Miguel Lozano
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clínic, University de Barcelona, Barcelona, Spain
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9
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Fujita H, Shiotani Y, Takada Y, Nishimura S. Effects of using potassium adsorption filters on salinefilled and saline-removed methods for the removal of potassium from red blood cell solutions. ACTA ACUST UNITED AC 2016. [DOI: 10.7243/2052-6962-4-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Fujita H, Okuda M, Ohara A, Kajiwara M, Koyama N, Takano H, Hosono S, Matsuzaki K, Yazawa Y, Maeda H, Miyata S. STANDARDIZED METHODS FOR IN-HOUSE SEPARATION OF A BLOOD PRODUCT FOR MULTIPLE USE. ACTA ACUST UNITED AC 2016. [DOI: 10.3925/jjtc.62.673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hiroshi Fujita
- Task Force on Standardized Methods for In-house Separation of a Blood Product for Multiple Use, Committee on Appropriate Blood Product Modifications, The Japan Society of Transfusion Medicine and Cell Therapy
- Department of Transfusion Medicine, Tokyo Metropolitan Bokutoh Hospital
| | - Makoto Okuda
- Task Force on Standardized Methods for In-house Separation of a Blood Product for Multiple Use, Committee on Appropriate Blood Product Modifications, The Japan Society of Transfusion Medicine and Cell Therapy
- Division of Blood Transfusion, Toho University Omori Medical Center
| | - Akira Ohara
- Task Force on Standardized Methods for In-house Separation of a Blood Product for Multiple Use, Committee on Appropriate Blood Product Modifications, The Japan Society of Transfusion Medicine and Cell Therapy
- Department of Pediatrics, Toho University School of Medicine
| | - Michiko Kajiwara
- Task Force on Standardized Methods for In-house Separation of a Blood Product for Multiple Use, Committee on Appropriate Blood Product Modifications, The Japan Society of Transfusion Medicine and Cell Therapy
- Department of Transfusion Medicine, Medical Hospital, Tokyo Medical and Dental University
| | - Norihisa Koyama
- Task Force on Standardized Methods for In-house Separation of a Blood Product for Multiple Use, Committee on Appropriate Blood Product Modifications, The Japan Society of Transfusion Medicine and Cell Therapy
- Department of Pediatrics, Toyohashi Municipal Hospital
| | - Hisayo Takano
- Task Force on Standardized Methods for In-house Separation of a Blood Product for Multiple Use, Committee on Appropriate Blood Product Modifications, The Japan Society of Transfusion Medicine and Cell Therapy
- Division of Blood Transfusion, St Mary's Hospital
| | - Shigeharu Hosono
- Task Force on Standardized Methods for In-house Separation of a Blood Product for Multiple Use, Committee on Appropriate Blood Product Modifications, The Japan Society of Transfusion Medicine and Cell Therapy
- Department of Pediatrics and Child Health, Nihon University School of Medicine
| | - Koji Matsuzaki
- Task Force on Standardized Methods for In-house Separation of a Blood Product for Multiple Use, Committee on Appropriate Blood Product Modifications, The Japan Society of Transfusion Medicine and Cell Therapy
- Japanese Red Cross Fukuoka Blood Center
| | - Yurika Yazawa
- Task Force on Standardized Methods for In-house Separation of a Blood Product for Multiple Use, Committee on Appropriate Blood Product Modifications, The Japan Society of Transfusion Medicine and Cell Therapy
- Division of Blood Transfusion, Tokyo Metropolitan Children's Medical Center
| | - Hiroo Maeda
- Task Force on Standardized Methods for In-house Separation of a Blood Product for Multiple Use, Committee on Appropriate Blood Product Modifications, The Japan Society of Transfusion Medicine and Cell Therapy
- Department of Transfusion Medicine and Cell Therapy, Saitama Medical Center, Saitama Medical University
| | - Shigeki Miyata
- Task Force on Standardized Methods for In-house Separation of a Blood Product for Multiple Use, Committee on Appropriate Blood Product Modifications, The Japan Society of Transfusion Medicine and Cell Therapy
- Division of Transfusion Medicine, National Cerebral and Cardiovascular Center
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11
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Morrison A, McMillan L, Campbell JDM, Petrik J. Evaluation of a potassium removal filter on irradiated red cells stored in SAGM. Transfus Med 2015; 25:320-5. [DOI: 10.1111/tme.12227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/29/2015] [Accepted: 06/24/2015] [Indexed: 12/01/2022]
Affiliation(s)
- A. Morrison
- National Science Laboratory, Microbiology & Components Research, Development & Innovation Group; Scottish National Blood Transfusion Service; Edinburgh UK
| | - L. McMillan
- National Science Laboratory, Microbiology & Components Research, Development & Innovation Group; Scottish National Blood Transfusion Service; Edinburgh UK
