RAPID RED-CELL TRANSFUSION BY APHERESIS

Packed red cells (RBC) are customarily infused slowly to allow time fo r re-equilibration of intravascular volume, but they may be given rapi dly for convenience during hemodialysis or partial RBC exchange when b lood volume can be adjusted extracorporeally. We describe an apheresis procedure for rapid transfusion of RBC to patients with chronic anemi a in which an equivalent volume of recipient plasma is withdrawn as do nor RBC are infused. Fifteen such procedures, transfusing 3 to 5 RBC u nits each, have been performed on nine patients (4 of them outpatients ) with either COBE Spectra or COBE 2997. Mean +/- SD procedure duratio n 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 fo r nine procedures on six patients in which rapid transfusion required .52 +/- .12 vs. 2.70 +/- .37 hr per unit (P < .001) and raised hemoglo bin by 1.22 +/- .30 vs. .88 +/- .34 g/dl per unit (P < .02). Pink plas ma noted during one procedure was attributable to infusion of an older AS-1 unit with extensive storage hemolysis. Rapid transfusion was sub jectively well tolerated. Immediate post-procedure systolic blood pres sures did not differ significantly from baseline, although one hyperte nsive patient had headache followed by increased blood pressure 4 hour s after a procedure. We conclude that rapid transfusion of RBC is a te chnically feasible and more time efficient means for RBC transfusion. It is particularly attractive in the outpatient setting, and could als o prevent fluid overload associated with RBC transfusion in some volum e-sensitive patients. (C) 1994 Wiley-Liss, Inc.