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

Published:September 20, 2022DOI:


      • 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.



      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.


      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.


      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.


      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.


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