PRBC Blood Gas

[Aether2000]

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From a Reddit posting, just for fun, they did a blood gas on a PRBC sample.

 

[coffeebythelake]

From a Reddit posting, just for fun, they did a blood gas on a PRBC sample. View attachment 318279

Most Surprised about the Hgb concentration

 

[deleted87051]

Most Surprised about the Hgb concentration

Yep. PRBC is not so packed.

 

[chocomorsel]

What’s the case? Covid? Plus ARF? Plus DKA? Plus impending doom?

 

[deleted87051]

What’s the case? Covid? Plus ARF? Plus DKA? Plus impending doom?

This is the patient....

 

[Twiggidy]

From a Reddit posting, just for fun, they did a blood gas on a PRBC sample. View attachment 318279

I have so many question but don't want to ask publicly out of fear of sounding stupid

 

[deleted162650]

I have so many question but don't want to ask publicly out of fear of sounding stupid

I think that ship has sailed.




😉

 

[Twiggidy]

I think that ship has sailed.




😉

 

[surgndoc]

Would guess that’s a pretty old unit of blood. Crit should usually be around 60 is what I was taught, don’t know about k value when those units are packed but K is probably high in this situation supporting the fact that this is old blood.

 

[Iso4ane]

I have so many question but don't want to ask publicly out of fear of sounding stupid

Like what? Asking questions is not stupid.

 

[chocomorsel]

This is the patient....

View attachment 318290

He dead?
Oh ok. I get it now. Didn’t pay attention to the source.
I see some pretty severe numbers working with Covid patients so this isn’t that strange.
But yeah @SaltyDog , I am the dumbest rock out there.
We know your IQ and disgusting sexist lockeroom jokes are way off the charts.

 

[Twiggidy]

Like what? Asking questions is not stupid.

Oh, on the "you know what measuring" site that is SDN....sometimes it can be

 

[deleted162650]

But yeah @SaltyDog , I am the dumbest rock out there.
We know your IQ and disgusting sexist lockeroom jokes are way off the charts.

I was joking around with Twig. My comment was directed at him, not you. Chill out and try reading the thread for a change.

 

[chocomorsel]

I was joking around with Twig. My comment was directed at him, not you. Chill out and try reading the thread for a change.

Yeah, sure ok.

 

[coffeebythelake]

Would guess that’s a pretty old unit of blood. Crit should usually be around 60 is what I was taught, don’t know about k value when those units are packed but K is probably high in this situation supporting the fact that this is old blood.

How would HCT change in an old bag of PRBC. Hemolysis?

 

[chocomorsel]

How would HCT change in an old bag of PRBC. Hemolysis?

Yup. Same reason the K is high.

 

[coffeebythelake]

Yup. Same reason the K is high.

I need to read up on some laboratory science. How they actually measure HCT.

 

[chocomorsel]

How would HCT change in an old bag of PRBC. Hemolysis?

But maybe they lied to us in Medical School. I don’t have any pathology friends to verify it.

 

[chocomorsel]

I need to read up on some laboratory science. How they actually measure HCT.

You beat me to it. I was trying to as well.

 

[GassYous]

I need to read up on some laboratory science. How they actually measure HCT.

light

 

[Aether2000]

It makes me ponder the effects of rapid infusion of >1 of these units of quite acidic, hyperkalemic PRBCs.

 

[coffeebythelake]

It makes me ponder the effects of rapid infusion of >1 of these units of quite acidic, hyperkalemic PRBCs.

We do it all the time in the OR. We don't transfuse just the fresh PRBCs, in fact blood bank tries to get rid of the older ones. So while the labs look very abnormal for PRBC (new or old) the clinical relevance doesn't seem so significant.

 

[drmwvr]

This is why I wash my cells thru a cell saver first. And that is a dubious hct if that is a non expired unit.

 

[fittipaldi1of1]

I’m also surprised by the blood sugar.. I would think high glucose would make a better culture for bacteria.

 

[deleted875186]

I’m also surprised by the blood sugar.. I would think high glucose would make a better culture for bacteria.

All the PRBC preservative solutions have dextrose and adenine to keep the cells alive, and phosphate buffer! ADSOL I believe is the name.

 

[WholeLottaGame7]

It makes me ponder the effects of rapid infusion of >1 of these units of quite acidic, hyperkalemic PRBCs.

Had an intraop death in residency that I wondered if it was related to old blood transfusion. VATS/decort for a mesothelioma pt, lots of suctioning noises, surgeon pulls the old "it's all old blood" card, pressure sags, pt was already anemic (8ish?), so started transfusing, QRS widened and went into VF, ACLS, eventually got back, lost again, never recovered. Wish we had an ABG right before things crumped but it was after the code started and looked like trash. Obviously acidotic and hyperkalemic. Could have been under-resuscitation leading to the code, but don't remember the hemodynamics being that deranged. Always wondered if that first bag of PRBC was one of those with like a K+ of 13 and that just tipped them over the edge.

 

[woopedazz]

It's called storage lesion guys... We get VIVA'd on it all the time in Australia. It's the worst.

For those wondering: The K+ goes a lot higher than 13. It's ~30mmol/L at 28 days. That's why you ring the lab and ask for fresh stuff if it's an acidotic, hyperkalaemic patient on the precipice.

 

[Lidolover]

It does appear to have some degree of hemolysis.
We transfuse A LOT in our hospital and we see hyperkalemia from transfusion At times. Even when you use the cell saver, you must expect it.

 

[surgndoc]

Not surprised to see others say K can get a lot higher than 8.

This is why you should asked for washed RBCs or RBCs less than 5 days old in certain pts (small children, severe liver dz) as washing lowers the K and lactate.

 

[chocomorsel]

Not surprised to see others say K can get a lot higher than 8.

This is why you should asked for washed RBCs or RBCs less than 5 days old in certain pts (small children, severe liver dz) as washing lowers the K and lactate.

Learning something new every day.

 

[deleted875186]

Love it, great thread from one ABG. I’ve only seen hyper K in massive transfusion, 10+ units. But definitely will be more cautious now hearing some other people’s experience.

 

[deleted875186]

Also, I’ve done a case with massive transfusion where we washed all the PRBCs with the cell saver, K never moved from around 4 the whole time

 

[deleted87051]

Also never microwave PRBC’s to warm them. This has actually been done and caused hyperkalemic arrest.

 

[GassYous]

The K from one bag of red cells isn't going to kill a patient. It's the acidosis that gets them. Keep up with the calcium, insulin and bicarb.

We have cases where the patient gets 100+ products and end up doing well.

 

[deleted162650]

Also never microwave PRBC’s to warm them. This has actually been done and caused hyperkalemic arrest.

Plus they get soggy.

 

[fakin' the funk]

It makes me ponder the effects of rapid infusion of >1 of these units of quite acidic, hyperkalemic PRBCs.

Hyperkalemia associated with transfusion is a well known entity.