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Milne A, Radhakrishnan A. Biochemical disturbance in damage control resuscitation: mechanisms, management and prognostic utility. Curr Opin Anaesthesiol 2023; 36:176-182. [PMID: 36728975 DOI: 10.1097/aco.0000000000001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW With advances in resuscitative techniques, trauma patients are surviving increasingly severe injuries and physiological insult. Timely recognition of futility remains important in terms of patient dignity and resource preservation yet is increasingly challenging in the face of these advances. The understanding of biochemical derangement from pathophysiological processes of trauma and iatrogenic effects of resuscitation has expanded recently. RECENT FINDINGS Acidosis and hypocalcaemia have been recognized as important contributors to mortality among trauma patients. Although less well recognized and studied, critical injury and high blood product volume resuscitation render patients vulnerable to life-threatening hyperkalaemia. The methods of correcting disruptions to acid-base and electrolyte homeostasis during damage control resuscitation have changed little recently and often rely on evidence from undifferentiated populations. Biochemical disturbances have value as ancillary predictors of futility in trauma resuscitation. SUMMARY These findings will contribute to a greater understanding among anaesthesiologists of the causative mechanisms and effects of biochemical derangement after severe injury and aid them in the delivery of well tolerated and effective damage control resuscitation. Gaps in the evidence base are highlighted to encourage future work.
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Affiliation(s)
- Andrew Milne
- Trauma Anaesthesia Group, Barts Health NHS Trust, Royal London Hospital, London, UK
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2
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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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Ogasawara K, Ohto H, Takano N, Nollet KE, Go H, Sato M, Momoi N, Hosoya M. Assessment of a downsized potassium adsorption filter designed to transfuse neonates. Transfusion 2020; 60:2494-2499. [PMID: 33217022 DOI: 10.1111/trf.16010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND During storage, the potassium level of red blood cell (RBC) components increases, especially after irradiation. Neonates are prone to hyperkalemia, for example, non-oliguric hyperkalemia, so using potassium adsorption filters during transfusion may be helpful. To overcome dilution of RBC components caused by saline priming of existing potassium adsorption filters, a downsized potassium adsorption filter for neonates (PAF-n, Kawasumi Laboratories Inc., Tokyo, Japan) was developed. STUDY DESIGN AND METHODS To assess the performance of PAF-n, its adsorption efficiency and RBC recovery rate were evaluated by testing pre-filtration and serial post-filtration (0-30 mL, 30-60 mL, 60-90 mL, and 90-120 mL) samples from 8 RBC components. RESULTS The average potassium adsorption rate of the PAF-n was 90.5% ± 0.78%, and never less than 89.0% in any of 8 RBC components. RBC recovery rates were 99.3% ± 1.12%. CONCLUSION The PAF-n showed an effective potassium ability with negligible RBC dilution.
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Affiliation(s)
- Kei Ogasawara
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hitoshi Ohto
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Nozomi Takano
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kenneth E Nollet
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hayato Go
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Maki Sato
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Nobuo Momoi
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
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4
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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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Serrano K, Pambrun C, Levin E, Devine DV. Supernatant reduction of stored gamma-irradiated red blood cells minimizes potentially harmful substances present in transfusion aliquots for neonates. Transfusion 2017; 57:3009-3018. [PMID: 28782124 DOI: 10.1111/trf.14270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/28/2017] [Accepted: 07/03/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND In neonate transfusion, the use of a dedicated red blood cell (RBC) unit decreases donor exposure. A separate safety measure involves gamma irradiation of the RBCs to abrogate the possibility of transfusion-associated graft-versus-host disease. However, in combination, storage of gamma-irradiated RBCs leads to accumulation of potentially harmful substances in the supernatant. STUDY DESIGN AND METHODS For this study, RBCs were pooled and split into three study arms. Centrifugation or gravity was used to pack RBCs of matched units thereby reducing the amount of supernatant that would be present in neonate transfusion aliquots; these were compared to matched control units. Supernatant measurements of potassium, hemoglobin (Hb), RBC microvesicle (RMV) content, and mannitol were made in aliquots prepared weekly up to 21 days after gamma irradiation. RBC morphology and osmotic fragility were also assessed to determine if supernatant reduction methods affected the storage lesion. RESULTS Potassium and mannitol were significantly decreased in transfusion aliquots prepared with either of the supernatant reduction methods. On Day 21, potassium levels from supernatant-reduced aliquots were below those of Day 7 control aliquots. A decrease in free Hb was only detected on Day 21 in centrifuged aliquots. RMVs were significantly reduced in centrifuged aliquots and significantly increased in gravity-settled aliquots. The only measurable effect on storage lesion was a small increase in osmotic fragility of the RBCs subjected to supernatant reduction. CONCLUSION Supernatant reduction by centrifugation effectively reduces potassium, mannitol, and RMVs in aliquots from gamma-irradiated RBCs stored up to 21 days.
