Original Article
Journal of Perinatology (2007) 27, 380–384; doi:10.1038/sj.jp.7211748; published online 19 April 2007
Increased hemolysis from saline pre-washing RBCs or centrifugal pumps in neonatal ECMO
C Masalunga1,4, M Cruz1,5, B Porter2,6, S Roseff3, B Chui1 and E Mainali1
- 1Department of Pediatrics, VCU Medical Center, Richmond, VA, USA
- 2Department of Internal Medicine-Pediatrics, VCU Medical Center, Richmond, VA, USA
- 3Department of Pathology, VCU Medical Center, Richmond, VA, USA
Correspondence: Dr E Mainali, Department of Pediatrics, VCUHS, 401 North 12th street, Room 6-500, Richmond, VA 23298, USA. E-mail: emainali@vcu.edu
4Present address: C Masalunga, Valley Hospital Medical Center, 620 Shadow Lane, St Las Vegas, NV 89106, USA
5Present address: M Cruz, Summerlin Hospital Medical Center, 657 Town Center Drive, Las Vegas, NV 89134, USA
6Present address: B Porter, NIH Office of Clinical Research, ICMOB/NIAID, 10 Center Drive 4-1479 MSC 1460, Bethesda, MD 20892, USA
Received 2 October 2006; Revised 27 February 2007; Accepted 20 March 2007; Published online 19 April 2007.
Abstract
Objectives:
Hemolysis is a significant complication of extracorporeal membrane oxygenation (ECMO), with a reported incidence of 12.2%. The aims of this study were (1) to investigate hemolysis caused by saline-washed versus unwashed RBCs, (2) to determine in vitro the effects of saline washing on erythrocyte hemolytic markers and (3) to investigate hemolysis by centrifugal versus roller pumps.
Study design:
(1) To evaluate the effect of pre-transfusion saline-washing versus non-washing, the peak plasma-free hemoglobin (FHb) and total bilirubin in the first 3 days versus the next 4 days of ECMO were compared (2) Pre- and postsaline-washed RBCs were analyzed for K+, hemoglobin, mean corpuscular volume, FHb and hemolysis at baseline and after 4 h of storage at 4°C. (3) Over 10 000 neonatal ECMO cases were retrospectively reviewed to study the effect of pump type on hemolysis.
Results:
(1) The washed blood group had significantly more hemolysis within the first 3 days of ECMO. (2) Immediately after saline washing, the K+ and Hb concentrations were significantly decreased compared with unwashed blood, and these differences were maintained after 4 h. The osmotic fragility of washed RBCs after 4 h of storage at 4°C was significantly higher than at baseline. (3) Hemolysis was reported more often in the centrifugal than in the roller pump group.
Conclusions:
(1) Using unwashed RBCs decreased hemolysis within the first 3 days of ECMO. (2) Saline washing, while decreasing the concentration of K+ in the plasma, significantly increases RBC membrane osmotic fragility. (3) Hemolysis is linked to the use of centrifugal pumps.
Keywords:
RBC, hemolysis, saline-washing, centrifugal pump
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