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Sepulveda S, Davis L, Schwab SJ
Blood transfusion during heparin-free hemodialysis
Kidney Int (Jun) 51:2018-2021 1997
Blood transfusion can increase the risk of clotting during heparin-free dialysis, presumably because of hemoconcentration in the dialyzer circuit. These authors prevented the problem by infusing the blood in the venous line, distal to the venous air trap. The infusion was done at the point where the venous line joined with the dual- lumen catheter, by inserting a large-bore stopcock. Because there is substantial positive pressure at this point in the blood line, the blood bag was hung 1 meter above the line and a pressure cuff was put around the blood bag as needed. The blood bag was not vented to prevent inadvertent air entry.
At QB=300 ml/min, it was noted that the baseline venous pressure (VP) of +246 mmHg increased to a mean of +281 during the transfusion. The authors transfused 80 units of blood to 27 patients during heparin-free dialysis in this manner without incident. No comparable figures are given for clotting rate without the use of this method, so the extent of the benefit associated with this technique of transfusion is difficult to assess. (John T. Daugirdas, M.D., University of Illinois at Chicago)
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