| | - J. D. M. Campbell
- National Science Laboratory, Microbiology & Components Research, Development & Innovation Group; Scottish National Blood Transfusion Service; Edinburgh UK
| | - J. Petrik
- National Science Laboratory, Microbiology & Components Research, Development & Innovation Group; Scottish National Blood Transfusion Service; Edinburgh UK
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12
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Matsuura H, Akatsuka Y, Muramatsu C, Isogai S, Sugiura Y, Arakawa S, Murayama M, Kurahashi M, Takasuga H, Oshige T, Yuba T, Mizuta S, Emi N. Evaluation of the potassium adsorption capacity of a potassium adsorption filter during rapid blood transfusion. Vox Sang 2015; 108:428-31. [DOI: 10.1111/vox.12242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 12/01/2014] [Accepted: 12/04/2014] [Indexed: 11/30/2022]
Affiliation(s)
- H. Matsuura
- Department of Clinical Laboratory Medicine; Fujita Health University Hospital; Toyoake Japan
- Department of Blood Transfusion Medicine; Fujita Health University Hospital; Toyoake Japan
| | - Y. Akatsuka
- Department of Blood Transfusion Medicine; Fujita Health University Hospital; Toyoake Japan
- Department of Hematology; Fujita Health University School of Medicine; Toyoake Japan
| | - C. Muramatsu
- Department of Clinical Laboratory Medicine; Fujita Health University Hospital; Toyoake Japan
- Department of Blood Transfusion Medicine; Fujita Health University Hospital; Toyoake Japan
| | - S. Isogai
- Department of Clinical Laboratory Medicine; Fujita Health University Hospital; Toyoake Japan
- Department of Blood Transfusion Medicine; Fujita Health University Hospital; Toyoake Japan
| | - Y. Sugiura
- Department of Clinical Laboratory Medicine; Fujita Health University Hospital; Toyoake Japan
- Department of Blood Transfusion Medicine; Fujita Health University Hospital; Toyoake Japan
| | - S. Arakawa
- Department of Clinical Laboratory Medicine; Fujita Health University Hospital; Toyoake Japan
- Department of Blood Transfusion Medicine; Fujita Health University Hospital; Toyoake Japan
| | - M. Murayama
- Department of Clinical Laboratory Medicine; Fujita Health University Hospital; Toyoake Japan
- Department of Blood Transfusion Medicine; Fujita Health University Hospital; Toyoake Japan
| | - M. Kurahashi
- Department of Clinical Laboratory Medicine; Fujita Health University Hospital; Toyoake Japan
- Department of Blood Transfusion Medicine; Fujita Health University Hospital; Toyoake Japan
| | - H. Takasuga
- Department of Clinical Laboratory Medicine; Fujita Health University Hospital; Toyoake Japan
- Department of Blood Transfusion Medicine; Fujita Health University Hospital; Toyoake Japan
| | - T. Oshige
- Kawasumi Laboratories, Inc.; Tokyo Japan
| | - T. Yuba
- Kawasumi Laboratories, Inc.; Tokyo Japan
| | - S. Mizuta
- Department of Blood Transfusion Medicine; Fujita Health University Hospital; Toyoake Japan
- Department of Hematology; Fujita Health University School of Medicine; Toyoake Japan
| | - N. Emi
- Department of Blood Transfusion Medicine; Fujita Health University Hospital; Toyoake Japan
- Department of Hematology; Fujita Health University School of Medicine; Toyoake Japan
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Suzuki T, Muto S, Miyata Y, Maeda T, Odate T, Shimanaka K, Kusano E. Characterization of the cation-binding capacity of a potassium-adsorption filter used in red blood cell transfusion. Ther Apher Dial 2015; 19:288-95. [PMID: 25656422 DOI: 10.1111/1744-9987.12278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Takao Suzuki
- Department of Clinical Engineering, Shimotsuke, Tochigi, Japan
| | - Shigeaki Muto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yukio Miyata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takao Maeda
- Department of Clinical Engineering, Shimotsuke, Tochigi, Japan
| | - Takayuki Odate
- Department of Clinical Engineering, Shimotsuke, Tochigi, Japan
| | - Kimio Shimanaka
- Department of Clinical Engineering, Shimotsuke, Tochigi, Japan
| | - Eiji Kusano
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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14
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Lee AC, Reduque LL, Luban NL, Ness PM, Anton B, Heitmiller ES. Transfusion-associated hyperkalemic cardiac arrest in pediatric patients receiving massive transfusion. Transfusion 2013; 54:244-54. [DOI: 10.1111/trf.12192] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 02/08/2013] [Accepted: 02/21/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Angela C. Lee
- Division of Anesthesiology and Pain Medicine; Division of Laboratory Medicine; Children's National Medical Center
- Department of Anesthesiology and Pediatrics; Department of Pediatrics and Pathology; George Washington University School of Medicine and Health Sciences; Washington DC
