M. Zaza1, Y. Wang1, M. George1, C. E. Wade1, J. C. Cardenas1, B. A. Cotton1 1McGovern Medical School at UTHealth,Acute Care Surgery,Houston, TX, USA
Introduction: Rapid infusion devices are often employed to deliver large volumes of warmed fluids and blood products. Typically, RBCs and plasma are delivered through the rapid infuser device, while platelets and cryoprecipitate are given through a separate intravenous line, as neither platelets nor cryoprecipitate are approved for use with such devices. The restriction on their use is due to concern with component injury and adherence to device filters and circuits. Many centers have recently adopted whole blood (WB) for emergency use. Given that WB contains platelets and fibrinogen, the purpose of this study was to evaluate the impact of rapid infusers on WB platelet count, platelet function, and overall clot strength.
Methods: Five units of WB (three days or less from donation to testing) were obtained from our regional blood center provider. A baseline samples was obtained from each unit from a non-filtered infusion line (BASELINE). Following this, samples were obtained on WB from four different infusion models: filtered blood tubing (FILTER), filtered blood tubing on a pressure bag at 300 mmHg (PRESSURE), and through a primed Belmont FMS 2000 run at 70 mL/hr (BELMONT70) and 100ml/hr (BELMONT100). Platelet count was assessed by complete blood count (HemaVet 950), while platelet function (AA, ADP, Thrombin, Ristocetin, P-selectin, and Annexin-v) was assessed with Multiplate. Overall hemostatic potential was assessed by thrombelastography (R-value, k-time, angle, MA, lysis) while thrombin generation (lag time, ETP, peak, ttpeak) was assessed with calibrated automated thrombogram (CAT). All testing was performed using STATA 12.1. Means were assessed with ANOVA (Bonferroni correction) while medians were assessed with Kruskal-Wallis.
Results: There was a statistically significant decrease in platelet count from baseline when samples were obtained from the BELMONT70 and BELMONT100 (TABLE). However, there were no differences detected in platelet function between infusion models; all p>0.20. While there were no differences in any thrombelastography parameters between baseline and infusion models (all p>0.20), there were significant differences in all thrombin generation parameters by CAT (TABLE). * = p<0.05
Conclusion: The use of rapid infusers with WB appears appropriate despite containing platelets and fibrinogen, which, as concentrates, are not approved for use with these devices. While platelet count is significantly decreased when WB is subjected to a rapid infuser device, platelet function and overall clot strength are preserved. Moreover, when compared to standard transfusion tubing or pressure bag, thrombin generation is accelerated and thrombin potential increased when WB is administered through a rapid infuser device.
