Advertisement

The effect of the Belmont rapid infuser on cold stored whole blood coagulability

Published:September 20, 2022DOI:https://doi.org/10.1016/j.injury.2022.09.033

      Highlights

      • Transfusion of platelets or cryoprecipitate is specifically listed as a contraindication in the Belmont manual.
      • This manuscript reveals important information about the impact of rapid warm transfusion via Belmont on platelet function when using cold stored leukoreduced whole blood.
      • There is a significant decrease in platelet number and function in cold stored whole blood when looking at complete blood count and TEG-MA before and after the rapid infuser.
      • It is unclear whether the effects we have observed are related to cold storage effects or if they are related to shear forces induced through the rapid infuser.
      • The information obtained from this study gives us an idea about mechanistic insights, but more studies are needed to examine in detail the mechanistic explanation of these findings.

      Abstract

      Introduction

      With the large-scale use of whole blood in massive transfusion using rapid infusers/fluid warmers such as the Belmont, questions remain as to whether coagulation potency, platelet number and function are preserved.  We aimed to study functional coagulation capacity and cell counts in whole blood before and after infusion through the Belmont rapid infuser utilizing TEG analysis and complete blood counts.

      Methods

      We evaluated 10 whole blood units before and after infusion through a Belmont Fluid Management System at a set rate of 200 mL/min and a temperature of 37.4 °C.  Cell counts and thromboelastography function of the specimens were measured. Parameters were compared utilizing paired Student's t-tests and paired Wilcoxon Rank Sign tests.

      Results

      Platelet count, R time, and Maximum amplitude showed significant decreases (defined as p<0.05) after being infused through the Belmont. Hemoglobin, hematocrit, MCV, and alpha angle were not statistically different before and after infusion.

      Conclusion

      Infusion of cold stored whole blood in a Belmont infuser, appeared to decrease platelet counts and function as well as activate clotting factors as demonstrated by a shorter R time while not affecting red cell counts or fibrin cross-linking as measured by TEG parameters and cell counts. This suggests that while it is possible to transfuse whole blood through a rapid infuser, platelet quantity and function may be negatively impacted.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Trunkey D.D.
        • Lim R.C.
        Analysis of 425 consecutive trauma fatalities: an autopsy study.
        J Am Coll Emerg Phys. 1974; 3: 368-371
        • Repine T.B.
        • Perkins J.G.
        • Kauvar D.S.
        • Blackborne L.
        The use of fresh whole blood in massive transfusion.
        J Trauma. 2006; 60: S59-S69
        • Holcomb J.B.
        • Tilley B.C.
        • Baraniuk S.
        • Fox E.E.
        • Wade C.E.
        • Podbielski J.M.
        • et al.
        Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial.
        JAMA. 2015; 313: 471-482
        • Borgman M.A.
        • Spinella P.C.
        • Perkins J.G.
        • Grathwohl K.W.
        • Repine T.
        • Beekley A.C.
        • et al.
        The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital.
        J Trauma. 2007; 63: 805-813
        • Spinella P.C.
        • Perkins J.G.
        • Grathwohl K.W.
        • Beekley A.C.
        • Holcomb J.B.
        Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries.
        J Trauma. 2009; 66: S69-S76
        • Strandenes G.
        • Austlid I.
        • Apelseth T.O.
        • Hervig T.A.
        • Sommerfelt-Pettersen J.
        • Herzig M.C.
        • et al.
        Coagulation function of stored whole blood is preserved for 14 days in austere conditions: a ROTEM feasibility study during a Norwegian antipiracy mission and comparison to equal ratio reconstituted blood.
        J Trauma Acute Care Surg. 2015; 78: S31-S38
      1. Technologies B.M. The Belmont ® rapid INFUSER, FMS2000. operators manual billerica, MA 01821, USA.

        • Fischer-Nielsen A.
        • Stissing T.
        • Maansson C.
        • Joergensen B.G.
        Pressure-aided transfusion of platelets: does it affect the platelets?.
        Transfusion. 2010; 50: 361-365
        • Konig G.
        • Yazer M.H.
        • Waters J.H.
        Stored platelet functionality is not decreased after warming with a fluid warmer.
        Anesth Analg. 2013; 117: 575-578
        • Hess A.S.
        • Ramamoorthy J.
        • Connor J.
        • Raife T.
        • Hess J.R.
        Stored platelet number and viscoelastic maximum amplitude are not altered by warming or rapid infusion.
        Transfusion. 2019; 59: 2997-3001
        • Alley T.
        • Taylor G.
        • Owens A.
        • Goodin J.W.
        • Rasnake N.
        • Daley B.J.
        • et al.
        Whole blood administration: comparison of in vitro platelet function of pressure bag, pressure bag with fluid warming device, and rapid infuser methods.
        J Trauma Nurs. 2020; 27: 351-354
        • Zaza M.
        • Meyer D.E.
        • Wang Y.W.
        • George M.
        • Daniels K.
        • Cardenas J.C.
        • et al.
        The impact of rapid infuser use on the platelet count, platelet function, and hemostatic potential of whole blood.
        J Surg Res. 2021; 260: 76-81