- Transfusion Medicine Division; Department of Pathology; Department of Anesthesiology and Critical Care Medicine; Department of Pediatrics; Johns Hopkins University School of Medicine
- Clinical Liaison for Library Services; Welch Medical Library; Johns Hopkins University; Baltimore Maryland
| | - Leila L. Reduque
- Division of Anesthesiology and Pain Medicine; Division of Laboratory Medicine; Children's National Medical Center
- Department of Anesthesiology and Pediatrics; Department of Pediatrics and Pathology; George Washington University School of Medicine and Health Sciences; Washington DC
- Transfusion Medicine Division; Department of Pathology; Department of Anesthesiology and Critical Care Medicine; Department of Pediatrics; Johns Hopkins University School of Medicine
- Clinical Liaison for Library Services; Welch Medical Library; Johns Hopkins University; Baltimore Maryland
| | - Naomi L.C. Luban
- Division of Anesthesiology and Pain Medicine; Division of Laboratory Medicine; Children's National Medical Center
- Department of Anesthesiology and Pediatrics; Department of Pediatrics and Pathology; George Washington University School of Medicine and Health Sciences; Washington DC
- Transfusion Medicine Division; Department of Pathology; Department of Anesthesiology and Critical Care Medicine; Department of Pediatrics; Johns Hopkins University School of Medicine
- Clinical Liaison for Library Services; Welch Medical Library; Johns Hopkins University; Baltimore Maryland
| | - Paul M. Ness
- Division of Anesthesiology and Pain Medicine; Division of Laboratory Medicine; Children's National Medical Center
- Department of Anesthesiology and Pediatrics; Department of Pediatrics and Pathology; George Washington University School of Medicine and Health Sciences; Washington DC
- Transfusion Medicine Division; Department of Pathology; Department of Anesthesiology and Critical Care Medicine; Department of Pediatrics; Johns Hopkins University School of Medicine
- Clinical Liaison for Library Services; Welch Medical Library; Johns Hopkins University; Baltimore Maryland
| | - Blair Anton
- Division of Anesthesiology and Pain Medicine; Division of Laboratory Medicine; Children's National Medical Center
- Department of Anesthesiology and Pediatrics; Department of Pediatrics and Pathology; George Washington University School of Medicine and Health Sciences; Washington DC
- Transfusion Medicine Division; Department of Pathology; Department of Anesthesiology and Critical Care Medicine; Department of Pediatrics; Johns Hopkins University School of Medicine
- Clinical Liaison for Library Services; Welch Medical Library; Johns Hopkins University; Baltimore Maryland
| | - Eugenie S. Heitmiller
- Division of Anesthesiology and Pain Medicine; Division of Laboratory Medicine; Children's National Medical Center
- Department of Anesthesiology and Pediatrics; Department of Pediatrics and Pathology; George Washington University School of Medicine and Health Sciences; Washington DC
- Transfusion Medicine Division; Department of Pathology; Department of Anesthesiology and Critical Care Medicine; Department of Pediatrics; Johns Hopkins University School of Medicine
- Clinical Liaison for Library Services; Welch Medical Library; Johns Hopkins University; Baltimore Maryland
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15
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Abstract
The supernatant potassium concentration [K+] of red blood cell (RBC) units is frequently much higher than normal human plasma potassium levels, especially in units nearing the end of their storage life. Clinical hyperkalemia resulting from RBC transfusions has been recognized as a transfusion complication for decades, and there have been reported cardiac arrests attributed to transfusion-associated hyperkalemia. This review summarizes the evidence surrounding RBC [K+] levels, effects of irradiation and washing on [K+], the evidence for clinical hyperkalemia and cardiac arrests resulting from transfusion, predictors of post-transfusion hyperkalemia, and their preventative strategies. Key points include: (a) the [K+] (in mmol/L) increases linearly and is approximately equal to the number of days of RBC unit storage; (b) irradiation causes a rapid increase in [K+]; (c) there is potentially sufficient potassium in the supernatant of current RBC preparations to lead to hyperkalemia with large transfusion volumes; (d) any rise in patient potassium after transfusion is usually transient due to the redistribution of the potassium load; (e) transfusion-associated hyperkalemic cardiac arrests probably do occur, although it is difficult to prove this fact conclusively; and (f) promising strategies to combat transfusion-associated hyperkalemia include RBC washing, the use of in-line potassium filters, and the use of traditional treatments for hyperkalemia such as the use of insulin.
