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Design of a Blood-Warming Device for Resource-Limited Settings

Article  in  European Journal of Scientific Research · January 2013

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European Journal of Scientific Research
ISSN 1450-216X / 1450-202X Vol.103 No.1 (2013), pp.7-15
http://www.europeanjournalofscientificresearch.com

Design of a Blood-Warming Device for Resource-Limited

Settings

C.F. Adams
Department of Biomedical Engineering, Faculty of Engineering Sciences
University of Ghana, Accra, Ghana

J.D. Chirawurah
Department of Biomedical Engineering, Faculty of Engineering Sciences
University of Ghana, Accra, Ghana

P.E. Agbekoh
Department of Biomedical Engineering, Faculty of Engineering Sciences
University of Ghana, Accra, Ghana

Elsie Effah Kaufmann

Corresponding Author, Department of Biomedical Engineering
Faculty of Engineering Sciences, University of Ghana, Accra, Ghana
E-mail: [email protected]
Tel: +233 244 621 935

Abstract

Blood warming is usually required to get the temperature of blood to 37o C from
storage temperatures of 1–6 oC to prevent hypothermia during transfusions. Needs
assessment at various hospitals revealed that blood warming is a major challenge in Ghana.
Local methods of warming blood include leaving blood bags on walls in the open at
ambient temperature to warm, putting bags in warm water or leaving blood bags under
running tap water. These methods are inefficient, unsafe and time consuming. Efficient
blood warmers are available but they are very expensive and unaffordable for the resource-
limited hospitals surveyed. A cost effective, safe and efficient blood warming and thawing
device was designed to address the above-mentioned problems in resource-limited settings.
Materials and components were selected based on specifications obtained from potential
users, functional analysis, existing products and standards. The components of the device
are encased in a housing insulated with polymer foam to reduce heat loss to the
environment. It is anticipated that this intervention will be invaluable in situations where
quick blood transfusions are required to save lives.

Keywords: Engineering Design, Hypothermia, Blood Warmer, Blood Tansfusions,

Prototype, Simulation, Red Blood Cells (RBCs), Haemolysis

1. Introduction
Technological evolution is occurring very fast and has brought in its trail, a need for new, cost
effective, high-quality and well-engineered products. It has been estimated that malfunction of new
equipment, delay in outdooring a new product and exorbitant cost constitute 85% of all manufacturing
Design of a Blood-Warming Device for Resource-Limited Settings 8

problems with poor design process being identified as the root cause (David, 2010). A problem
identification program organized under the joint auspices of University of Michigan and University of
Ghana, uncovered challenges faced by medical personnel in Ghana. One of the daunting problems is
the absence of a blood-warming device in many of the hospitals. In ordinary medical practice, whole
blood, which is stored at a temperature of 4°C, is warmed to 37°C before transfusion whilst blood
plasma refrigerated at a temperature of -25°C, is thawed to about 6°C before transfusion (WHO, 2002).
It therefore suggests that patients in emergency situations requiring transfusion of blood at short notice
in these hospitals stand the risk of receiving cold blood transfusions, which can lead to hypothermia
(Elliot and Kiran, 2006), which can be fatal.
A probe into the problem revealed that the absence of blood warmers in most of these hospitals
could be attributed to their high cost of purchase and operation. Also, it was discovered that improvised
local methods employed by medical personnel such as warming blood in hot water or running tap
water over blood bags were inefficient and pose a threat in the form of damage to delicate blood
components or possible contamination of blood. As a result, this project was geared towards the design
of an affordable and efficient blood-warming device that requires minimal cost of operation.
Input from potential users, customers and research findings immensely contributed to the
development of product specifications. Using the specifications as a yardstick, various concepts were
developed and evaluated. A mathematical model of the system was built on a computer simulation
platform.
The results from the simulation indicated a high propensity for a prototype to meet major
objectives of the project. The final concept was implemented in the form of a mock up for further
testing.

Figure 1: Objective Tree for the Design of a Blood-Warming Device

9 C.F. Adams, J.D. Chirawurah, P.E. Agbekoh and Elsie Effah Kaufmann

2. The Design
An annotated computer aided drawing of the design is shown below in Figure 2. The device has been
designed to minimize heat loss to the environment by the insertion of a lagging material in between its
double wall (Figure 3). An isometric view of the device is also provided in Figure 6.

Figure 2: Computer Aided Drawing of the Blood-Warming Device

Figure 3: Top Orthographic View of the Device with Dimensions (in mm)

Space between walls

2.1. The Electrical Circuitry

The electrical and electronic components such as fan, heating element, timer, electrical motor and alert
components such as LEDs were simulated on a computer software (Proteus, Labcenter
Electronics,Version 7.9). Figure 4 shows how these components are interconnected and linked to the
AC power supply.

