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    Mimetização in vitro da prática transfusional em neonatos: influência do tipo de cateter e da irradiação de concentrados de hemácias sobre marcadores de hemólise
    (Universidade Federal de São Paulo (UNIFESP), 2019-11-28) Orsi, Kelly Cristina Sbampato Calado [UNIFESP]; Avelar, Ariane Ferreira Machado [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: In transfusion practice in neonates, predominantly irradiated red blood cell (RBC) are administered by smaller caliber catheters due to small diameter and vascular fragility of neonates. The literature does not define precisely whether the mechanical action of the devices on the RBC, as well as the irradiation process can influence on occurrence of harmful hemolysis levels to newborn´s health. Objectives: To evaluate the effect of RBC irradiation on hemolysis marker levels; to compare the levels of irradiated and non-irradiated RBC hemolysis markers after in vitro infusion by peripheral intravenous catheter (PIV), umbilical catheter and peripheral inserted central catheter (PICC); to verify the influence of the infusion method on hemolysis markers administered in vitro in PIV. Materials and methods: Experimental study conducted in laboratory under controlled temperature and humidity conditions. Data collection occurred after approval of the ethical merit (nº 3,116,300) .Irradiated and non-irradiated RBC type A+ conserved in CPDA-1, with maximum 7 days of storage, were used. RBC was randomly administered in triplicate by syringe pump at 10 ml/h velocity, in 24 Gauge PIV, 2 French PICC and , 5Fr umbilical catheter, and gravitational method only on 24G PIV. Aliquots were collected directly from the RBC bag - M1, after manual filling of the infusion system (syringe and extension tube)-M2 and after infusion by catheters -M3. The hemolytic markers analyzed were: hemolysis degree (%), hematocrit - Ht (%); total hemoglobin - Hbt (g / dl); free hemoglobin - Hbl (g / dl); potassium - K (mmol / l) and lactate dehydrogenase - LDH (U / L). 360 aliquots were analyzed and levels of 1800 irradiated and non-irradiated RBC hemolysis markers were identified. The mean storage time of RBC were 4.9 (± 2.1) days Descriptive and inferential analysis were used and, according to the nature of the variables, the Mann – Whitnney, Wilcoxon, Kruskall Wallis, and / or Student's T tests, p <0.05, were applied. Results: Irradiated RBC presentes higher potassium levels 25,40±7,19) than non irradiated (18,92± 4,83) (p<0,001). CIVP have no influence in hemolysis markers, in both blood types. After umbilical cateter infusion we noted incremente in Hbl [0,04±0,01 to 0,05±0,02g/dl]; Ht [69,60±5,84 to 75,60±4,29%]; K [17,95±19,69 to 19,69±3,30] of RBc non irradiated, and Ht [65,80±5,96 to 68,20±7,46%]; e LDH [118,73(107,93-82,13) to 146,01(113,33-irradiated RBC, and Hbl [0,03±0,01 to 0,04± 0,02g/dl] e grau de hemólise [0,04±0,01 to 0,05±0,02g/dl] (p=0,020) on irradiated RBC. The gravitational infusion influenced on incremente of Hbl [0,03±0,02 to 0,05±0,02g/dl], Ht [72,00(70,00-73,00) to74,00(72,00-74,5)%], K [26,27±5,19 to 30,2±4,23] e LDH [118,73(107,93-223,96) to 159,20(122,77-236,10)U/L] of irradiated RBC.Conclusion: Red blood cell irradiation had an influence on potassium and LDH levels, and in vitro infusion with CCIP and umbilical catheter resulted in significant changes in the levels of some hemolysis markers, regardless of the type of blood evaluated. In the infusion of irradiated and non-irradiated RBC by PIV, the gravitational method caused greater variation of hemolysis markers when compared to the syringe infusion pump. The levels of hemolysis markers identified, regardless of blood type, catheter or infusion method, do not suggest clinical repercussions in the neonate and are safe for transfusion therapy.