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Wiltshire M, Cardigan R, Thomas S. Manufacture of red cells in additive solution from whole blood refrigerated for 5 days or remanufactured from red cells stored in plasma. Transfus Med 2011; 20:383-91. [PMID: 20681977 DOI: 10.1111/j.1365-3148.2010.01024.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate methods for the production of red cell concentrates (RCC) in saline, adenine, glucose and mannitol (SAG-M), from whole blood or red cells stored in plasma for 5 or 6 days and to provide evidence that exchange transfusion RCC in citrate phosphate dextrose (CPD) plasma or citrate, phosphate, dextrose, adenine (CPDA-1) plasma are of comparable quality. METHODS AND MATERIALS Ten RCC in SAG-M were produced following the remanufacture of red cells in CPD plasma on day 5/6 or after 5 days hold as leucodepleted CPD whole blood. In addition, 10 RCC in CPD plasma and 9 in CPDA-1 plasma were stored without further processing. Units were assessed for red cell parameters including haemolysis, adenosine triphosphate (ATP), 2,3-diphosphoglycerate (2,3-DPG) and extracellular potassium. RESULTS Units in SAG-M produced by remanufacture of RCC in plasma or by delayed manufacture of whole blood had comparable levels of haemolysis, ATP and 2,3-DPG. Furthermore, these units underwent biochemical changes similar to reference SAG-M units, with the exception of haemolysis which was greater at the end of shelf life and supernatant potassium which was lower following remanufacture. As expected, the decline in ATP was greater in red cells stored in CPD plasma compared with CPDA-1 plasma. In general, units in CPD plasma were of similar quality at day 28 compared to those in CPDA-1 plasma at day 35. CONCLUSIONS RCC produced following the remanufacture of RCC in plasma or the delayed manufacture of whole blood are of acceptable in vitro quality and should be assigned the same shelf life as standard RCC in SAG-M.
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Affiliation(s)
- Michael Wiltshire
- Components Development Laboratory, NHS Blood and Transplant, Brentwood, UK.
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Yamada C, Heitmiller ES, Ness PM, King KE. Reduction in potassium concentration of stored red blood cell units using a resin filter. Transfusion 2010; 50:1926-33. [PMID: 20561298 DOI: 10.1111/j.1537-2995.2010.02742.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Hyperkalemia is a serious complication of rapid and massive blood transfusion due to high plasma potassium (K) in stored red blood cell (RBC) units. A potassium adsorption filter (PAF) was developed in Japan to remove K by exchanging with sodium (Na). We performed an in vitro evaluation of its efficacy and feasibility of use. STUDY DESIGN AND METHODS Three AS-3 RBC units were filtered by each PAF using gravity; 10 PAFs were tested. Blood group, age, flow rate, and irradiation status were recorded. Total volume, K, Na, Cl, Mg, total Ca (tCa), RBC count, hemoglobin (Hb), hematocrit (Hct), and plasma Hb were measured before and after filtering each unit. Ionized Ca (iCa), pH, and glucose were measured for some units. RESULTS After filtration, the mean decrease in K was 97.5% in the first RBC unit, 91.2% in the second unit, and 64.4% in the third unit. The mean increases in Na, Mg, and tCa were 33.0, 151.4, and 116.1%, respectively. iCa and pH remained low; glucose was unchanged. RBC count, Hb, and Hct decreased slightly after filtration of first units; plasma Hb was unchanged. After filtration, there was no visual evidence of increased hemolysis or clot formation. CONCLUSION The PAF decreased K concentration in stored AS-3 RBC units to minimal levels in the first and second RBC units. Optimally, one filter could be used for 2 RBC units. Although Na increased, the level may not be clinically significant. PAF may be useful for at-risk patients receiving older units or blood that has been stored after gamma irradiation.
