title: The limits of bloodwarming: maximally heating blood with an inline microwave bloodwarmer.
abstract: BACKGROUND
  Bloodwarmers, mandatory for use in trauma resuscitation, are currently limited to a maximum temperature of 42 degrees C by the American Association of Blood Banks. Using newly available inline microwave bloodwarming technology, we sought to identify the maximal temperature to which blood may be safely heated.
  
  
  METHODS
  Using an inline microwave bloodwarmer, we warmed refrigerated packed red blood cells to settings ranging from "Off" to 60 degrees C. We evaluated heated blood for changes in red cell structure and function by measuring hemoglobin/hematocrit, potassium, lactate dehydrogenase, plasma hemoglobin, blood smear, osmotic fragility, PO2, giving 50% O2 saturation, and hemoglobin electrophoresis.
  
  
  RESULTS
  Measures of hemolysis showed no increase above control until temperatures of 51 to 53 degrees C were achieved (p < 0.05). Red cell size remained unaffected until temperatures of 53 degrees C were achieved (p < 0.05). Osmotic fragility was not elevated until 60 degrees C (p < 0.05). PO2 giving 50% O2 saturation was low for all samples. Hemoglobin electrophoresis remained unchanged at all temperature settings.
  
  
  CONCLUSIONS
  An inline microwave bloodwarmer may be used to heat blood safely to 49 degrees C. Blood warmed to this temperature may significantly increase the amount of heat returned to the hypothermic trauma patient.
authors.affiliation: Department of Surgery, New England Medical Center, Boston, Massachusetts 02111, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Herron
authors.forename: R
authors.initials: R
authors.lastname: Grabowy
authors.forename: R
authors.initials: R
authors.lastname: Connolly
authors.forename: S D
authors.initials: SD
authors.lastname: Schwaitzberg
mesh_terms: D001784:Blood Gas Analysis; D001797:Blood Protein Electrophoresis; D001803:Blood Transfusion; D004909:Erythrocyte Indices; D006454:Hemoglobins / Q000032:analysis; D006461:Hemolysis; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008872:Microwaves; D009996:Osmotic Fragility; D010100:Oxygen / Q000097:blood; D011188:Potassium / Q000097:blood; D013696:Temperature
chemical_list: D006454:Hemoglobins; D007770:L-Lactate Dehydrogenase; D011188:Potassium; D010100:Oxygen