Acid-base, electrolyte and metabolite concentrations in packed red blood cells for major transfusion in infants

Methods: Acid–base, electrolyte and metabolite concentrations were determined in 100 U of packed red blood cells (RBC) preserved in extended‐storage media to be used for major transfusion in paediatric and cardiac surgery. Results: In fresh RBC, low pH, bicarbonate (cHCO3−), base excess (BE) and high glucose values were observed all outside the physiological range. With lengthening storage duration, values of pH, cHCO3−, BE, sodium and glucose decreased and carbon dioxide, potassium and lactic acid concentrations increased [mean ± SD (range): storage duration 6.7 ± 3.8 (1–17) days, pH 6.79 ± 0.1 (6.53–6.99); mmol·l–1: cHCO3− 11.1 ± 1.5 (6.2–14.5), BE − 29.2 ± 4.1 ([−39.4] − [−20.9]), potassium 20.5 ± 7.8 (4.2–43.6), glucose 24.1 ± 6.1 (16.7–29.2), lactic acid 9.4 ± 4 (4.3–21.4)]. Conclusions: Massive and rapid transfusion of RBC may lead to a severe burden of hydrogen ions, carbon dioxide, potassium, glucose and lactic acid and this can be avoided by cell saver blood processing, when autologous erythrocytes from the operative field are saved and substrate load and storage lesions from packed red blood cells are minimized in one step by washing.