Co-administration of morphine and packed red blood cells safe for children

WESTPORT, CT (Reuters Health) – Analgesic therapy need not be interrupted, nor another venous access line started, in order to give a pediatric patient a coincident blood transfusion, Canadian investigators report.

Dr. G. Allen Finley and associates from Dalhousie University in Halifax, Nova Scotia simulated transfusions in which red blood cells were exposed to saline 0.9% and to morphine at concentrations of 0.1, 1.0 and 10.0 mg/mL. The mixtures were infused through a mock central venous catheter system.

Indicators of hemolysis–levels of potassium, plasma hemoglobin, and lactic dehydrogenase–did not differ from controls for admixtures of morphine at 0.1 mg/mL and 1.0 mg/mL. As reported in the Journal of Pain and Symptom Management for August, red blood cell counts and morphology remained unchanged. The investigators attribute the hemolysis observed when morphine reached 10 mg/mL to hypotonicity.

Dr. Finley and his colleagues conclude that adding morphine at the lower concentrations to packed red blood cells does not damage the cells. "In our clinical experience with children receiving palliative care, where the benefits were felt to far outweigh the risks, there has been no evidence of adverse effects nor of diminished efficacy in pain control" when cells and morphine are co-administered, they note.

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