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Affiliation(s)
- Chisa Yamada
- Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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18
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Newcomer RG, Moussallem MD, Keller TCS, Schlenoff JB, Sang QXA. Human coronary artery smooth muscle cell responses to bioactive polyelectrolyte multilayer interfaces. BIOTECHNOLOGY RESEARCH INTERNATIONAL 2010; 2011:854068. [PMID: 21350669 PMCID: PMC3042685 DOI: 10.4061/2011/854068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 10/05/2010] [Indexed: 02/03/2023]
Abstract
Under normal physiological conditions, mature human coronary artery smooth muscle cells (hCASMCs) exhibit a "contractile" phenotype marked by low rates of proliferation and protein synthesis, but these cells possess the remarkable ability to dedifferentiate into a "synthetic" phenotype when stimulated by conditions of pathologic stress. A variety of polyelectrolyte multilayer (PEMU) films are shown here to exhibit bioactive properties that induce distinct responses from cultured hCASMCs. Surfaces terminated with Nafion or poly(styrenesulfonic acid) (PSS) induce changes in the expression and organization of intracellular proteins, while a hydrophilic, zwitterionic copolymer of acrylic acid and 3-[2-(acrylamido)-ethyl dimethylammonio] propane sulfonate (PAA-co-PAEDAPS) is resistant to cell attachment and suppresses the formation of key cytoskeletal components. Differential expression of heat shock protein 90 and actin is observed, in terms of both their magnitude and cellular localization, and distinct cytoplasmic patterns of vimentin are seen. The ionophore A23187 induces contraction in confluent hCASMC cultures on Nafion-terminated surfaces. These results demonstrate that PEMU coatings exert direct effects on the cytoskeletal organization of attaching hCASMCs, impeding growth in some cases, inducing changes consistent with phenotypic modulation in others, and suggesting potential utility for PEMU surfaces as a coating for coronary artery stents and other implantable medical devices.
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Affiliation(s)
- Robert G Newcomer
- Department of Chemistry and Biochemistry, Institute of Molecular Biophysics, The Florida State University, 3501 Chemical Sciences Laboratory Building, 102 Varsity Way, Tallahassee, FL 32306-4390, USA
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Cid J, Ramiro L, Bertran S, Martínez N, Claparols M, Maymó RM, Puig L, Pla RP. Efficacy in reducing potassium load in irradiated red cell bags with a potassium adsorption filter. Transfusion 2008; 48:1966-70. [DOI: 10.1111/j.1537-2995.2008.01776.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hyperkalemia after packed red blood cell transfusion in trauma patients. ACTA ACUST UNITED AC 2008; 64:S86-91; discussion S91. [PMID: 18376177 DOI: 10.1097/ta.0b013e318160c0b8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND 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. METHODS 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). RESULTS 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). CONCLUSIONS 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.
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Smith HM, Farrow SJ, Ackerman JD, Stubbs JR, Sprung J. Cardiac arrests associated with hyperkalemia during red blood cell transfusion: a case series. Anesth Analg 2008; 106:1062-9, table of contents. [PMID: 18349174 DOI: 10.1213/ane.0b013e318164f03d] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Transfusion-associated hyperkalemic cardiac arrest is a serious complication of rapid red blood cell (RBC) administration. We examined the clinical scenarios and outcomes of patients who developed hyperkalemia and cardiac arrest during rapid RBC transfusion. METHODS We retrospectively reviewed the Mayo Clinic Anesthesia Database between November 1, 1988, and December 31, 2006, for all patients who developed intraoperative transfusion-associated hyperkalemic cardiac arrest. RESULTS We identified 16 patients with transfusion-associated hyperkalemic cardiac arrest, 11 adult and 5 pediatric. The majority of patients underwent three types of surgery: cancer, major vascular, and trauma. The mean serum potassium concentration measured during cardiac arrest was 7.2 +/- 1.4 mEq/L (range, 5.9-9.2 mEq/L). The number of RBC units administered before cardiac arrest ranged between 1 (in a 2.7 kg neonate) and 54. Nearly all patients were acidotic, hyperglycemic, hypocalcemic, and hypothermic at the time of arrest. Fourteen (87.5%) patients received RBC via central venous access. Commercial rapid infusion devices (pumps) were used in 8 of 11 (72.7%) of the adult patients, but RBC units were rapidly administered (pressure bags, syringe pumped) in all remaining patients. Mean resuscitation duration was 32 min (range, 2-127 min). The in-hospital survival rate was 12.5%. CONCLUSION The pathogenesis of transfusion-associated hyperkalemic cardiac arrest is multifactorial and potassium increase from RBC administration is complicated by low cardiac output, acidosis, hyperglycemia, hypocalcemia, and hypothermia. Large transfusion of banked RBCs and conditions associated with massive hemorrhage should raise awareness of the potential for hyperkalemia and trigger preventative measures.
