Lee Sukyung, Lee Sooho, Oh Jong Eun, Shin Won-Jung, Min Won-Ki, Gwak Mijeung
Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
J Dent Anesth Pain Med. 2015 Dec;15(4):229-233. doi: 10.17245/jdapm.2015.15.4.229. Epub 2015 Dec 31.
Although water chambers are often used as surrogate blood-warming devices to facilitate rapid warming of red blood cells (RBCs), these cells may be damaged if overheated. Moreover, filtered and irradiated RBCs may be damaged during the warming process, resulting in excessive hemolysis and extracellular potassium release.
Using hand-held syringes, each unit of irradiated and leukocyte-filtered RBCs was rapidly passed through a water chamber set to different temperatures (baseline before blood warming, 50℃, 60℃, and 70℃). The resulting plasma potassium and free hemoglobin levels were then measured.
Warming RBCs to 60℃ and 70℃ induced significant increases in free hemoglobin (median [interquartile ranges] = 60.5 mg/dl [34.9-101.4] and 570.2 mg/dl [115.6-2289.7], respectively). Potassium levels after warming to 70℃ (31.4 ± 7.6 mEq/L) were significantly higher compared with baseline (29.7 ± 7.1 mEq/L; P = 0.029). Potassium levels were significantly correlated with storage duration after warming to 50℃ and 60℃ (r = 0.450 and P = 0.001; r = 0.351 and P = 0.015, respectively).
Rapid warming of irradiated leukoreduced RBCs to 50℃ may not further increase the extracellular release of hemoglobin or potassium. However, irradiated leukoreduced RBCs that have been in storage for long periods of time and contain higher levels of potassium should be infused with caution.
尽管水腔室常被用作替代血液加温装置以促进红细胞（RBC）的快速加温，但如果过热，这些细胞可能会受损。此外，过滤和辐照后的红细胞在加温过程中可能会受损，导致过度溶血和细胞外钾释放。
使用手持注射器，将每单位辐照和白细胞过滤的红细胞快速通过设置为不同温度（血液加温前的基线温度、50℃、60℃和70℃）的水腔室。然后测量所得血浆钾和游离血红蛋白水平。
将红细胞加温至60℃和70℃会导致游离血红蛋白显著增加（中位数[四分位间距]=分别为60.5mg/dl[34.9 - 101.4]和570.2mg/dl[115.6 - 2289.7]）。加温至70℃后的钾水平（31.4±7.6mEq/L）与基线水平（29.7±7.1mEq/L；P = 0.029）相比显著更高。加温至50℃和60℃后，钾水平与储存时间显著相关（r = 0.450，P = 0.001；r = 0.351，P = 0.015）。
将辐照白细胞滤除的红细胞快速加温至50℃可能不会进一步增加血红蛋白或钾的细胞外释放。然而，对于储存时间长且钾含量较高的辐照白细胞滤除的红细胞，输注时应谨慎。
