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Expediting red blood cell transfusions by syringing causes significant hemolysis
Willem Lambertus De Villiers1, Adriaan Albertus Murray1, Andrew Ian Levin1
1Department of Anesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa.
Transfusion
|August 24, 2017
Summary
Manual syringing significantly increases red blood cell (RBC) hemolysis during rapid transfusions. Pneumatic pressurization of RBC bags is a safer alternative, causing no more hemolysis than standard gravity transfusions.
Area of Science:
- Hematology
- Transfusion Medicine
- Biomedical Engineering
Background:
- Rapid blood transfusions are crucial in emergencies.
- Common methods include pneumatic pressurization and manual syringing of red blood cell (RBC) bags.
- The risk of RBC hemolysis with these techniques requires investigation.
Purpose of the Study:
- To compare the efficacy and safety of pneumatic pressurization versus manual syringing for rapid RBC transfusions.
- To quantify the degree of RBC hemolysis associated with each rapid transfusion technique.
Main Methods:
- A simulated transfusion model was used to test two rapid transfusion techniques on 15 warmed RBC units.
- Techniques included pneumatic pressurization (300 mmHg) and manual syringing (20-mL syringe).
- Control group used gravity-only transfusion; free hemoglobin (Hb) and percent hemolysis were measured.
Main Results:
- Manual syringing resulted in a 10-fold increase in free Hb and hemolysis compared to control (p < 0.0001).
- Pneumatic pressurization showed similar hemolysis levels to the control group.
- Cannula size (18- vs. 22-gauge) did not significantly impact hemolysis.
Conclusions:
- Forceful manual syringing causes significant red blood cell hemolysis.
- Pneumatic pressurization of RBC bags does not increase hemolysis compared to gravity transfusions.
- Avoid manual syringing for rapid RBC transfusions; opt for pneumatic pressurization.
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