Mechanical hemolysis in pediatric patients associated with rapid transfusion and one‐way valve
BACKGROUND Four similar transfusion reactions involving infants were reported in less than 1 year. After transfusion of red blood cells (RBCs) via syringe in the operating room, each patient experienced discolored urine, laboratory evidence of hemolysis, and acute kidney injury. Clerical and serolog...
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| Veröffentlicht in: | Transfusion (Philadelphia, Pa.) Pa.), 2018-05, Vol.58 (5), p.1228-1233 |
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| creator | Gniadek, Thomas J. Richtsfeld, Martina Pulkrabek, Shelley Hansen, Kayla R. Barnett, Susan L. Joyner, Nitasha Kinney, Stephanie Zantek, Nicole D. Azakie, Anthony Cohn, Claudia S. |
| description | BACKGROUND
Four similar transfusion reactions involving infants were reported in less than 1 year. After transfusion of red blood cells (RBCs) via syringe in the operating room, each patient experienced discolored urine, laboratory evidence of hemolysis, and acute kidney injury. Clerical and serologic investigations were unremarkable. Mechanical hemolysis was considered.
STUDY DESIGN AND METHODS
Simulated syringe transfusions were performed. Measurements included hematocrit (Hct), free hemoglobin, and visual hemolysis index. Washed and unwashed RBCs were tested with or without a recently introduced one‐way valve, using a 24‐ or 16‐gauge intravenous catheter. Constant manual pressure (1.43 ± 0.49 mL/sec) or syringe pump (2 mL/min) was used and a subset was timed.
RESULTS
The valve increased hemolysis during manual transfusion using both catheters with washed and unwashed RBCs. With the 24‐gauge catheter, the change in Hct was –3.53 ± 0.69% with the valve and 0.22 ± 0.13% without (p |
| doi_str_mv | 10.1111/trf.14554 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2010369966</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2028936358</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3534-53a655fe487712a0a84ed370536ab9cb35a1fd3ec20107fc7e5f89116f0f49103</originalsourceid><addsrcrecordid>eNp10MtKxDAUBuAgio6XhS8gATe6qJM0TdssRbyBIsi4rmfSEybSSWvSOszOR_AZfRKjoy4EzyZw-PJz-AnZ5-yExxn33pzwTMpsjYy4FEWSKiXXyYixjCeci3SLbIfwxBhLFeObZCtVmSqZFCPyeIt6Bs5qaOgM522zDDZQ62iHtYXeW0076C26PlAIodVxiTVd2H5GPXS2pr0HF8wQbOsouJq2Dt9f3xawpC_QvOAu2TDQBNz7fnfIw8X55Owqubm7vD47vUm0kCJLpIBcSoNZWRQ8BQZlhrUo4o05TJWeCgnc1AJ1yjgrjC5QmlJxnhtmMsWZ2CFHq9zOt88Dhr6a26CxacBhO4Tq85_IlcrzSA__0Kd28C5eF1VaKpELWUZ1vFLatyF4NFXn7Rz8suKs-qy9irVXX7VHe_CdOEznWP_Kn54jGK_Awja4_D-pmtxfrCI_AI5RjQM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2028936358</pqid></control><display><type>article</type><title>Mechanical hemolysis in pediatric patients associated with rapid transfusion and one‐way valve</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Gniadek, Thomas J. ; Richtsfeld, Martina ; Pulkrabek, Shelley ; Hansen, Kayla R. ; Barnett, Susan L. ; Joyner, Nitasha ; Kinney, Stephanie ; Zantek, Nicole D. ; Azakie, Anthony ; Cohn, Claudia S.</creator><creatorcontrib>Gniadek, Thomas J. ; Richtsfeld, Martina ; Pulkrabek, Shelley ; Hansen, Kayla R. ; Barnett, Susan L. ; Joyner, Nitasha ; Kinney, Stephanie ; Zantek, Nicole D. ; Azakie, Anthony ; Cohn, Claudia S.</creatorcontrib><description>BACKGROUND
Four similar transfusion reactions involving infants were reported in less than 1 year. After transfusion of red blood cells (RBCs) via syringe in the operating room, each patient experienced discolored urine, laboratory evidence of hemolysis, and acute kidney injury. Clerical and serologic investigations were unremarkable. Mechanical hemolysis was considered.
