Effect of modern infusion pumps on RBC quality

Area of Science:

• Biomedical Engineering
• Hematology
• Transfusion Medicine

Background:

• Mechanical stress on red blood cells (RBCs) is a concern during blood administration using infusion pumps.
• Current North American standards lack specific guidance on infusion pump safety for transfusion, necessitating facility-manufacturer consultation.
• Research on the effects of various pumps and RBC conditions on hemolysis is limited.

Purpose of the Study:

• To evaluate the impact of different infusion pumps on red blood cell integrity.
• To assess hemolysis and other markers of RBC damage under various pumping conditions and storage durations.
• To determine the safety of using infusion pumps for blood transfusion.

Main Methods:

• Red blood cell units were pumped through four types of infusion pumps at different time points post-collection and post-irradiation.
• Hemolysis, microvesicles, potassium, lactate dehydrogenase, and mechanical fragility were measured after pumping at clinical rates.
• Morphological evaluations of RBCs were performed.

Main Results:

• Hemolysis levels were not significantly different between piston/linear peristaltic pumps and gravity controls.
• Peristaltic pumps showed slightly higher hemolysis (max 0.05% difference) compared to gravity.
• Pumping at 50 mL/h and using older or irradiated RBC units (d40, I21d22) resulted in higher hemolysis, but total hemolysis remained below 0.8% for all tested conditions.
• Lactate dehydrogenase release was the only other marker showing minor differences between pump and gravity infusion.

Conclusions:

• Infusion pump design influences the degree of red blood cell hemolysis, but the increase is minimal across all tested pumps and RBC conditions.
• Hemolysis measurements at 50 mL/h for d40 and I21d22 RBC units are suitable parameters for evaluating infusion pump safety.
• The study suggests that current infusion pumps are safe for blood transfusion with minimal impact on RBC integrity.