Rapid admixture blood warming

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Abstract
The technique of rapid admixture blood warming of cold erythrocyte units is designed to warm erythrocyte units rapidly (< 30 sec) while simultaneously providing saline for dilution. However, questions have been raised about the recommended use of a standard 250-ml bolus of 70.degree. C admixture saline, the uniformity and speed of blood unit warming, the difficulties inherent in keeping saline bags at 70.degree. C, and the safety of the methodology. To answer these questions, a series of tests were performed and modifications of the technique were introduced. The mean weight of 1000 successive units of erythrocytes for adult infusion was 305 g (range 220 to 410). The maximum temperature was 44.degree. C, using an internal temperature probe (1-cm temperature gradations; 2-sec recording intervals) when the smallest unit was admixed with a 250 ml 70.degree. C saline bolus; the largest unit had a minimum temperature of 30.degree. C. Plasma Hgb, osmotic fragility, and K of the minimum size erythrocyte unit showed no significant deviation from its control. Both thermographic photographs and the internal temperature recordings of the erythrocyte units demonstrated that solely due to fluid turbulence, uniform mixing occurs within approximately 30 sec of beginning the admixture process. Inverting the blood units caused a thermal layering of fluids and an unacceptable maximum blood temperature of 50.degree. C. There was no difference between the mixing time or efficacy in the presence of standard or large-bore iv tubing or additional in-line filters. Volumes of the 250-ml saline bags for admixture decreased markedly with deviations in electrolyte composition after > 2 wk at 70.degree. C. Admixture blood warming is a rapid, safe, and easy procedure if saline bags are replaced after 14 days of storage at 70.degree. C and erythrocyte units are kept upright during the infusion process.

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