STUDY DESIGN AND METHODS
Simulated syringe transfusions were performed. Measurements included hematocrit (Hct), free hemoglobin, and visual hemolysis index. Washed and unwashed RBCs were tested with or without a recently introduced one‐way valve, using a 24‐ or 16‐gauge intravenous catheter. Constant manual pressure (1.43 ± 0.49 mL/sec) or syringe pump (2 mL/min) was used and a subset was timed.
RESULTS
The valve increased hemolysis during manual transfusion using both catheters with washed and unwashed RBCs. With the 24‐gauge catheter, the change in Hct was –3.53 ± 0.69% with the valve and 0.22 ± 0.13% without (p < 0.00001). Comparing the individual valves tested, differences in hemolysis were observed (change in Hct, p < 0.0001). During manual transfusion with 24‐gauge catheter and unwashed RBCs, the degree of hemolysis was greater when it took longer to transfuse with a valve (change in Hct versus time, r = –0.75, p < 0.0001) compared to a slight increase in hemolysis for samples that took less time to transfuse without a valve (change in Hct versus time, r = 0.58, p = 0.23).
CONCLUSIONS
Mechanical hemolysis should be considered when investigating possible hemolytic transfusion reactions, especially with high rates of transfusion and use of a valve. During rapid manual transfusion with the valve, greater resistance was associated with increased hemolysis.</description><identifier>ISSN: 0041-1132</identifier><identifier>EISSN: 1537-2995</identifier><identifier>DOI: 10.1111/trf.14554</identifier><identifier>PMID: 29498053</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Blood transfusion ; Catheters ; Cells, Cultured ; Discoloration ; Erythrocyte Transfusion - adverse effects ; Erythrocyte Transfusion - methods ; Erythrocytes ; Hematocrit ; Hemoglobin ; Hemolysis ; Humans ; Infant ; Infants ; Intravenous administration ; Medical instruments ; Models, Biological ; Syringes ; Time Factors ; Transfusion ; Transfusion Reaction ; Urine</subject><ispartof>Transfusion (Philadelphia, Pa.), 2018-05, Vol.58 (5), p.1228-1233</ispartof><rights>2018 AABB</rights><rights>2018 AABB.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3534-53a655fe487712a0a84ed370536ab9cb35a1fd3ec20107fc7e5f89116f0f49103</citedby><cites>FETCH-LOGICAL-c3534-53a655fe487712a0a84ed370536ab9cb35a1fd3ec20107fc7e5f89116f0f49103</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Ftrf.14554$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Ftrf.14554$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29498053$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gniadek, Thomas J.</creatorcontrib><creatorcontrib>Richtsfeld, Martina</creatorcontrib><creatorcontrib>Pulkrabek, Shelley</creatorcontrib><creatorcontrib>Hansen, Kayla R.</creatorcontrib><creatorcontrib>Barnett, Susan L.</creatorcontrib><creatorcontrib>Joyner, Nitasha</creatorcontrib><creatorcontrib>Kinney, Stephanie</creatorcontrib><creatorcontrib>Zantek, Nicole D.</creatorcontrib><creatorcontrib>Azakie, Anthony</creatorcontrib><creatorcontrib>Cohn, Claudia S.</creatorcontrib><title>Mechanical hemolysis in pediatric patients associated with rapid transfusion and one‐way valve</title><title>Transfusion (Philadelphia, Pa.)</title><addtitle>Transfusion</addtitle><description>BACKGROUND
Four similar transfusion reactions involving infants were reported in less than 1 year. After transfusion of red blood cells (RBCs) via syringe in the operating room, each patient experienced discolored urine, laboratory evidence of hemolysis, and acute kidney injury. Clerical and serologic investigations were unremarkable. Mechanical hemolysis was considered.
STUDY DESIGN AND METHODS
Simulated syringe transfusions were performed. Measurements included hematocrit (Hct), free hemoglobin, and visual hemolysis index. Washed and unwashed RBCs were tested with or without a recently introduced one‐way valve, using a 24‐ or 16‐gauge intravenous catheter. Constant manual pressure (1.43 ± 0.49 mL/sec) or syringe pump (2 mL/min) was used and a subset was timed.
