Hemolysis risk after packed red blood cells transfusion with infusion pumps

An experimental and randomized study was designed simulating the clinical practice of transfusion. Two linear peristaltic infusion pumps from different manufactures were studied in triplicate at 100 mL/h and 300mL/h infusion rates. The chosen hemolysis biomarkers were total hemoglobin, free hemoglobin, hematocrit, potassium and degree of hemolysis. They were analyzed before and after each infusion.

Results:

Potassium showed statistically significant variations in all scenarios of the experiment (P<0.010). In a separated analysis, potassium increased mainly at 300mL/h rate (P=0.021) and free hemoglobin had significant variation when comparing infusion pumps from different manufacturers (P=0.026). Although hematocrit, total hemoglobin and degree of hemolysis had increased after infusion, no statistically significance variations were identified.

Conclusions:

Hemolysis risk induced by a linear peristaltic infusion pump was identified by an increase in free hemoglobin and potassium markers. As the potassium biomarker is often increased in aged packed red blood cells, we do not recommend using them in this scenario. Additional studies should be performed about other markers and using larger samples in order to reinforce the transfusion practice in nursing.

Descriptors:
Infusion Pumps; Erythrocytes; Hemolysis; Evidence-based Nursing; Blood Transfusion; Patient Safety

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Ana Maria Miranda Martins Wilson E-mail:
anamaria.martins@usp.br

	Experiment					Total
Variable		IPA* 100 mL/h^‡	IPA* 300 mL/h^‡	IPB^† 100 mL/h^‡	IPB^† 300 mL/h^‡
Ht^§ (%)	Mean ± SD^\|\|	71.3±2.2	68.3±1.3	72.9±2.5	68.4±0.9	70.2±2.6
Ht^§ (%)	Min-Max^¶	70-75	67-70	70-76	67-70	67-76
Total Hb** (g/dl^††)	Mean ± SD^\|\|	24.4±1.7	26.1±2.4	25.1±1.8	27.1±2.0	25.7±2.2
Total Hb** (g/dl^††)	Min-Max^¶	22.9-28.6	22.8-30.8	23.5-28	23.9-29,8	22.8-30.8
Free Hb** (g/dl^††)	Mean ± SD^\|\|	0.160±0.152	0.444±0.170	0.258±0.147	0.368±0.203	0.308±0.201
Free Hb** (g/dl^††)	Min-Max^¶	0.046-0.458	0.206-0.651	0.047-0.395	0.206-0.694	0.046-0.694
Degree of hemolysis (%)	Mean ± SD^\|\|	0.16±0.14	0.55±0.24	0.26±0.14	0.43±0.24	0.35±0.24
Degree of hemolysis (%)	Min-Max^¶	0.06-0.40	0.20-0.81	0.06-0.38	0.23-0.83	0.06-0.83
Potassium (mmol/L^‡‡)	Mean ± SD^\|\|	39.2±2.2	39.1±2,5	41.5	40.9±2.4	40.2±2.5
Potassium (mmol/L^‡‡)	Min-Max^¶	35.6-43.7	35.8-42.9	37.6-44.5	37.4-42.9	35.6-44.5

	Experiment phases
Marker	C1*	C2^†	V^‡	Mean difference C1* and V^‡ (CI^§ 95%)	P
Ht^\|\| (%)	70.08 (67-75)	70.25 (67-76)	70.40 (67-75)	0.32 (-1.24 to 0.57)	0.705^¶
Total Hb** (g/dL^††)	24.60 ±1.71	26.32 ±2.35	26.09 ±2.19	-1.48 (-3.07 to 0.10)	0.267^‡‡
Free Hb** (g/dL^††)	0.298 ±0.20	0.312 ±0.21	0.313 ±0.20	-0.01 (-0.04 to 0.01)	0.064^‡‡
Degree of hemolysis (%)	0.35 ±0.25	0.35 ±0.24	0.35 ±0.24	0.006 (-0.03 to 0.05)	0.744^‡‡
Potassium (mmol/L^§§)	39.5 ±2.0	40.1 ±3.03	40.9 ±2.5	-1.39 (-2.28 to -0.48)	<0.010^‡‡

