Rapid Admixture Blood Warming: Fast, Safe & Inexpensive

Abstract

            The international standard for banked blood, including packed red blood cells (PRBCs), requires keeping it at 4ºC. Patients who need rapid PRBC unit transfusions benefit tremendously from blood being warmed to body temperature (37ºC), since hypothermia resulting from rapid infusion of cold blood is a major risk factor in exanguinating patients. It increases morbidity and mortality as well as often producing other adverse reactions, including those simulating transfusion reactions. Ideally, methods to warm blood for rapid transfusion should bring the unit to body temperature (37ºC), and be rapid, safe and inexpensive.            In most centres, clinicians’ ability to adequately warm PRBC units suffers from the time constraints of needing to infuse blood quickly, the frequent need to infuse blood simultaneously through multiple IV lines, and the cost and availability of blood-warming equipment. There are three methods available for re-warming PRBC units: passive warming towards room temperature (inadequate), in-line warming (slow or extremely expensive), and pre-warming.             This paper describes a safe, rapid and inexpensive method to pre-warm PRBC units. The only piece of capital equipment needed for this process is a standard 70ºC laboratory incubator in which to preheat 250 0.9 normal saline (NS) bags. Only one incubator, which generally lasts for decades, is needed for an emergency department, operating room, or intensive care unit; if they are in close proximity, only one is needed for all of them.            Published studies and extensive clinical experience have shown that this method not only is safe and easy to use, but also preserves erythrocyte integrity and survival time. Rapid admixture blood warming is so inexpensive, simple, safe, and fast that it can and should be the primary method used for blood warming in most parts of the world.