RESULTS
The valve increased hemolysis during manual transfusion using both catheters with washed and unwashed RBCs. With the 24‐gauge catheter, the change in Hct was –3.53 ± 0.69% with the valve and 0.22 ± 0.13% without (p < 0.00001). Comparing the individual valves tested, differences in hemolysis were observed (change in Hct, p < 0.0001). During manual transfusion with 24‐gauge catheter and unwashed RBCs, the degree of hemolysis was greater when it took longer to transfuse with a valve (change in Hct versus time, r = –0.75, p < 0.0001) compared to a slight increase in hemolysis for samples that took less time to transfuse without a valve (change in Hct versus time, r = 0.58, p = 0.23).
CONCLUSIONS
Mechanical hemolysis should be considered when investigating possible hemolytic transfusion reactions, especially with high rates of transfusion and use of a valve. During rapid manual transfusion with the valve, greater resistance was associated with increased hemolysis.</description><subject>Blood transfusion</subject><subject>Catheters</subject><subject>Cells, Cultured</subject><subject>Discoloration</subject><subject>Erythrocyte Transfusion - adverse effects</subject><subject>Erythrocyte Transfusion - methods</subject><subject>Erythrocytes</subject><subject>Hematocrit</subject><subject>Hemoglobin</subject><subject>Hemolysis</subject><subject>Humans</subject><subject>Infant</subject><subject>Infants</subject><subject>Intravenous administration</subject><subject>Medical instruments</subject><subject>Models, Biological</subject><subject>Syringes</subject><subject>Time Factors</subject><subject>Transfusion</subject><subject>Transfusion Reaction</subject><subject>Urine</subject><issn>0041-1132</issn><issn>1537-2995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10MtKxDAUBuAgio6XhS8gATe6qJM0TdssRbyBIsi4rmfSEybSSWvSOszOR_AZfRKjoy4EzyZw-PJz-AnZ5-yExxn33pzwTMpsjYy4FEWSKiXXyYixjCeci3SLbIfwxBhLFeObZCtVmSqZFCPyeIt6Bs5qaOgM522zDDZQ62iHtYXeW0076C26PlAIodVxiTVd2H5GPXS2pr0HF8wQbOsouJq2Dt9f3xawpC_QvOAu2TDQBNz7fnfIw8X55Owqubm7vD47vUm0kCJLpIBcSoNZWRQ8BQZlhrUo4o05TJWeCgnc1AJ1yjgrjC5QmlJxnhtmMsWZ2CFHq9zOt88Dhr6a26CxacBhO4Tq85_IlcrzSA__0Kd28C5eF1VaKpELWUZ1vFLatyF4NFXn7Rz8suKs-qy9irVXX7VHe_CdOEznWP_Kn54jGK_Awja4_D-pmtxfrCI_AI5RjQM</recordid><startdate>201805</startdate><enddate>201805</enddate><creator>Gniadek, Thomas J.</creator><creator>Richtsfeld, Martina</creator><creator>Pulkrabek, Shelley</creator><creator>Hansen, Kayla R.</creator><creator>Barnett, Susan L.</creator><creator>Joyner, Nitasha</creator><creator>Kinney, Stephanie</creator><creator>Zantek, Nicole D.</creator><creator>Azakie, Anthony</creator><creator>Cohn, Claudia S.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7U9</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>201805</creationdate><title>Mechanical hemolysis in pediatric patients associated with rapid transfusion and one‐way valve</title><author>Gniadek, Thomas J. ; Richtsfeld, Martina ; Pulkrabek, Shelley ; Hansen, Kayla R. ; Barnett, Susan L. ; Joyner, Nitasha ; Kinney, Stephanie ; Zantek, Nicole D. ; Azakie, Anthony ; Cohn, Claudia S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3534-53a655fe487712a0a84ed370536ab9cb35a1fd3ec20107fc7e5f89116f0f49103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Blood transfusion</topic><topic>Catheters</topic><topic>Cells, Cultured</topic><topic>Discoloration</topic><topic>Erythrocyte Transfusion - adverse effects</topic><topic>Erythrocyte Transfusion - methods</topic><topic>Erythrocytes</topic><topic>Hematocrit</topic><topic>Hemoglobin</topic><topic>Hemolysis</topic><topic>Humans</topic><topic>Infant</topic><topic>Infants</topic><topic>Intravenous administration</topic><topic>Medical instruments</topic><topic>Models, Biological</topic><topic>Syringes</topic><topic>Time Factors</topic><topic>Transfusion</topic><topic>Transfusion Reaction</topic><topic>Urine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gniadek, Thomas J.