Hemolysis of irradiated leukoreduced red blood cells during rapid warming: An in vitro experimental study

Background: 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. Methods: 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, $50^{\circ}C$, $60^{\circ}C$, and $70^{\circ}C$). The resulting plasma potassium and free hemoglobin levels were then measured. Results: Warming RBCs to $60^{\circ}C$ and $70^{\circ}C$ 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 $70^{\circ}C$ ($31.4{\pm}7.6mEq/L$) were significantly higher compared with baseline ($29.7{\pm}7.1mEq/L$; P = 0.029). Potassium levels were significantly correlated with storage duration after warming to $50^{\circ}C$ and $60^{\circ}C$ (r = 0.450 and P = 0.001; r = 0.351 and P = 0.015, respectively). Conclusions: Rapid warming of irradiated leukoreduced RBCs to $50^{\circ}C$ 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.