Rapid transfusion of blood mixture in adult liver transplantation recipients

Abstract

Background There is little information regarding the use of rapid infusion device and blood mixture prefilled in the reservoir. The current study aimed at describing acute biochemical changes following rapid transfusion of blood mixture during liver transplantation.

Methods Ten adult liver recipients treated with massive transfusion during hepatic dissection were sequentially enrolled. Blood mixture composed of red blood cell, fresh frozen plasma and normal saline (4 units: 4 units: 800 ml) was prepared in the reservoir of the rapid infusion device. During massive hemorrhage, 300 ml bolus of blood mixture was repeatedly transfused at a rate of 500 ml/min. Blood samples were gathered during the 1st, 3rd, 5th and 7th bolus transfusions. For each transfusion, three sequential blood samples were taken from the arterial line, blood mixture and the arterial line, respectively, before, during and after transfusion. Changes of pH, base excess, hematocrit and concentrations of potassium, sodium, ionized calcium, glucose and lactate were measured and analyzed.

Results Significant increase of potassium and decrease of hematocrit were observed during the former and latter half of transfusion, respectively. Hypocalcemia and acidosis needed immediate corrections after each bolus transfusion. Significant changes were observed for sodium, glucose and lactate after transfusion of one reservoir volume, however of little clinical importance.

Discussion & Conclusions Acute hypocalcemia and acidosis require prompt corrections during rapid transfusion. Acute hyperkalemia and anemia as well as delayed hyperglycemia may be potential risks associated with repeated infusions of blood mixture. We conclude that rapid transfusion of blood mixture is substantially safe only if aggressive intraoperative care be given during liver transplantation surgery.