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Safety of blood mixture transfusion by rapid infusion device in liver transplantation recipients
Anesth Pain Med 2019;14(1):54-62
Published online January 31, 2019
© 2019 Korean Society of Neuroscience in Anesthesiology and Critical Care.

Seong Mi Yang , Chul-Woo Jung , Won Ho Kim , Ho-Geol Ryu , Soo Bin Yoon , and Hyung-Chul Lee
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
Correspondence to: Hyung-Chul Lee, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: 82-2-2072-2467 Fax: 82-2-747-5639 zE-mail:
Received September 27, 2018; Revised October 26, 2018; Accepted October 30, 2018.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Information on biochemical changes following rapid transfusion of blood mixtures in liver transplantation patients is limited.


A blood mixture composed of red blood cells, fresh frozen plasma, and 0.9% saline was prepared in a ratio of 1 unit:1 unit:250 ml. During massive hemorrhage, 300 ml of the blood mixture was repeatedly transfused. A blood mixture sample as well as pre- and post-transfusion arterial blood samples were collected at the first, third, fifth, and seventh bolus transfusions. Changes in pH, hematocrit, electrolytes, and glucose were measured with a point-of-care analyzer. The biochemical changes were described, and the factors driving the changes were sought through linear mixed effects analysis.


A total of 120 blood samples from 10 recipients were examined. Potassium and sodium levels became normalized during preservation. Biochemical changes in the blood mixture were significantly related to the duration of blood bank storage and reservoir preservation (average R2 = 0.41). Acute acidosis and hypocalcemia requiring immediate correction occurred with each transfusion. Both the pre-transfusion value of the patient and the blood mixture value were significant predictors of post-transfusion changes in the body (average R2 = 0.87); however, the former was more crucial.


Rapid infusion of blood mixture is relatively safe because favorable biochemical changes occur during storage in the reservoir, and the composition of the blood mixture has little effect on the body during rapid transfusion in liver recipients. However, acute hypocalcemia and acidosis requiring immediate correction occurred frequently due to limited citrate metabolism in the liver recipients.

Key Words : Blood safety, Blood transfusion, Liver transplantation

July 2019, 14 (3)
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