The Effects of Morphine Sulfate on Agglutination, Clot Formation and Hemolysis in Packed Red Blood Cells
Uniformed Services University Of The Health Sciences Bethesda United States
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Morphine sulfate is an opium alkaloid narcotic frequently used on patients suffering from acute and chronic disease processes. Often patients receiving either acute or long term pain therapy with morphine require concomitant blood transfusion therapy. Based on current American Association of Blood Banks guidelines the addition of any medication other than normal saline to packed red blood cells is strictly prohibited. This restriction can lead to unwanted delays in medication schemes when patients with limited intravenous access are in need of both therapies at the same time. Few studies exist that have investigated the effects of morphine sulfate on packed red blood cells. Most of these have, in a limited manner, presented contrasting evidence on the efficacy of this practice. The aim of this study was to measure the in-vitro effects of morphine sulfate on packed red blood cells, while imitating the modern clinical infusion system. The effects of morphine sulfate on packed red blood cells was studied by measuring clot formation, agglutination, and hemolysis using relative semi-quantitative visual assay. Morphine sulfate did not cause time or temperature dependent clot formation or agglutination in the samples studied. This may be due to the fact that clotting was not possible due to removal of clotting factors during processing of the PRBCs. Grossly evident hemolysis occurred in both the control and test groups, most likely due to secondary sources. Findings from this study do not support compatibility between Morphine sulfate and Packed red blood cells. Recommendations for practice remain in accord with current practice standards.