Risk Assessment of Red Cell Transfusion in Congenital Heart Disease

Abstract

Background The storage time of packed red blood cells (pRBC) is an indicator of change in the product's pH, potassium, and lactate levels. Blood–gas analysis is a readily available bedside tool on every intensive care ward to measure these factors prior to application, thus facilitating a calculated decision on a transfusion's quantity and duration.

Our first goal is to assess the impact of storage time on pH, potassium, and lactate levels in pRBC. The influence of those parameters in the transfused children will then be evaluated.

Methods In this retrospective study, we conducted blood–gas analyses of pRBC units before they were administered over 4 hours to neonates, infants, and children in our pediatric cardiac intensive care ward. All patients underwent regular blood–gas analyses themselves, before and after transfusion.

Results We observed a highly significant correlation between the storage time of pRBC units and a drop in pH, as well as an increase in potassium and lactate of stored red cells (p< 0.0001). Median age of recipients with a complete blood–gas dataset was 0.1 (interquartile range [IQR] = 0.0–0.7) years; median pRBC storage duration was 6 (IQR = 5–8) days. Further analyses showed no statistically significant effect on children's blood gases within 4 hours after transfusion, even after stratifying for pRBC storage time ≤7 days and >7 days.

Conclusion Stored red blood cells show a rapid decrease in pH and increase in potassium and lactate. Slow transfusion of these units had no adverse effects on the recipients' pH, potassium, and lactate levels.

Keywords

blood transfusion - congenital heart disease - intensive care - neonate - pediatric

• References

• 1 Barbosa FT, Jucá MJ, Castro AA, Duarte JL, Barbosa LT. Artificial oxygen carriers as a possible alternative to red cells in clinical practice. Sao Paulo Med J 2009; 127 (02) 97-100
• 2 Mazine A, Rached-D'Astous S, Ducruet T, Lacroix J, Poirier N. Pediatric Acute Lung Injury and Sepsis Investigators Network. Blood transfusions after pediatric cardiac operations: a North American Multicenter Prospective Study. Ann Thorac Surg 2015; 100 (02) 671-677
• 3 Valentine SL, Bembea MM, Muszynski JA. et al; Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI), Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Consensus recommendations for RBC transfusion practice in critically ill children from the pediatric critical care transfusion and anemia expertise initiative. Pediatr Crit Care Med 2018; 19 (09) 884-898
• 4 Cholette JM, Willems A, Valentine SL, Bateman ST, Schwartz SM. Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI), Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Recommendations on RBC transfusion in infants and children with acquired and congenital heart disease from the pediatric critical care transfusion and anemia expertise initiative. Pediatr Crit Care Med 2018; 19 (9S, suppl 1): S137-S148
• 5 Lion N, Crettaz D, Rubin O, Tissot J-D. Stored red blood cells: a changing universe waiting for its map(s). J Proteomics 2010; 73 (03) 374-385
• 6 Flatt JF, Bawazir WM, Bruce LJ. The involvement of cation leaks in the storage lesion of red blood cells. Front Physiol 2014; 5: 214
• 7 Bennett-Guerrero E, Veldman TH, Doctor A. et al. Evolution of adverse changes in stored RBCs. Proc Natl Acad Sci U S A 2007; 104 (43) 17063-17068
• 8 Du X, Chen H, Song X. et al. Risk factors for low cardiac output syndrome in children with congenital heart disease undergoing cardiac surgery: a retrospective cohort study. BMC Pediatr 2020; 20 (01) 87
• 9 Şahutoğlu C, Yaşar A, Kocabaş S, Aşkar FZ, Ayık MF, Atay Y. Correlation between serum lactate levels and outcome in pediatric patients undergoing congenital heart surgery. Turk Gogus Kalp Damar Cerrahisi Derg 2018; 26 (03) 375-385
• 10 D'Alessandro A, D'Amici GM, Vaglio S, Zolla L. Time-course investigation of SAGM-stored leukocyte-filtered red blood cell concentrates: from metabolism to proteomics. Haematologica 2012; 97 (01) 107-115
• 11 Hess JR. Red cell changes during storage. Transfus Apheresis Sci 2010; 43 (01) 51-59
• 12 Perrotta S, Gallagher PG, Mohandas N. Hereditary spherocytosis. Lancet 2008; 372 (9647): 1411-1426
• 13 Safeukui I, Buffet PA, Deplaine G. et al. Quantitative assessment of sensing and sequestration of spherocytic erythrocytes by the human spleen. Blood 2012; 120 (02) 424-430
• 14 Hod EA, Spitalnik SL. Stored red blood cell transfusions: iron, inflammation, immunity, and infection. Transfus Clin Biol 2012; 19 (03) 84-89
• 15 Bardyn M, Rappaz B, Jaferzadeh K. et al. Red blood cells ageing markers: a multi-parametric analysis. Blood Transfus 2017; 15 (03) 239-248
• 16 Steiner ME, Ness PM, Assmann SF. et al. Effects of red-cell storage duration on patients undergoing cardiac surgery. N Engl J Med 2015; 372 (15) 1419-1429
• 17 Fergusson DA, Hébert P, Hogan DL. et al. Effect of fresh red blood cell transfusions on clinical outcomes in premature, very low-birth-weight infants: the ARIPI randomized trial. JAMA 2012; 308 (14) 1443-1451
• 18 Fergusson D, Hébert PC, Lee SK. et al. Clinical outcomes following institution of universal leukoreduction of blood transfusions for premature infants. JAMA 2003; 289 (15) 1950-1956
• 19 Khan SY, Kelher MR, Heal JM. et al. Soluble CD40 ligand accumulates in stored blood components, primes neutrophils through CD40, and is a potential cofactor in the development of transfusion-related acute lung injury. Blood 2006; 108 (07) 2455-2462
• 20 Heddle NM, Klama LN, Griffith L, Roberts R, Shukla G, Kelton JG. A prospective study to identify the risk factors associated with acute reactions to platelet and red cell transfusions. Transfusion 1993; 33 (10) 794-797
• 21 Savorgnan F, Bhat PN, Checchia PA. et al. RBC transfusion induced ST segment variability following the Norwood procedure. Crit Care Explor 2021; 3 (05) e0417
• 22 Muraki R, Hiraoka A, Nagata K. et al. Novel method for estimating the total blood volume: the importance of adjustment using the ideal body weight and age for the accurate prediction of haemodilution during cardiopulmonary bypass. Interact Cardiovasc Thorac Surg 2018; 27 (06) 802-807
• 23 Hall TL, Barnes A, Miller JR, Bethencourt DM, Nestor L. Neonatal mortality following transfusion of red cells with high plasma potassium levels. Transfusion 1993; 33 (07) 606-609