TY - JOUR
T1 - Infusion pump-mediated mechanical hemolysis in pediatric patients
AU - Hughes, Jonathan
AU - McNaughton, Janet
AU - Andrews, Jennifer
AU - George, Tracy
AU - Bergero, Cassandra
AU - Pyke-Grimm, Kimberly
AU - Galel, Susan A.
AU - Gonzalez, Christopher
AU - Goodnough, Lawrence Tim
AU - Fontaine, Magali J.
N1 - Publisher Copyright:
© 2015 by the Association of Clinical Scientists, Inc.
PY - 2015
Y1 - 2015
N2 - 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.
AB - 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.
KW - Corrective action
KW - Infusion pump
KW - Mechanical hemolysis
KW - Quality improvement
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M3 - Article
C2 - 25887866
AN - SCOPUS:84929331165
SN - 0091-7370
VL - 45
SP - 140
EP - 147
JO - Annals of Clinical and Laboratory Science
JF - Annals of Clinical and Laboratory Science
IS - 2
ER -