Article Data

  • Views 192
  • Dowloads 5

Original Research

Open Access

Biochemical changes in the patient’s plasma after red blood cell transfusion


1,Department of Anesthesiology Resuscitation and Intensive Medicine University Hospital Olomouc

DOI: 10.22514/SV62.102011.9 Vol.6,Issue 2,October 2011 pp.64-71

Published: 31 October 2011

*Corresponding Author(s): RADOVAN UVIZL E-mail:


Introduction. The study aimed at in vivo assessment of the impact of administered red blood cells (RBCs) concentrates on the plasma levels of K+, lactate, pH, Na+, Ca++ and glucose, depending on the volume and age of administered products. Biochemical changes occurring during the storage of these products were studied in vitro simultaneously. 

Materials and methods. Arterial blood samples were collected in vivo from patients before and after RBCs transfusion and plasma levels of biochemical parameters were determined. A group of 80 RBCs samples was analyzed simultaneously, with the samples being equally distributed throughout the recommended storage time of 1–35 days. 

Results. The age of RBCs concentrate results in increased potassium and lactate levels and decreased pH, sodium and glucose levels in the RBCs samples. The concentrations were in the following ranges: potassium 4.0–40.5 mmol/L; lactate 4.1–28.0 mmol/L; pH 7.0–6.65; sodium 137–116 mmol/L; glucose 29.0–14.0 mmol/L. A prospectively selected group of 46 patients were administered a total of 354 RBCs units. The mean age of RBCs concentrates was 16.18 days. The number of administered RBCs units ranged from 2 to 38, a mean of 7.7 RBCs units/patient. The administration of 1 RBCs unit was asso-ciated with a mean in vivo increase of the potassium level by 0.07 mmol/L and lactate level by 0.13 mmol/L. 

Conclusion. The administration of larger amounts of RBCs concentrates may lead to an increase in the patient’s plasma levels of potassium and lactate. This increase is proportional to the age and volume of RBCs.


red blood cells, transfu-sion, hyperkalemia, lactate

Cite and Share

RADOVAN UVIZL,BRONISLAV KLEMENTA,MILAN ADAMUS,JAN NEISER. Biochemical changes in the patient’s plasma after red blood cell transfusion. Signa Vitae. 2011. 6(2);64-71.


1. Larsen R. Anestezie. Praha: Grada publishing 2004;718-53.

2. Brecher ME. Non infectious complications of blood transfusion. AABB technical manual 2005;577-600.

3. Ho J, Sibbald WJ, Chin-Yee IH. Effects of storage of red cell transfusion: when is it not safe? Crit Care Med 2003;31:687-97.

4. Cetkovský P. Intenzivní pé􀀁e v hematologii. Praha: Galén 2004;169-79.

5. Aboudara MC, Hurst FP, Abbott KC, Perkins RM. Hyperkalemia after packed red blood cell transfusion in trauma patients. J Trauma 2008;64:86-91.

6. Smith HM, Farrow SJ, Ackerman JD, Stubbs JR, Sprung J. Cardiac Arrest Associated with Hyperkalemia During Red Blood Cell Transfusion: A Case Series. Anesthesia and analgesia 2008;106:1062-9.

7. Hillyer CD, Hillyer KL, Strobl FJ, Jefferies LC, Silberstein LE. Handbook of transfusion medicine. Academic Press 2001;275-82.

8. Sever MS, Erek E, Vanholder R, Kantarci G. Serum potassium in the crush syndrome victims of the Marmara disaster. Clin Nephrol 2003;59.

9. Larson PJ. Other noninfectious complications of transfusion. In: Hillyer CD, Hyllier KL, Strobl FJ, Jefferies LC, Silberstein LE, editors. Hand-book of transfusion medicine. Academic press 2001; p. 263-71.

10. Vítovec J, Špinar J. Intenzivní pé􀀁e v kardiologii. IPVZ Brno 1994;12-4.

11. Zima T. Laboratorní diagnostika. Praha: Galén 2002;276-8.

12. Hess JR, Sparrow RL, Van der Meer PF, Acker JP, Cardigan RA, Devine DV. Red blood cell hemolysis during blood bank storage: using national quality management data to answer basic scientific questions. Transfusion 2009;49:2599-603.

13. Luten M, Roerdinkholder-Stoelwinder B, Schaap NP, de Grip WJ, Bos HJ. Survival of red blood cells after transfusion: a comparison between red cells concentrates of different storage periods. Transfusion 2008; 48:1478-85.

