RAPID RED-CELL TRANSFUSION BY APHERESIS

Packed red cells (RBC) are customarily infused slowly to allow time for re-equilibration of intravascular volume, but they may be given rapidly for convenience during hemodialysis or partial RBC exchange when blood volume can be adjusted extracorporeally. We describe an apheresis procedure for rapid transfusion of RBC to patients with chronic anemia in which an equivalent volume of recipient plasma is withdrawn as donor RBC are infused. Fifteen such procedures, transfusing 3 to 5 RBC units each, have been performed on nine patients (4 of them outpatients) with either COBE Spectra or COBE 2997. Mean +/- SD procedure duration was 1.79 +/- .44 hr; patient hemoglobin rose from 7.3 +/- 1.5 to 12.0 +/- 1.5 g/dl. Comparison to conventional transfusion was possible for nine procedures on six patients in which rapid transfusion required .52 +/- .12 vs. 2.70 +/- .37 hr per unit (P < .001) and raised hemoglobin by 1.22 +/- .30 vs. .88 +/- .34 g/dl per unit (P < .02). Pink plasma noted during one procedure was attributable to infusion of an older AS-1 unit with extensive storage hemolysis. Rapid transfusion was subjectively well tolerated. Immediate post-procedure systolic blood pressures did not differ significantly from baseline, although one hypertensive patient had headache followed by increased blood pressure 4 hours after a procedure. We conclude that rapid transfusion of RBC is a technically feasible and more time efficient means for RBC transfusion. It is particularly attractive in the outpatient setting, and could also prevent fluid overload associated with RBC transfusion in some volume-sensitive patients. (C) 1994 Wiley-Liss, Inc.