Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Increased hemolysis from saline pre-washing RBCs or centrifugal pumps in neonatal ECMO

Journal of Perinatology volume 27, pages 380–384 (2007)Cite this article

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Brown BA . Hematology: Principles and Procedures. 6th ed. Lea & Febiger: Boston, MA, 1993.

    Google Scholar 

  2. Rao R, Georgieff MK . Iron in fetal and neonatal nutrition. Semin Fetal Neonatal Med 2007; 12: 54–63.

    Article  Google Scholar 

  3. Tamura T, Goldenberg RL, Hou J, Johnston KE, Cliver SP, Ramey SL et al. Cord serum ferritin concentrations and mental and psychomotor development of children at five years of age. J Pediatr 2002; 140: 165–170.

    Article  CAS  Google Scholar 

  4. Wennberg RP, Ahlfors CE, Bhutani VK, Johnson LH, Shapiro SM . Toward understanding kernicterus: a challenge to improve the management of jaundiced newborns. Pediatrics 2006; 117: 474–485.

    Article  Google Scholar 

  5. Telford RD, Sly GJ, Hahn AG, Cunningham RB, Bryant C, Smith JA . Footstrike is the major cause of hemolysis during running. J Appl Physiol 2003; 94: 38–42.

    Article  CAS  Google Scholar 

  6. Kameneva MV, Burgreen GW, Kono K, Repko B, Antaki JF, Umezu M . Effects of turbulent stresses upon mechanical hemolysis: experimental and computational analysis. ASAIO J 2004; 50: 418–423.

    Article  Google Scholar 

  7. AAP subcommittee on hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114: 297–316.

    Article  Google Scholar 

  8. Bhutani VK, Johnson LH, Jeffrey MM, Newman TB, Phibbs C, Stark AR et al. Kernicterus: epidemiological strategies for its prevention through systems-based approaches. J Perinatol 2004; 24: 650–662.

    Article  Google Scholar 

  9. Knichwitz G, Zahl M, Van Aken H, Semjonow A, Booke M . Intraoperative washing of long-stored packed red blood cells by using an autotransfusion device prevents hyperkalemia. Anesth Analg 2002; 95: 324–325, table.

    CAS  PubMed  Google Scholar 

  10. Biffl WL, Moore EE, Offner PJ, Ciesla DJ, Gonzalez RJ, Silliman CC . Plasma from aged stored red blood cells delays neutrophil apoptosis and primes for cytotoxicity: abrogation by poststorage washing but not prestorage leukoreduction. J Trauma 2001; 50: 426–431.

    Article  CAS  Google Scholar 

  11. Sowemimo-Coker SO . Red blood cell hemolysis during processing. Transfus Med Rev 2002; 16: 46–60.

    Article  Google Scholar 

  12. Strauss RG . Routinely washing irradiated red cells before transfusion seems unwarranted. Transfusion 1990; 30: 675–677.

    Article  CAS  Google Scholar 

  13. Weiskopf RB, Schnapp S, Rouine-Rapp K, Bostrom A, Toy P . Extracellular potassium concentrations in red blood cell suspensions after irradiation and washing. Transfusion 2005; 45: 1295–1301.

    Article  CAS  Google Scholar 

  14. Berg JM, Tymoczko JL, Stryer L . Biochemistry. 5 ed. WH Freeman, New York, NY, 2002.

    Google Scholar 

  15. Steinhorn RH, Isham-Schopf B, Smith C, Green TP . Hemolysis during long-term extracorporeal membrane oxygenation. J Pediatr 1989; 115: 625–630.

    Article  CAS  Google Scholar 

  16. Kawahito K, Nose Y . Hemolysis in different centrifugal pumps. Artif Organs 1997; 21: 323–326.

    Article  CAS  Google Scholar 

  17. Van Meurs KP, Newman KD, Anderson KD, Short BL . Effect of extracorporeal membrane oxygenation on survival of infants with congenital diaphragmatic hernia. J Pediatr 1990; 117: 954–960.

    Article  CAS  Google Scholar 

  18. Lawson DS, Walczak R, Lawson AF, Shearer IR, Ing R, Schulman S et al. North American neonatal extracorporeal membrane oxygenation (ECMO) devices: 2002 survey results. J Extra Corpor Technol 2004; 36: 16–21.

    PubMed  Google Scholar 

  19. Trittenwein G, Golej J, Burda G, Hermon M, Marx M, Wollenek G et al. Neonatal and pediatric extracorporeal membrane oxygenation using nonocclusive blood pumps: the Vienna experience. Artif Organs 2001; 25: 994–999.

    Article  CAS  Google Scholar 

  20. Lawson DS, Ing R, Cheifetz IM, Walczak R, Craig D, Schulman S et al. Hemolytic characteristics of three commercially available centrifugal blood pumps. Pediatr Crit Care Med 2005; 6: 573–577.

    Article  Google Scholar 

Download references

Acknowledgements

We thank Dr Shirley K DeSimone for editing and critical reading of this paper.

Author information

Author notes

  1. C Masalunga

    Present address: 4Present address: C Masalunga, Valley Hospital Medical Center, 620 Shadow Lane, St Las Vegas, NV 89106, USA,

  2. M Cruz

    Present address: 5Present address: M Cruz, Summerlin Hospital Medical Center, 657 Town Center Drive, Las Vegas, NV 89134, USA,

  3. B Porter

    Present address: 6Present address: B Porter, NIH Office of Clinical Research, ICMOB/NIAID, 10 Center Drive 4-1479 MSC 1460, Bethesda, MD 20892, USA,

Authors and Affiliations

  1. Department of Pediatrics, VCU Medical Center, Richmond, VA, USA,

    C Masalunga, M Cruz, B Chui & E Mainali

  2. Department of Internal Medicine-Pediatrics, VCU Medical Center, Richmond, VA, USA,

    B Porter

  3. Department of Pathology, VCU Medical Center, Richmond, VA, USA,

    S Roseff

Authors
  1. C Masalunga
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Cruz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B Porter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S Roseff
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B Chui
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E Mainali
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E Mainali.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Masalunga, C., Cruz, M., Porter, B. et al. Increased hemolysis from saline pre-washing RBCs or centrifugal pumps in neonatal ECMO. J Perinatol 27, 380–384 (2007). https://doi.org/10.1038/sj.jp.7211748

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211748

Keywords

This article is cited by

Search

Advanced search

Quick links