	Experiment phases
Markers	Flow mL/h*	C1^†	C2^‡	V^§	Mean differences C1^† and V^§	P-value
Ht^¶ (%)	100	70.08 (70-75)	70.25 (70-76)	70.40 (70-75)	(CI^\|\| 95%)	0.905**
Ht^¶ (%)	300	70.08 (67-70)	70.25 (67-70)	70.40 (67-70)	-0.50 (-1.94 to 0.94)	0.497**
Total Hb^†† (g/dL^‡‡)	100	23.83 ±0.77	25.48 ±2.23	24.89 ±1.83	-1.05 (-2.80 to 0.68)	0.180^§§
Total Hb^†† (g/dL^‡‡)	300	25.37 ±2.10	27.16 ±2.35	27.29 ±1.93	-1.92 (-5.32 to 1.48)	0.207^§§
Free Hb^†† (g/dL^‡‡)	100	0.192 ±0.15	0.220 ±0.19	0.215 ±0.17	- 0.03 (-0.04 to 0.02)	0.068^§§
Free Hb^†† (g/dL^‡‡)	300	0.403 ±0.21	0.404 ±021	0.410 ±0.19	0.02 (- 0.07 to 0.05)	0.78^§§
Degree of hemolysis (%)	100	0.21 ±0.15	0.22 ±0.17	0.22 ±0.15	-0.08 (-0.22 to 0.06)	0.209^§§
Degree of hemolysis (%)	300	0.50 ±0.26	0.48 ±0.25	0.48 ±0.25	0.02 (-0.08 to 0.12)	0.617^§§
Potassium (mmol/L^\|\|\|\|)	100	39.6 ±1.4	40.2 ±3.6	41.3 ±2.8	- 1.76 (-3.73 to 0.20)	0.069^§§
Potassium (mmol/L^\|\|\|\|)	300	39.5 ±2.7	40.0 ±2.7	40.5 ±2.5	-1.87 (-1.78 to -0.22)	0.021^§§

	Experiment phases
Markers	IP*	C1^†	C2^‡	V^§	Mean differences C1^† and V^§ (CI^\|\| 95%)	p-value
Ht^¶ (%)	IPA**	70.08 (67-72)	70.25 (67-75)	70.40 (67-75)	-0.50 (-1.78 to 0.78)	0.368^††
Ht^¶ (%)	IPB^‡‡	70.08 (67-75)	70.25 (68-76)	70.40 (68-75)	-0.16 (-1.97 to 1.64)	0.790^††
Total Hb^§§ (g/ dL^\|\|\|\|)	IPA**	24.08 ±1.35	26.55 ±2.85	25.09 ±1.71	-1.00 (-3.00 to 0.98)	0.249^¶¶
Total Hb^§§ (g/ dL^\|\|\|\|)	IPB^‡‡	25.12 ±1.98	26.09 ±1.99	27.09 ±2.29	-1.96 (-5.22 to 1.28)	0.181^¶¶
Free Hb^§§ (g/ dL^\|\|\|\|)	IPA**	0.282 ±0.22	0.309 ±0.24	0.315 ±0.24	-0.03 (-0.05 to -0.07)	0.026^¶¶
Free Hb^§§ (g/ dL^\|\|\|\|)	IPB^‡‡	0.298 ±0.20	0.312 ±0.21	0.313 ±0.20	0.02 (- 0.05 to 0.06)	0.922^¶¶
Degree of hemolysis (%)	IPA**	0.36 ±0.27	0.35 ±0.29	0.38 ±0.30	-0.02 (-0.06 to 0.01)	0.222^¶¶
Degree of hemolysis (%)	IPB^‡‡	0.36 ±0.25	0.35 ±0.22	0.33 ±0.19	0.03 (-0.05 to 0.12)	0.345^¶¶
Potassium (mmol/L***)	IPA**	39.0 ±2.1	38.5 ±2.2	39.9 ±2.7	-0.89 (-2.26 to 0.46)	0.151^¶¶
Potassium (mmol/L***)	IPB^‡‡	40.1 ±1.2	41.7 ±3,0	41.9 ±2.2	-1.87 (-3.41 to -0.33)	0.022^¶¶