2.2. Warming Basket

The device has a container; the warming basket, made of polypropylene that holds the blood (Figure
5). Chilled blood in a standard blood bag is put into the warming basket that functions to support the
blood bag and promotes the effective distribution of heat around the blood bag during the warming
process.
Design of a Blood-Warming Device for Resource-Limited Settings 10

2.3. Timer
This is a component that switches off the device when the warming process is complete. In its
operation, the user makes an input by selecting a desired warming time using the timer switch. Some
amount of thermal energy is delivered to the blood during the preset time. The timer device is wired to
a mechanical bell that serves as an alert system to indicate the end of operation.

Figure 4: Circuit Diagram for Blood-Warming Device

Figure 5: The Warming Basket

2.4. Thermal Regulator

This is a device that controls the heat within the warming chamber, when the device is in operation. It
monitors the temperature within the warming chamber and initiates the appropriate response. The
thermal regulator controls the energy supplied to the heating unit by breaking the circuit if the preset
temperature in the warming chamber (80 oC) is reached.

2.5. Heat Distribution System (Blood Paddle)

This component ensures the even distribution of heat within the blood bag. This component is fixed to
the warming basket and causes the basket to slowly oscillate back and forth to ensure effective heat
distribution within the blood bag.
11 C.F. Adams, J.D. Chirawurah, P.E. Agbekoh and Elsie Effah Kaufmann

2.6. Temperature Measuring Device

This is a component of the device that measures the temperature within the warming basket and
displays it to the user. This device has a probe, which is located within the warming basket.

2.7. Device Protector

This is a component that controls the power and protects the device from damage. The device protector
has the capacity to break the circuit if the incoming power is greater than that required for the normal
operation of the device.

2.8. Housing of Device

The housing of the device is made of polypropylene, which sandwiches polyurethane foam. The
polyurethane foam serves as a lagging material. Both materials have a low thermal conductivity and
therefore help to conserve heat within the device.

Figure 6: Isometric View of the Device in a Closed State

2.9. Transparent Window

In order to enable the user to view the operations within the blood warmer, a transparent window made
of polycarbonate is specified for the device door. The polycarbonate door has a low thermal
conductivity and will therefore help conserve heat within the device.

Table 1: Bill of Materials for the Blood-Warming Device

No. Part/Item Quantity Description/ Specification Function

1 Fan 1 Speed: 2500 rpm, Current: 0.14 A, Ensures uniform distribution of heat
Voltage: 12 V in warming chamber
2 Blood Paddle 1 Material: Stainless steel Speed: 1-10 Ensures uniform distribution of heat
(Crank) rpm within the blood bag
3 Heating Element 1 Material: Nickel Chrome (80/20), Produces heat to warm blood
Voltage: 85V, Resistance: 31 Ohms,
4 Temperature Micro- 1 Temperature range: 0 to 99 oC Controls amount of heat within the
controller Model: AT89S52 system
5 Timer Switch 1 Range: 1-20 min Controls warming time
6 Bolts and Nuts 10 Material: ASTM A193 Grade B16 Attaching components to the flask
7 Relay Switch 1 Voltage: 5-12V (DC) Control power supply to device
8 Warming Basket 1 Volume: 0.0075 Holds blood bag
9 Transparent Window 1 Area: 0.0255 Allows viewing of operation
10 Power Socket 1 Voltage (input): 220-240V (AC) Connects device to power source
11 Flask 1 Volume: 0.125 Comprises housing material, door
and lagging material
12 Bevel Gear Set 1 Material: Stainless steel Rotates the crank
Design of a Blood-Warming Device for Resource-Limited Settings 12

3. Mode of Operation
The blood warming device has been designed to raise the temperature of blood from 4°C to 37 °C. A
heating unit produces thermal energy into the warming space at a constant rate. The temperature within
the warming chamber of the device is set to a value greater than 37 °C (typically, 80°C) to create the
necessary temperature gradient for heat influx into the blood unit. To prevent excessively high
temperature buildup within the warming chamber, a temperature controller is employed. The
temperature controller is preset to the maximum desirable temperature expected within the warming
chamber (80 oC). When the temperature exceeds the preset value by 1°C, the thermal regulator breaks
power supply to the heating unit. Power supply to the heating unit is activated when the warming
chamber temperature falls below the preset temperature. As a result of this effect, the temperature
within the device remains almost constant. A fan is embedded within the device to ensure effective
distribution of heat within the system. The container that bears the blood bags is made to oscillate at a
slow rate under the action of a crank (Blood paddle), which is propelled by a gear motor. This ensures
effective heat distribution within the blood. The warming system is akin to a forced convection system
(Incropera, 2009), because of the presence of the fan in a convective medium of air and a heat source.
To operate the device, the user must first load the blood bags (maximum of two units) into the
device. The user then selects the warming time using the knob of the timer. The timer activates a
mechanical bell to ring when the process is completed. A green LED on the display panel also
indicates that the operation has been completed. To prevent over-exposure of one side of the blood unit
to the thermal energy, the device has been configured to be non-operational if the fan fails to function.
A mathematical model of the system based on relevant thermodynamic equations (Equations 1
and 2) was simulated in Simulink environment of Matlab (Version R2011a) to test the feasibility of the
design concept. The rate of heat exchange between the heating unit, the blood and the device
boundaries was considered during the model development. The result of the Simulink simulation
(Figure 7) indicates that a unit of blood can be warmed from an initial temperature of 4 °C to a
temperature of 36°C in 10 minutes (purple line of Figure 7).
P = eσ A(T 4 − Tc4 ) [Equation 1]
dq
= h * A * (∆t) [Equation 2]
dt
Where P is net radiated power, A is radiating area, T is temperature, t is time, Tc is the
temperature of the surroundings, σ is Stefan’s constant and e is emissivity.

