title: Safety of blood transfusions using 27 gauge neonatal PICC lines: an in vitro study on hemolysis.
abstract: Blood transfusions are required by the majority of extremely premature infants. Packed red blood cells (PRBCs) are usually applied via simple peripheral cannulas. In situations where no peripheral venous access is achievable, 27 Gauge (G) neonatal PICC lines - that are ideally exclusively dedicated to application of parenteral nutrition - may represent a useful alternative access for PRBC transfusions. However, transfusion via small scaled catheters may damage PRBCs and lead to hemolysis. We here evaluate whether transfusion of irradiated PRBCs via 27 G PICC lines leads to hemolysis in vitro.Experimental transfusions of gamma-irradiated PRBCs were performed at increasing velocities (2.5, 3.7, 5 ml/h; full force manual push approximating 30 ml/h) via 27 G PICC lines of 20 and 30 cm length. Parameters of hemolysis (lactate dehydrogenase, potassium and free hemoglobin) were measured from the supernatants of transfused PRBCs and the percentage of hemolysis was calculated.Potassium and lactate dehydrogenase after transfusion at increasing velocities did not differ significantly from negative controls. Free hemoglobin levels showed a small but significant increase at the slowest transfusion speed (2.5 ml/h) using the 30 cm 27 G PICC line, with a relative hemolysis of only 0.13%. A manual push (approximating 30 ml/h) showed no significant changes of parameters from baseline.We conclude that transfusion of gamma-irradiated PRBCs using a 27 G neonatal PICC line does not cause clinically relevant hemolysis in vitro. Clinical studies are needed to confirm the feasibility and safety of the approach in vivo.
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Repa
authors.affiliation: Department of Laboratory Medicine, Medical University Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Mayerhofer
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria.
authors.forename: F
authors.initials: F
authors.lastname: Cardona
authors.affiliation: Department of Blood Group Serology and Transfusion Medicine, Medical University Vienna, Austria.
authors.forename: N
authors.initials: N
authors.lastname: Worel
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria.
authors.forename: P
authors.initials: P
authors.lastname: Deindl
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Pollak
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Berger
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria.
authors.forename: N
authors.initials: N
authors.lastname: Haiden
mesh_terms: D001783:Blood Flow Velocity; D058731:Blood Safety; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D017707:Erythrocyte Transfusion / Q000295:instrumentation*; D005260:Female; D006452:Hemoglobinometry; D006461:Hemolysis; D006801:Humans; D066298:In Vitro Techniques; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000097:blood / Q000628:therapy*; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D011188:Potassium / Q000097:blood
chemical_list: D007770:L-Lactate Dehydrogenase; D011188:Potassium