Safety of Blood Transfusions Using 27 Gauge Neonatal PICC Lines: An in vitro Study on Hemolysis

A. Repa; M. Mayerhofer; F. Cardona; N. Worel; P. Deindl; A. Pollak; A. Berger; N. Haiden

doi:10.1055/s-0033-1355329

Klinische Pädiatrie, Table of Contents

Klin Padiatr 2013; 225(07): 379-382
DOI: 10.1055/s-0033-1355329

Original Article

Safety of Blood Transfusions Using 27 Gauge Neonatal PICC Lines: An in vitro Study on Hemolysis

Sicherheit von Bluttransfusionen über 27-Gauge-PICC-Katheter: Eine In-vitro-Studie zur Hämolyse

Authors

A. Repa

¹Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria
M. Mayerhofer

²Department of Laboratory Medicine, Medical University Vienna, Austria
F. Cardona

¹Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria
N. Worel

³Department of Blood Group Serology and Transfusion Medicine, Medical University Vienna, Austria
P. Deindl

¹Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria
A. Pollak

¹Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria
A. Berger

¹Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria
N. Haiden

¹Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria

Abstract

Background:

Blood transfusions are required by the majority of extremely premature infants. Packed red blood cells (PRBCs) are usually applied via simple peripheral cannulas. In situations where no peripheral venous access is achievable, 27 Gauge (G) neonatal PICC lines – that are ideally exclusively dedicated to application of parenteral nutrition – may represent a useful alternative access for PRBC transfusions. However, transfusion via small scaled catheters may damage PRBCs and lead to hemolysis. We here evaluate whether transfusion of irradiated PRBCs via 27 G PICC lines leads to hemolysis in vitro.

Methods:

Experimental transfusions of gamma-irradiated PRBCs were performed at increasing velocities (2.5, 3.7, 5 ml/h; full force manual push approximating 30 ml/h) via 27 G PICC lines of 20 and 30 cm length. Parameters of hemolysis (lactate dehydrogenase, potassium and free hemoglobin) were measured from the supernatants of transfused PRBCs and the percentage of hemolysis was calculated.

Results:

Potassium and lactate dehydrogenase after transfusion at increasing velocities did not differ significantly from negative controls. Free hemoglobin levels showed a small but significant increase at the slowest transfusion speed (2.5 ml/h) using the 30 cm 27 G PICC line, with a relative hemolysis of only 0.13%. A manual push (approximating 30 ml/h) showed no significant changes of parameters from baseline.

Conclusions:

We conclude that transfusion of gamma-irradiated PRBCs using a 27 G neonatal PICC line does not cause clinically relevant hemolysis in vitro. Clinical studies are needed to confirm the feasibility and safety of the approach in vivo.

Zusammenfassung

Hintergrund:

Extrem unreife Frühgeborene benötigen oft mehrfach Bluttransfusionen, die normalerweise über periphere Venenverweilkatheter verabreicht werden. Ist kein peripherer Zugang möglich, könnten für die parenterale Ernährung gedachte 27 Gauge (G) peripher inserierbare Katheter (PICC) auch für Transfusionen verwendet werden. Der sehr enge Querschnitt dieser Katheter könnte jedoch zu einer Beschädigung der transfundierten Erythrozyten und zu Hämolyse führen.

Methodik:

Experimentelle Transfusionen von bestrahlten Erythrozytenkonzentraten über 27-GPICC-Katheter (20 und 30 cm Länge) wurden mit definierten Geschwindigkeiten (2,5, 3,7, 5 ml/h und manuelle Transfusion mit ungefähr 30 ml/h) durchgeführt. Die Hämolyseparameter (Laktat-Dehydrogenase, Kalium und freies Hämoglobin) wurden in den Überständen der Erythrozyten nach Transfusion gemessen und die relative Hämolyse berechnet.

Ergebniss:

Die nach Transfusion gemessenen Kalium und LDH-Werte zeigten keinen Unterschied zu den Negativkontrollen. Nur nach Transfusion über den 30-cm-27-G-PICC-Katheter mit der langsamsten Geschwindigkeit (2,5 ml/h) kam es zu einem minimalem, aber signifikanten Anstieg des freien Hämoglobins, mit einer relativen Hämolyse von nur 0,13%. Nach manueller Transfusion (ungefähr 30 ml/h) fand sich kein Anstieg der Hämolyseparameter.

Konklusion:

27-G-PICC-Katheter wurden für Transfusionen in vitro ohne Hinweis auf relevante Hämolyse verwendet. Eine Evaluation in der Klinik bezüglich der Machbarkeit und Sicherheit steht aus.

Key words

preterm infants - extremely low birth weight infants - catheter - red blood cell transfusion - hemolysis - safety

Schlüsselwörter

Frühgeburt - Extrem niedriges Geburtsgewicht - Katheter - Bluttransfusion - Hämolyse - Sicherheit

Full Text

References

References
1 Commare CE, Tappenden KA. Development of the infant intestine: implications for nutrition support. Nutr Clin Pract 2007; 22: 159-173
2 Frelich R, Ellis MH. The effect of external pressure, catheter gauge, and storage time on hemolysis in RBC transfusion. Transfusion 2001; 41: 799-802
3 Horbar JD, Carpenter JH, Badger GJ et al. Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009. Pediatrics 2012; 129: 1019-1026
4 Koletzko B, Goulet O, Hunt J et al. 1. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr 2005; 41 (Suppl. 02) S1-S87
5 Leverett LB, Hellums JD, Alfrey CP et al. Red blood cell damage by shear stress. Biophys J 1972; 12: 257-273
6 Lippi G, Blanckaert N, Bonini P et al. Haemolysis: an overview of the leading cause of unsuitable specimens in clinical laboratories. Clin Chem Lab Med 2008; 46: 764-772
7 Lippi G, Salvagno GL, Montagnana M et al. Influence of hemolysis on routine clinical chemistry testing. Clin Chem Lab Med 2006; 44: 311-316
8 Miller MA, Schlueter AJ. Transfusions via hand-held syringes and small-gauge needles as risk factors for hyperkalemia. Transfusion 2004; 44: 373-381
9 Paulson PR, Miller KM. Neonatal peripherally inserted central catheters: recommendations for prevention of insertion and postinsertion complications. Neonatal Netw 2008; 27: 245-257
10 Pisciotto PT. Technical Considerations/Mechanical Devices. In: Christopher D, Hillyer M, Strauss RG, Naomi LC, Luban ed. Handbook of Pediatric Transfusion Medicine. Elsevier; 2004: 121-130
11 Riggert J, Schwartz DW, Wieding JU et al. Prestorage inline filtration of whole blood for obtaining white cell-reduced blood components. Transfusion 1997; 37: 1039-1044
12 Shortland D, Trounce JQ, Levene MI. Hyperkalaemia, cardiac arrhythmias, and cerebral lesions in high risk neonates. Arch Dis Childh 1987; 62: 1139-1143
13 Sowemimo-Coker SO. Red blood cell hemolysis during processing. Transf Med Rev 2002; 16: 46-60
14 Stichtenoth G, Demmert M, Bohnhorst B et al. Major contributors to hospital mortality in very-low-birth-weight infants: data of the birth year 2010 cohort of the German Neonatal Network. Klin Padiatr 2012; 224: 276-281
15 Widness JA. Treatment and Prevention of Neonatal Anemia. NeoRev 2008; 9: 526-533
16 Wilcox GJ, Barnes A, Modanlou H. Does transfusion using a syringe infusion pump and small-gauge needle cause hemolysis?. Transfusion 1981; 21: 750-751