14. Walsh TS, McArdle F, McLellan SA, Maciver C, Maginnis M, Prescott RJ, et al. Does the storage time of transfused red blood cells influence regional or global indexes of tissue oxygenation in anemic critically ill patients? Crit Care Med 2004; 32:364-71.

15. Lelubre C, Piagnerelli M, Vincent JL. Association between duration of storage of transfused red blood cells and morbidity and mortality in adult patients: myth or reality? Transfusion 2009;49:1384-94.

16. Yap CH, Lau L, Krishnaswamy M, Koch CG, Li L, Sessler DI. Clinical impact of blood storage lesions - Recent Reports. Ann Thorac Surg 2008;86:554-9, 358, 1229-39.

17. Weinberg JA, McGwin G Jr, Marques MB, Cherry SA 3rd, Reiff DA, Kerby JD, et al. Transfusions in the less severely injured: does age of transfused blood affect outcomes? J Trauma 2008;65:794-8.

18. Eikelboom JW, Cook RJ, Liu Y, Heddle NM, Am Heart J. Duration of red cell storage before transfusion and in-hospital mortality. Am Heart J 2010;159:737-43.

19. Basran S, Frumento RJ, Cohen A, Lee S, Du Y, Nishanian E, et al. The association between duration of storage of transfused red blood cells and morbidity and mortality after reoperative cardiac surgery. Anesth Analg 2006;103:15-20.

20. Koch CG, Li L, Sessler DI, Figueroa P, Hoeltge GA, Mihaljevic T, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med 2008;20:1229-39.

21. Leal-Noval SR, Munoz-Gomez M, Arellano-Orden V, Marin-Caballos A, Amaya-Villar R, Marin A. Impact of age of transfused blood on cerebral oxygenation in male patients with severe traumatic brain injury. Crit Care Med 2008;36:1290-6.

22. Weiskopf RB, Feiner J, Hopf H, Lieberman J, Finlay HE, Quah C. Fresh blood and aged stored blood are equally efficacious in immediately reversing anemia-induced brain oxygenation deficits in humans. Anesthesiology 2006;104:911-20.

23. Hess JR, Rugg N, Knapp AD, Gormas JF, Silberstein EB, Greenwalt TJ. Successful storage of RBCs for 10 weeks in a new additive solu-tion. Transfusion 2000;40:1012-16.

24. Cid J, Ramiro L, Bertran S, Martinez N, Claparols M, Maymo RM. Efficacy in reducing potassium load in irradiated red cell bags with a potassium adsorption filter. Transfusion 2008;48:1966-70.

25. Zallen G, Offner PJ, Moore EE, Blackwell J, Ciesla DJ, Gabriel J. Age of transfused blood is an independent risk factor for postinjury multiple organ failure. Am J Surg 1999;178:570-2.

26. Rose BD, Post TW. Clinical Physiology of Acid-Base and Electrolyte Disorders, 5th ed. McGraw-Hill, New York 2001. p. 383–96, 898-910.

27. Friedman DF. Hepatitis. In: Hillyer CD, Hillyer KL, Strobl FJ, Jefferies LC, Silberstein LE, editors. Handbook of transfusion medicine. Aca-demic Press 2001. p. 275-82.

28. Kiraly LN, Underwood S, Differding JA, Schreiber MA. Transfusion of aged packed red blood cells results in decreased tissue oxygenation in critically injured trauma patients. J Trauma 2009;67:29-32.

29. Kaplan HS, Callum JL, Fastman BR, Merkley LL. The medical event reporting system for transfusion medicine: Will it help to get the right blood to the right patient? Transfusion Medicine Reviews 2002;16:86-102.

30. Raghavan M, Marik PE. Anemia, allogenic blood transfusion, and immunomodulation in

the critically ill. Chest 2005;127:295-307.

31. Toy P, Popovsky MA, Abraham E. Transfusion-related acute lung injury: Definition and review. Crit Care Med 2005;33:721-6.

32. Consensus conference: Perioperative red blood cell transfusion. Jama 1988;260:2700–3.

33. Guidelines for red blood cell and plasma transfusion for adults and children. Expert Working Group. Can Med Assoc J 2008;56(11 suppl):1-24.

34. Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill. A systematic review of the literature. Crit Care Med 2008;36:2667-74.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time