</creatorcontrib><creatorcontrib>Richtsfeld, Martina</creatorcontrib><creatorcontrib>Pulkrabek, Shelley</creatorcontrib><creatorcontrib>Hansen, Kayla R.</creatorcontrib><creatorcontrib>Barnett, Susan L.</creatorcontrib><creatorcontrib>Joyner, Nitasha</creatorcontrib><creatorcontrib>Kinney, Stephanie</creatorcontrib><creatorcontrib>Zantek, Nicole D.</creatorcontrib><creatorcontrib>Azakie, Anthony</creatorcontrib><creatorcontrib>Cohn, Claudia S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Transfusion (Philadelphia, Pa.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gniadek, Thomas J.</au><au>Richtsfeld, Martina</au><au>Pulkrabek, Shelley</au><au>Hansen, Kayla R.</au><au>Barnett, Susan L.</au><au>Joyner, Nitasha</au><au>Kinney, Stephanie</au><au>Zantek, Nicole D.</au><au>Azakie, Anthony</au><au>Cohn, Claudia S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mechanical hemolysis in pediatric patients associated with rapid transfusion and one‐way valve</atitle><jtitle>Transfusion (Philadelphia, Pa.)</jtitle><addtitle>Transfusion</addtitle><date>2018-05</date><risdate>2018</risdate><volume>58</volume><issue>5</issue><spage>1228</spage><epage>1233</epage><pages>1228-1233</pages><issn>0041-1132</issn><eissn>1537-2995</eissn><abstract>BACKGROUND
Four similar transfusion reactions involving infants were reported in less than 1 year. After transfusion of red blood cells (RBCs) via syringe in the operating room, each patient experienced discolored urine, laboratory evidence of hemolysis, and acute kidney injury. Clerical and serologic investigations were unremarkable. Mechanical hemolysis was considered.
STUDY DESIGN AND METHODS
Simulated syringe transfusions were performed. Measurements included hematocrit (Hct), free hemoglobin, and visual hemolysis index. Washed and unwashed RBCs were tested with or without a recently introduced one‐way valve, using a 24‐ or 16‐gauge intravenous catheter. Constant manual pressure (1.43 ± 0.49 mL/sec) or syringe pump (2 mL/min) was used and a subset was timed.
RESULTS
The valve increased hemolysis during manual transfusion using both catheters with washed and unwashed RBCs. With the 24‐gauge catheter, the change in Hct was –3.53 ± 0.69% with the valve and 0.22 ± 0.13% without (p < 0.00001). Comparing the individual valves tested, differences in hemolysis were observed (change in Hct, p < 0.0001). During manual transfusion with 24‐gauge catheter and unwashed RBCs, the degree of hemolysis was greater when it took longer to transfuse with a valve (change in Hct versus time, r = –0.75, p < 0.0001) compared to a slight increase in hemolysis for samples that took less time to transfuse without a valve (change in Hct versus time, r = 0.58, p = 0.23).
CONCLUSIONS
Mechanical hemolysis should be considered when investigating possible hemolytic transfusion reactions, especially with high rates of transfusion and use of a valve. During rapid manual transfusion with the valve, greater resistance was associated with increased hemolysis.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>29498053</pmid><doi>10.1111/trf.14554</doi><tpages>6</tpages></addata></record> |
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| ispartof | Transfusion (Philadelphia, Pa.), 2018-05, Vol.58 (5), p.1228-1233 |
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| language | eng |
| recordid | cdi_proquest_miscellaneous_2010369966 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Blood transfusion Catheters Cells, Cultured Discoloration Erythrocyte Transfusion - adverse effects Erythrocyte Transfusion - methods Erythrocytes Hematocrit Hemoglobin Hemolysis Humans Infant Infants Intravenous administration Medical instruments Models, Biological Syringes Time Factors Transfusion Transfusion Reaction Urine |
| title | Mechanical hemolysis in pediatric patients associated with rapid transfusion and one‐way valve |
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