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Effect of incubation with crystalloid solutions or medications on packed red blood cells

Domagoj Mladinov1, Kristine Yarnoff2, Enika Nagababu1

  • 1Department of Anesthesiology, University of Alabama, Birmingham, Alabama.

Transfusion
|May 29, 2019
PubMed

Insights

Co-incubating packed red blood cells (PRBCs) with isotonic crystalloids or catecholamines for five minutes does not harm PRBCs. However, co-incubation with 5% dextrose in water (D5W) or Propofol may increase hemolysis.

Area of Science:

  • Transfusion Medicine
  • Hematology
  • Critical Care Medicine

Background:

  • Current American Association of Blood Banks (AABB) guidelines recommend dedicated intravenous (IV) catheters for packed red blood cell (PRBC) administration.
  • Limited literature supports this recommendation, despite the risks associated with obtaining additional IV access, including pain, cost, and infection.
  • This study investigates the impact of co-incubating PRBCs with common crystalloids and medications on key red blood cell parameters.

Purpose of the Study:

  • To evaluate the effect of co-incubating PRBCs with various crystalloids and medications on PRBC hemolysis, membrane deformability, and aggregation.
  • To assess the impact of co-incubation on medication concentration within the PRBC mixture.
  • To provide evidence-based data to inform transfusion practices regarding IV catheter use for PRBC administration.

Main Methods:

  • Packed red blood cells (PRBCs) were co-incubated for 5 minutes with plasma, normal saline (NS), 5% dextrose in water (D5W), Plasmalyte, epinephrine, norepinephrine, dopamine, or Propofol.
  • Assessed parameters included hemolysis (free hemoglobin, serum potassium), membrane deformability (elongation index), aggregation (smear, critical shear stress), and drug concentration using LCMS-MS.
  • Statistical significance was determined using Wilcoxon-paired comparisons or Wilcoxon/Kruskall Wallis with post-hoc Dunn's test.

Main Results:

  • Co-incubation with D5W significantly increased hemolysis (elevated free hemoglobin and potassium) compared to plasma.
  • Membrane deformability showed a trend towards lower values with D5W and higher values with Propofol.
  • PRBC aggregation was significantly reduced with NS, D5W, and Plasmalyte, and trended lower with epinephrine, norepinephrine, and dopamine.
  • Medication concentrations were intermediate between predicted values based on plasma-only or full distribution.

Conclusions:

  • Short-term (5 minutes) co-incubation of PRBCs with isotonic crystalloids or catecholamines does not adversely affect hemolysis, membrane deformability, or aggregation.
  • 5% dextrose in water (D5W) co-incubation appears to increase PRBC hemolysis.
  • Propofol co-incubation may also promote hemolysis, warranting further investigation.
Abstract

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