Infusion pump-mediated mechanical hemolysis in pediatric patients

Jonathan Hughes, Janet McNaughton, Jennifer Andrews, Tracy George, Cassandra Bergero, Kimberly Pyke-Grimm, Susan A. Galel, Christopher Gonzalez, Lawrence Tim Goodnough, Magali J. Fontaine

Research output: Contribution to journalArticle

Abstract

Context. Hemoglobinuria was observed after packed red blood cell transfusion in a series of patients at our pediatric treatment center. Laboratory testing was suggestive of intravascular hemolysis with no support for an immunohematologic process. Objective. We investigated these adverse events to define a quality improvement plan and to prevent future hemolytic adverse events. Multiple factors were investigated, and the only change identified was the implementation of a new infusion pump (Pump A) that replaced a previous model (Pump B). Design. In vitro pump analyses, a retrospective review of urinalyses, and prospective urinalysis and nursing surveillances were also performed. Results. In in vitro analysis of the pumps, irradiated units with higher hematocrit at a low flow rate through Pump A had a greater than thirty-fold increase in free hemoglobin from baseline compared to minimal free hemoglobin changes seen with Pump B. Irradiated units with a lower hematocrit had a minimal change in free hemoglobin from baseline with both Pumps A and B at either low or high flow rate. Subsequently, only units with lower hematocrits were issued for transfusion of pediatric patients, and Pump A was replaced by Pump B in the outpatient unit. Retrospective and prospective surveillances found no additional unexplained cases of gross hemoglobinuria associated with transfusion. Conclusion. The investigation determined that infusion of higher hematocrit units using a specific commercial pump was associated with mechanical hemolysis. The change to units with lower hematocrit through an alternative pump has been an effective corrective action to date.

Original languageEnglish (US)
Pages (from-to)140-147
Number of pages8
JournalAnnals of Clinical and Laboratory Science
Volume45
Issue number2
StatePublished - Jan 1 2015
Externally publishedYes

Keywords

  • Corrective action
  • Infusion pump
  • Mechanical hemolysis
  • Quality improvement

ASJC Scopus subject areas

  • Microbiology
  • Immunology and Allergy
  • Pathology and Forensic Medicine
  • Immunology
  • Molecular Biology
  • Hematology
  • Clinical Biochemistry
  • Medical Laboratory Technology

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  • Cite this

    Hughes, J., McNaughton, J., Andrews, J., George, T., Bergero, C., Pyke-Grimm, K., Galel, S. A., Gonzalez, C., Goodnough, L. T., & Fontaine, M. J. (2015). Infusion pump-mediated mechanical hemolysis in pediatric patients. Annals of Clinical and Laboratory Science, 45(2), 140-147.