Anesth Pain Med.  2019 Jan;14(1):54-62. 10.17085/apm.2019.14.1.54.

Safety of blood mixture transfusion by rapid infusion device in liver transplantation recipients

• Yang SM
• Jung CW
• Kim WH
• Ryu HG
• Yoon SB
• Lee HC

• KMID: 2434200
• DOI: http://doi.org/10.17085/apm.2019.14.1.54

Abstract

BACKGROUND
Information on biochemical changes following rapid transfusion of blood mixtures in liver transplantation patients is limited.
METHODS
A blood mixture composed of red blood cells, fresh frozen plasma, and 0.9% saline was prepared in a ratio of 1 unit:1 unit:250 ml. During massive hemorrhage, 300 ml of the blood mixture was repeatedly transfused. A blood mixture sample as well as pre- and post-transfusion arterial blood samples were collected at the first, third, fifth, and seventh bolus transfusions. Changes in pH, hematocrit, electrolytes, and glucose were measured with a point-of-care analyzer. The biochemical changes were described, and the factors driving the changes were sought through linear mixed effects analysis.
RESULTS
A total of 120 blood samples from 10 recipients were examined. Potassium and sodium levels became normalized during preservation. Biochemical changes in the blood mixture were significantly related to the duration of blood bank storage and reservoir preservation (average R2 = 0.41). Acute acidosis and hypocalcemia requiring immediate correction occurred with each transfusion. Both the pre-transfusion value of the patient and the blood mixture value were significant predictors of post-transfusion changes in the body (average R2 = 0.87); however, the former was more crucial.
CONCLUSIONS
Rapid infusion of blood mixture is relatively safe because favorable biochemical changes occur during storage in the reservoir, and the composition of the blood mixture has little effect on the body during rapid transfusion in liver recipients. However, acute hypocalcemia and acidosis requiring immediate correction occurred frequently due to limited citrate metabolism in the liver recipients.

Keyword

Blood safety; Blood transfusion; Liver transplantation

MeSH Terms

Acidosis
Blood Banks
Blood Safety
Blood Transfusion
Citric Acid
Electrolytes
Erythrocytes
Glucose
Hematocrit
Hemorrhage
Humans
Hydrogen-Ion Concentration
Hypocalcemia
Liver Transplantation*
Liver*
Metabolism
Plasma
Point-of-Care Systems
Potassium
Sodium
Citric Acid
Electrolytes
Glucose
Potassium
Sodium

Figure

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  Fig. 1 Biochemical changes of the blood mixture in the reservoir. During transfusion, the laboratory values are either consistently low (pH and ionized calcium), steadily decreased (hematocrit, potassium, and glucose), or increased (sodium) in the blood mixture. The concentration of ionized calcium is assumed to be zero because it cannot be measured. *Bonferroni corrected P < 0.05 between values.

• 

  Fig. 2 Acute biochemical changes in the body during rapid transfusion. Immediate post-transfusion changes are observed in the body during the early (potassium), late (hematocrit), and entire (pH, ionized calcium, sodium and glucose) transfusion periods. *P < 0.05 vs. pre-transfusion value.

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