Processing of stored packed red blood cells using autotransfusion devices decreases potassium and microaggregates: A prospective, randomized, single-blinded in vitro study

Department of Transfusion Medicine, University of Muenster, Muenster, Germany.
Transfusion Medicine (Impact Factor: 1.65). 05/2007; 17(2):89-95. DOI: 10.1111/j.1365-3148.2007.00732.x
Source: PubMed


The aim of the study was to compare the potential of autotransfusion devices to reduce non-infectious complications related to transfusion of long-stored packed red blood cells (PRBC; n= 57), such as changes in electrolytes, blood cells and the load of free microaggregates. Following a baseline measurement, a blood pool of three PRBC was divided into three equal volumes and washed with either the Haemonetics Cell Saver (HCS) or the continuous autotransfusion system (C.A.T.S), using the quality (CATS(quality)) and emergency (CATS(emergency)) mode. After the washing procedure, measurements for electrolytes, blood cells and free microaggregates were repeated (n= 19 each). Compared with baseline, the investigated autotransfusion devices reduced the median load of potassium (baseline: 52 mEq L(-1); HCS: 4 mEq L(-1); CATS(quality): 4 mEq L(-1); CATS(emergency): 17 mEq L(-1); each P < 0.001), restored a physiologic electrolyte balance and significantly decreased the load of leucocytes, glucose and protein. Whereas the quantity of microaggregates was not reduced by HCS, CATS(emergency) decreased the load of cell fragments below 7.8 microm (P < 0.05 vs. baseline). Using CATS(quality) decreased the load of cell fragments not only to a diameter below 7.8 microm (P < 0.001 vs. baseline) but also of microaggregates between 7.8 and 17.6 microm (P < 0.05 vs. baseline). In situations where long-stored PRBC have to be transfused, the procedure described here may be feasible to reduce clinically relevant side effects, i.e. hyperkalaemia and microvascular obstruction secondary to free cell fragments. This approach could be especially useful in patients undergoing massive transfusion and/or suffering from renal failure.

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    • "Compared with the quality mode, the emergency mode is characterized by faster processing, thereby consuming less washing solution. According to a previous article, quality mode CATS reduced the median load of K+ to 92% of the baseline, whereas the emergency mode CATS reduced it to only 70% of that [10]. "
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    ABSTRACT: 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.
    Korean journal of anesthesiology 03/2012; 62(3):281-4. DOI:10.4097/kjae.2012.62.3.281
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    • "In cardiac surgical patients, transfusion of red cells that had been stored for more than 2 weeks was associated with a significantly increased risk of postoperative complications as well as reduced short-term and long-term survival [19]. This is maybe explained by the fact that transfusion of old blood causing microvascular obstruction secondary to free cell fragments and strong proinflammatory effect [20,21]. Stored blood contains extracellular bioactive substances: Plasminogen Activator Inhibitor-1 (PAI-1) and IL-1beta which increase with the duration of blood storage [22]. "
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