Page 17 - ANZCP Gazette April 2021

energy in the form of ATP to achieve this (Wallas, 1979; Flatt References
et. al., 2014). If this process is inhibited, for example by a fall in ATP levels, a rise in intracellular Sodium (Na+) concentration and a fall in intracellular K+ will result (Wallas, 1979). While the results demonstrated no significant differences in the rate of haemolysis or extracellular K+ concentration, the samples containing glucose saw slight decreases in the extracellular K+ concentrations over the four-hour period. A lack of substrate to maintain this ATPase pump could potentially explain higher extracellular K+ concentrations in the samples not containing glucose. This may indicate that the activity of the electrolyte exchange pumps may have been somewhat preserved via the addition of glucose as a substrate for ATP synthesis.
This study demonstrated no variation in the amount of haemolysis between the two test groups. However, this could be due to the limited sensitivity of the test used, which only gives results in increments of 0.1 g/L, the company also specifies that the device is accurate within the range of 0.3–30 g/L. In retrospect, it may have been more accurate to express the amount of haemolysis as a percentage of total haemoglobin present in the sample or by spectrophotometer measurement.
Limitations and conclusion
There are several limitations of this study that should be addressed. Firstly, the small sample size of the study significantly limits the ability to develop statistical inferences from the data collected. Another potential limitation of this study is the variability between the donor units of pRBCs. There is potential variation in the amount of K+, lactate, glucose in each unit of packed red blood cells due to differences in unit age, donor unit volume and variability in the rate of cation leak across cell membranes between donors (Flatt et. al., 2014). Furthermore, this study did not investigate the differences in morphological or enzymatic changes that occurred between the sample groups such as levels of 2,3 DPG, cell wall fragility and changes in erythrocyte shape and flexibility.
This study demonstrates that over time RBCs metabolise glucose within the CPB prime, this process involves a concomitant decrease in glucose concentration and an increased level of lactate production. If the initiation of CPB is delayed after blood priming, for example during a redo operation in which there is a significant amount of adhesions, this could lead to a hypoglycaemic prime. Therefore, it is important to sample the CPB prime immediately before CPB initiation so that adjustments in electrolytes/metabolites can be made to ensure the blood prime circuit is as physiological as possible.
The results of this study warrant further larger-scale research to investigate whether alterations in the timing of the addition of glucose to RBCs is beneficial to prevent potential lactate acidosis as well as further investigation into the biochemical, morphological and metabolic impact that glucose has upon the RBCs within the CPB circuit prime.
Funding and conflicts of interest
The author wishes to declare no funding was received for this paper, and there are no conflicts of interest to declare.
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