J Dent Anesth Pain Med.  2015 Dec;15(4):229-233.

Hemolysis of irradiated leukoreduced red blood cells during rapid warming: An in vitro experimental study

• Lee S
• Lee S
• Oh JE
• Shin WJ
• Min WK
• Gwak M

Abstract

BACKGROUND
Although water chambers are often used as surrogate blood-warming devices to facilitate rapid warming of red blood cells (RBCs), these cells may be damaged if overheated. Moreover, filtered and irradiated RBCs may be damaged during the warming process, resulting in excessive hemolysis and extracellular potassium release.
METHODS
Using hand-held syringes, each unit of irradiated and leukocyte-filtered RBCs was rapidly passed through a water chamber set to different temperatures (baseline before blood warming, 50℃, 60℃, and 70℃). The resulting plasma potassium and free hemoglobin levels were then measured.
RESULTS
Warming RBCs to 60℃ and 70℃ induced significant increases in free hemoglobin (median [interquartile ranges] = 60.5 mg/dl [34.9-101.4] and 570.2 mg/dl [115.6-2289.7], respectively). Potassium levels after warming to 70℃ (31.4 ± 7.6 mEq/L) were significantly higher compared with baseline (29.7 ± 7.1 mEq/L; P = 0.029). Potassium levels were significantly correlated with storage duration after warming to 50℃ and 60℃ (r = 0.450 and P = 0.001; r = 0.351 and P = 0.015, respectively).
CONCLUSIONS
Rapid warming of irradiated leukoreduced RBCs to 50℃ may not further increase the extracellular release of hemoglobin or potassium. However, irradiated leukoreduced RBCs that have been in storage for long periods of time and contain higher levels of potassium should be infused with caution.

Keyword

Hemolysis; Hyperkalemia; Red blood cells; Transfusion

MeSH Terms

Erythrocytes*
Hemolysis*
Hyperkalemia
In Vitro Techniques*
Plasma
Potassium
Syringes
Water
Potassium
Water

Figure

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  Fig. 1 Effects of temperature on the free hemoglobin and plasma potassium levels. At 60℃ and 70℃, the free hemoglobin concentrations significantly increased in comparison with baseline and 50℃ temperatures. Potassium levels were significantly higher at 70℃ in comparison with baseline. *P < 0.05. Bars and whiskers indicate the mean ± standard error, respectively.

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