Under Pressure: Rapid Infusion of Stored Whole Blood Alters Coagulation Parameters

Abstract

Introduction

The use of normothermic rapid transfusers to deliver high volumes of warmed blood products to hemorrhaging patients is common practice. However, the effects of these transfusers on the coagulation profile of stored compared to fresh whole blood has not been studied.

Methods

Units of fresh whole blood and blood stored for 21 days were acquired from our local blood bank. Rapid infusion was simulated using a Level 1 H-1200 at 42°C and 300 mmHg of pressure. Samples were taken preinfusion and postinfusion and examined for cell counts, biochemical changes, viability, viscoelastic properties, and microvesicle concentrations.

Results

Fresh whole blood was unaffected by rapid infusion in all end points. In contrast, rapid infusion of stored whole blood resulted in significantly higher levels of free hemoglobin (63 ± 25 mg/mL preinfusion to 101 ± 41 mg/mL postinfusion, P = 0.0025), decreased platelet contribution to clot (73 ± 5% to 66 ± 6%, P = 0.0075), decreased platelet aggregation (10.1 ± 5.5 to 6.0 ± 3.7 area under the curve with arachidonic acid, P = 0.03), and increased platelet derived microvesicles (164 ± 151 to 260 ± 163 events/μL, P = 0.01). Platelet and platelet microvesicle concentrations expressing CD62 in stored whole blood remained unchanged postinfusion (P > 0.05).

Conclusions

Infusion of stored whole blood via a rapid infuser resulted in hemolysis, platelet dysfunction, and increased platelet-derived microvesicles. We suspect that platelet destruction due to pressurized infusion leads to an increase in microvesicle concentration and a subsequently altered coagulation profile.