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Affiliation(s)
- Hugh M Smith
- Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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22
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Eder AF, Chambers LA. Noninfectious complications of blood transfusion. Arch Pathol Lab Med 2007; 131:708-18. [PMID: 17488156 DOI: 10.5858/2007-131-708-ncobt] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2006] [Indexed: 11/06/2022]
Abstract
CONTEXT Serious noninfectious complications are far more likely to occur than viral disease transmission from blood component transfusion. OBJECTIVE To compile a comprehensive list of the noninfectious risks of transfusion, examples of published risk estimates, and summaries of recent information regarding cause, prevention, or management of noninfectious transfusion risks. DATA SOURCES Information was obtained from peer-reviewed English-language medical journal publications since 1990. CONCLUSIONS Early complications, although potentially more serious, usually occur less frequently (<1 in 1000 transfusions) than late complications, which often affect more than 1% of recipients. Areas of active investigation and discussion include acute hemolytic reactions, transfusion-related acute lung injury, red cell alloimmunization, platelet transfusion refractoriness, and transfusion immunosuppression. Continued effort toward research and education to promote recognition and prevention of noninfectious complications associated with blood components is warranted.
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Affiliation(s)
- Anne F Eder
- Biomedical Headquarters, American Red Cross, Washington, DC, USA
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Weisbach V, Riego W, Strasser E, Zingsem J, Ringwald J, Zimmermann R, Eckstein R. The in vitro quality of washed, prestorage leucocyte-depleted red blood cell concentrates. Vox Sang 2004; 87:19-26. [PMID: 15260818 DOI: 10.1111/j.1423-0410.2004.00526.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES No data are currently available on the quality of washed prestorage leucocyte-depleted red blood cell concentrates (RCCs). MATERIALS AND METHODS Five groups of RCCs stored in additive solution (SAG-M) were washed. The groups differed in the age of RCCs (2-5 days or 11-15 days), the temperature during the washing procedure and a 6-h storage period (4 degrees C or room temperature) and the washing solution (saline, SAG-M or 5% albumin). We measured ATP, 2,3-diphosphoglycerate (2,3-DPG), haemolysis, blood cell count, Na(+), K(+), pH, pO(2), pCO(2) and lactate, before and after the washing procedure and hourly during the 6-h postwash storage period. RESULTS The erythrocyte ATP content increased by 2-13%, relative to the baseline value, during the washing procedure. The 2,3-DPG level decreased by 15-35% in 2-6-day-old RCCs and by 30-40% in 11-15-day-old RCCs (relative to baseline values) during the washing procedure. In RCCs that were washed and stored at room temperature, and in 2-week-old RCCs, a further decrease in 2,3-DPG of up to 40%, relative to the baseline value, was observed during the 6-h postwash time-period. CONCLUSIONS Washing of RCCs stored in SAG-M results in a considerable, significant loss of erythrocyte 2,3-DPG, especially in older RCCs. This loss increases in during a 6-h storage period postwash, even at 4 degrees C. This loss of erythrocyte quality might well outweigh the benefits of washed SAG-M RCCs during massive transfusion in neonates.
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Affiliation(s)
- V Weisbach
- Department of Transfusion Medicine and Haemostaseology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
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Nakagawa M, Kubota M, Endo I, Inoue S, Seo N. Use of a K+-adsorption filter for the massive transfusion of irradiated red blood cells in a child. Can J Anaesth 2004; 51:639-40. [PMID: 15197132 DOI: 10.1007/bf03018413] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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