washed pRBC

Case:  62 year old male with Chronic Kidney Disease (CKD)-5 is admitted to ICU with active gastro-intestinal bleed (GIB). Hemoglobin (Hb) is reported at 6.2 g /dL and Potassium (K) level is reported at 5.9 meq/L. What strategies can be applied to reduce the risk of hyperkalemia in this CKD-5 patient with blood transfusion, who is not on hemodialysis yet?


Answer: Potassium overload can be a concern with ongoing pRBC transfusion particularly in renal patients. There are two strategies which may help to reduce this risk

• fresher units, or 
• washed red cells

Many times it is difficult for blood bank to supply fresher units of pRBCs. Washing of pRBC is done in an automated system with the use of normal saline immediately before transfusion. Washed pRBCs can be preserved for 4 hours on shelf/bedside at 20 to 24°C. Longer preservation can be done for 24 hours if stored at 1 to 6°C.

#transfusion
#hematology
#nephrology
#electrolytes


References: 

1. Raza S, Ali Baig M, Chang C, et al. A prospective study on red blood cell transfusion related hyperkalemia in critically ill patients. J Clin Med Res. 2015;7(6):417–421. doi:10.14740/jocmr2123w 

2. Bansal I, Calhoun BW, Joseph C, Pothiawala M, Baron BW. A comparative study of reducing the extracellular potassium concentration in red blood cells by washing and by reduction of additive solution. Transfusion. 2007 Feb;47(2):248-50.