• Maria Paula Oliveira Pires, PeterliniMaria Angélica SorginiMASSafety, Technology and Care Research Group, Department of Paediatric Nursing, Universidade Federal de São Paulo (Federal University of Sao Paulo), R. Napoleão de Barros, 754 - Vila Clementino, Sao Paulo, SP, 04024-002, Br, Amanda J Ullman, Andrew C Bulmer, Claire M Rickard, and PedreiraMavilde Luz GonçalvesMLGSafety, Technology and Care Research Group, Department of Paediatric Nursing, Universidade Federal de São Paulo (Federal University of Sao Paulo), R. Napoleão de Barros, 754 - Vila Clementino, Sao Paulo, SP, 04024-002, Braz.
• Safety, Technology and Care Research Group, Department of Paediatric Nursing, Universidade Federal de São Paulo (Federal University of Sao Paulo), R. Napoleão de Barros, 754 - Vila Clementino, Sao Paulo, SP, 04024-002, Brazil; Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, 170 Kessels Road Nathan, Qld, 4111, Brisbane, Queensland, Australia; Paulista University, Health Sciences Institution, R. Vergueiro, 1211 - Aclimação, Sao Paulo, SP, 01533-000, Brazil. Electronic address: mp.pires2@gmail.com.
• Aust Crit Care. 2021 May 1; 34 (3): 235-240.

BackgroundTransfusion of red blood cell (RBC) concentrates is a common procedure to restore blood volume and tissue oxygen delivery in patients with trauma. Although RBC warmers may prevent hypothermia, some warming or infusion equipment may lead to haemolysis and patient injury.ObjectivesThe aim of this study was to test the effect of (i) RBC warming and (ii) administration via manual vs. pump infusion on haemolysis.MethodsThis experimental ex vivo study studied haemolysis markers of RBC injury. The sample consisted of 90 RBC infusions in two simulations, randomly, 45 warmed RBC infusions and 45 nonwarmed RBC infusions, in two or three stages: before the intervention (baseline-warming, N= 45; nonwarming, N= 45), after water bath warming at 42 °C (warmed, N= 45), and then after the warmed or nonwarmed RBCs were infused by manual or pump infusion at a rate of 100 mL/h (infusion-warming, N= 45; nonwarming, N= 45).ResultsWarmed RBCs showed significantly lower total haemoglobin (Hb) and haematocrit levels and increase in free Hb levels, haemolysis levels, and lactate dehydrogenase (LDH) activity (all p<0.05) than baseline RBCs. Pump infusion RBCs were associated with reduced total Hb and increased free Hb, haemolysis, and potassium (K) levels (all p<0.05) compared with warmed RBCs. In contrast, manual infusion of warmed RBCs resulted in significantly reduced total Hb levels and increased LDH activity (both <0.05). After infusion, total Hb, free Hb, haematocrit, haemolysis, and LDH values were significantly different for warmed vs. nonwarmed RBCs (p<0.05).ConclusionsHaemolysis biomarkers increase with RBC warming and infusion, especially when using infusion pumps. Critically ill patients should be carefully monitored for possible complications during and after RBC infusion.Copyright © 2020 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

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