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
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Article info
Publication history
Published online: September 20, 2022
Accepted:
September 19,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
