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Blood warmer use for platelets


tbostock
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I'm having a hard time finding an actual reference (not just a recommendation) for not using a blood warmer for platelets. It makes sense since they should be at 20-24 degrees. Our blood warmers are set at 41 degrees, and there is anecdotal information that platelets are ineffective at that temp, but I can't seem to find a good reference for this. Hoping someone can help.

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In the body they are at 37C. They are on the way into the body when they are in the blood warmer. Does the blood product really reach 41 degrees or is that the warmer's setting? How long do they spend getting warmed as they infuse? What do the blood warmer's instructions say about using them for platelets? I would say that plts shouldn't be warmed but during a massive transfusion they probably use the same warmer for blood and plts and aren't going to want to have separate systems. Is that the context of your question?

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We use 3 different blood warmers/rapid infusers in my hospital. All 3 say they are "FDA approved for blood products". However, one of them (the rapid infuser that they use for massive transfusions) says that it is contraindicated to transfuse platelets because "warming may make the platelets ineffective". I have been cited for this and am working on a corrective action. Some anesthesiologists say that they were always told it was OK, some say you shouldn't, but nobody seems to have a concrete reference.

AABB recommends against it, but it's a Guideline, not a regulation: I have ordered this:

AABB Guidelines for the Use of Blood Warming Devices (© 2002). This AABB publication lists the following as one of the few "absolute contraindications" to use of a blood warming device: "Administration of Platelets, Cryoprecipitate, or Granulocyte suspensions (Warming may render these products less effective.)" Additional references are cited in this publication.

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I don't suppose you could use the argument that since you can cite a recommended guideline against warming platelets and they cannot cite a recommended guideline or regulation for warming the platelet......so you win ??

Donna

LOL, good point Donna! This may be all I have. :tongue:

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What brand is the warming device that specifically says it is contraindicated? I need to see if we have the same problem.

The Level 1 warmer/rapid infuser that we use in the trauma room:

Important Safety Information® Warmer.

CONTRAINDICATIONS

• Not for use in warming platelets, cryo-precipitates, or

granulocyte suspensions.

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Our Trauma Coordinator asked me this question several times over the last two years, and like Terri, I couldn't find anything in my Blood Bank literatuare that says it can't be used, so that was my answer each time. Our Nurse Educator actually read the literature for the rapid infuser, and gee, it says the same as Terri quoted above. We had to rewrite our MTP/Trauma protocols to exclude Platelets and cryo. I don't think they were happy, but we couldn't go against manufacturer's instructions.

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  • 6 years later...

I'm reactivating this topic because it has come up again.  The AABB Guidelines quoted above are over 15 years old and the only reference in them that says not to use for platelets is to a specific blood warmer's operation manual.  Does anyone know of any studies with modern rapid infusers like Belmont RI-2 and Level 1 regarding infusion of platelets and cryo?  It seems like they should be safe and it really helps with the workflow to use them but we need evidence.

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  • 2 years later...

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