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
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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Available from: Jin-Tae Kim
- "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 . "
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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
Available from: Elsayed Elmistekawy
- "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 . 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 . "
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ABSTRACT: Preoperative patients' characteristics can predict the need for perioperative blood component transfusion in cardiac surgical operations. The aim of this prospective observational study is to identify perioperative patient characteristics predicting the need for allogeneic packed red blood cell (PRBC) transfusion in isolated primary coronary artery bypass grafting (CABG) operations.
105 patients undergoing isolated, first-time CABG were reviewed for their preoperative variables and followed for intraoperative and postoperative data. Patients were 97 males and 8 females, with mean age 58.28 +/- 10.97 years. Regression logistic analysis was used for identifying the strongest perioperative predictors of PRBC transfusion.
PRBC transfusion was used in 71 patients (67.6%); 35 patients (33.3%) needed > 2 units and 14 (13.3%) of these needed > 4 units. Univariate analysis identified female gender, age > 65 years, body weight < or = 70 Kg, BSA < or = 1.75 m(2), BMI < or = 25, preoperative hemoglobin < or = 13 gm/dL, preoperative hematocrit < or = 40%, serum creatinine > 100 micromol/L, Euro SCORE (standard/logistic) > 2, use of CPB, radial artery use, higher number of distal anastomoses, and postoperative chest tube drainage > 1000 mL as significant predictors. The strongest predictors using multivariate analysis were CPB use, hematocrit, body weight, and serum creatinine.
The predictors of PRBC transfusion after primary isolated CABG are use of CPB, hematocrit < or = 40%, weight < or = 70 Kg, and serum creatinine > 100 micromol/L. This leads to better utilization of blood bank resources and cost-efficient targeted use of expensive blood conservation modalities.
Journal of Cardiothoracic Surgery 05/2009; 4(1):20. DOI:10.1186/1749-8090-4-20 · 1.03 Impact Factor
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ABSTRACT: Breaking gravity waves are studied in a wave tank at small grazing
angles (4.5°-11°) where all four polarization elements (HH, VV,
HV, VH) are simultaneously measured. Temporally averaged Doppler spectra
are obtained for mechanically-generated 4 m breaking waves of various
energies. The authors describe the dependence on breaking-wave energy of
the parameters describing the backscatter. The results of grazing angle
dependence of the backscatter are also shown and discussed
Geoscience and Remote Sensing Symposium, 1996. IGARSS '96. 'Remote Sensing for a Sustainable Future.', International; 06/1996
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