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Affiliation(s)
- Katherine Serrano
- Department of Pathology and Laboratory Medicine and Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Blood Services Centre for Innovation, Vancouver, British Columbia, Canada
| | - Chantale Pambrun
- Canadian Blood Services Donor and Clinical Services, Ottawa, Ontario, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Elena Levin
- Department of Pathology and Laboratory Medicine and Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Blood Services Centre for Innovation, Vancouver, British Columbia, Canada
| | - Dana V Devine
- Department of Pathology and Laboratory Medicine and Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Blood Services Centre for Innovation, Vancouver, British Columbia, Canada
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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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Imashuku Y, Kitagawa H, Mizuno T, Fukushima Y. Hyperkalemia caused by rapid red cell transfusion and the potassium absorption filter. Saudi J Anaesth 2017; 11:114-116. [PMID: 28217070 PMCID: PMC5292834 DOI: 10.4103/1658-354x.197354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of transient hyperkalemia during hysterectomy after cesarean section, due to preoperatively undiagnosed placenta accreta that caused unforeseen massive hemorrhage and required rapid red cell transfusion. Hyperkalemia-induced by rapid red cell transfusion is a well-known severe complication of transfusion; however, in patients with sudden massive hemorrhage, rapid red cell transfusion is necessary to save their life. In such cases, it is extremely important to monitor serum potassium levels. For an emergency situation, a system should be developed to ensure sufficient preparation for immediate transfusion and laboratory tests. Furthermore, sufficient stock of preparations to treat hyperkalemia, such as calcium preparations, diuretics, glucose, and insulin is required. Moreover, a transfusion filter that absorbs potassium has been developed and is now available for clinical use in Japan. The filter is easy to use and beneficial, and should be prepared when it is available.
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Affiliation(s)
- Yasuhiko Imashuku
- Department of Anesthesiology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Hirotoshi Kitagawa
- Department of Anesthesiology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Takayoshi Mizuno
- Department of Anesthesiology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Yutaka Fukushima
- Department of Anesthesiology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
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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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Washing out potassium absorption filters with normal saline after use. Clin Exp Nephrol 2015; 19:984. [DOI: 10.1007/s10157-015-1093-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 02/03/2015] [Indexed: 10/24/2022]
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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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13
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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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Winter KM, Johnson L, Kwok M, Reid S, Alarimi Z, Wong JKL, Dennington PM, Marks DC. Understanding the effects of gamma-irradiation on potassium levels in red cell concentrates stored in SAG-M for neonatal red cell transfusion. Vox Sang 2014; 108:141-50. [DOI: 10.1111/vox.12194] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/30/2014] [Accepted: 08/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- K. M. Winter
- Research and Development; Australian Red Cross Blood Service; Sydney NSW Australia
| | - L. Johnson
- Research and Development; Australian Red Cross Blood Service; Sydney NSW Australia
| | - M. Kwok
- Research and Development; Australian Red Cross Blood Service; Sydney NSW Australia
| | - S. Reid
- Research and Development; Australian Red Cross Blood Service; Sydney NSW Australia
| | - Z. Alarimi
- Medical, Transplantation and Quality Services; Australian Red Cross Blood Service; Sydney NSW Australia
| | - J. K. L. Wong
- Medical, Transplantation and Quality Services; Australian Red Cross Blood Service; Sydney NSW Australia
| | - P. M. Dennington
- Medical, Transplantation and Quality Services; Australian Red Cross Blood Service; Sydney NSW Australia
| | - D. C. Marks
- Research and Development; Australian Red Cross Blood Service; Sydney NSW Australia
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15
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Olson J, Talekar M, Sachdev M, Castellani W, De la Cruz N, Davis J, Liao J, George M. Potassium changes associated with blood transfusion in pediatric patients. Am J Clin Pathol 2013; 139:800-5. [PMID: 23690124 DOI: 10.1309/ajcp2mp8oiixnkxf] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Storing packed red blood cells (pRBCs) increases the potassium concentration. This effect is characterized in citrate phosphate dextrose/citrate phosphate dextrose adenine units but not published for Adsol (AS-5) units. The change in whole-blood potassium concentration in pediatric patients during routine transfusion is also poorly characterized. In this study, pediatric patients undergoing transfusion had pre- and posttransfusion whole-blood potassium measurements. The pRBC unit transfused and the unit's segment were sampled, with potassium concentration measured. In addition, potassium concentration in AS-5 units was measured over 42 days of storage. Unit extracellular potassium increased in AS-5 units after day 7 at 0.83 mmol/L/d. The mean change in patient potassium concentration was 0.08 mmol/L (range, -0.5 to 0.5 mmol/L). No correlation with unit age or unit potassium concentration was identified with change in patient whole-blood potassium concentration. The lack of clinical effect on patient potassium does not support the use of "fresh" pRBC units with routine pediatric transfusion.
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16
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El Kenz H, Corazza F, Van Der Linden P, Chabab S, Vandenvelde C. Potassium content of irradiated packed red blood cells in different storage media: is there a need for additive solution-dependent recommendations for infant transfusion? Transfus Apher Sci 2013; 49:249-53. [PMID: 23711835 DOI: 10.1016/j.transci.2013.04.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 02/22/2013] [Accepted: 04/25/2013] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- H El Kenz
- Brugmann University Hospital Centre, Queen Fabiola University Children Hospital Blood Bank, Brussels, Belgium.
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17
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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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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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O'Leary MF, Szklarski P, Klein TM, Young PP. Hemolysis of red blood cells after cell washing with different automated technologies: clinical implications in a neonatal cardiac surgery population. Transfusion 2010; 51:955-60. [PMID: 21091957 DOI: 10.1111/j.1537-2995.2010.02935.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND 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. STUDY DESIGN AND METHODS 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. RESULTS 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. CONCLUSIONS Hemolysis levels vary among different cell washers. Decreasing the expiration time of units after washing may be warranted.
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Affiliation(s)
- Mandy Flannery O'Leary
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
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