Figure 7: Temperature-time Graph of Matlab Model. A Unit of Blood can be Warmed from 4 °C to 36°C in
10 Minutes (purple line) when the Warming Space is Kept at 80 °C (Yellow Line).
13 C.F. Adams, J.D. Chirawurah, P.E. Agbekoh and Elsie Effah Kaufmann

4. Testing
A mock-up of the device was built from readily available materials (Table 1) and tested on a unit of
whole human blood. A unit of blood at an initial temperature of 7°C was warmed for ten minutes by
keeping the temperature of the warming chamber constant at 80°C. A positive control experiment was
setup by warming another unit of blood for 20 minutes. A sample of blood was taken into separate test
tubes before and after warming. Each sample was washed in saline and centrifuged at 3900 rpm for
two minutes.

4.1. Results
The sample warmed for 10 minutes attained a final temperature of 35 °C whilst the positive control
achieved a temperature of 65 °C. The clear supernatant of the blood unit warmed to 35°C (Figure 8b,
left test tube) indicates an insignificant amount of haemolysis whilst the red supernatant of the control
(Figure 8b, right test tube) indicates substantial damage to cells and thus expulsion of haemoglobin
(Eastlund et al, 1999). Figure 8a shows the supernatant of blood before warming.

Figure 8a: Supernatant of Blood Sample after Figure 8b: Supernatant after Warming to 35 °C (left
Centrifugation (Before Warming) test tube) and Supernatant after Warming
to 65 °C (Right Test Tube)

5. Advantages of the Device

• The device is relatively affordable ($238) as compared to existing products which cost between
$700- 6000 (Alibaba, 2012)
• The device has a warming time less than 15 minutes which is shorter compared to the
traditional improvised methods that take 45 minutes or more
• The device helps to avoid possible contamination associated with using water as a warming
medium by using dry heat as supported by D’Angelo, et al. (1995)
• The device is able to warm blood to the expected temperature
• The device is portable and therefore will occupy little space in a hospital where congestion is a
problem
• The device is easy to use with a short user learning time
• The device has a power protection system that prevents damage to the device in the case of
power surges, which is a commonplace in resource-limited settings.

6. Discussion
The design project was broken down into phases as outlined by a formal engineering design process
(Haik, 2003). A thorough understanding of the need statement made it possible to develop
specifications for the device. Potential users, on-line sources and some experts contributed immensely
Design of a Blood-Warming Device for Resource-Limited Settings 14

to the development of detailed specifications. The various concepts were proposed in consideration of
the developed functional structure and some similar products on the market. Concepts were then
evaluated using general system specifications. Finally, individual components were assembled to form
the final product.
One of the cardinal objectives of the project was the preservation of blood integrity after
warming. Even in recent times, a test for haemolysis of red blood cells (RBCs) is one of the fastest and
cheapest methods used to validate wholeness of blood (Hess et al., 2009). Blood warmed from 7°C to
35°C using the mockup tested negative for RBC haemolysis. This indicates that the device can perform
its intended function of warming blood without the destruction of red blood cells. Other tests may be
conducted in future studies to fully characterize the effect of warming on whole blood integrity.
The design of a blood warming-device has been successful in three main areas as far as the
goals of the project are concerned. In the first instance, the final product is cost effective and
economical to operate. This is evidenced by the fact that the cost of the mockup (GH¢475, equivalent
to US$ 238) using readily available materials was less than half the target value (GH¢1000, equivalent
to US$ 500). Also, the primary goal of raising the temperature of blood from 4°C to 37°C has almost
been achieved since the device could warm blood from 7°C to 35°C in a time space less than 15
minutes without significant haemolysis of RBCs. Finally, the device is easy to use and does not require
special training to operate it.
In spite of the success achieved, some significant work remains to be accomplished. The device
is currently being refined to improve its performance. For instance the time and temperature control
modules are being digitized to take full advantage of automation and flexibility associated with the use
of digital systems. All these efforts dovetail into the achievements of a higher warming efficiency with
minimal harm to delicate blood components. More laboratory tests are in progress to fine-tune the
device to warm and thaw blood products quickly to the expected temperature while preserving their
biological integrity.

7. Conclusion
A cost effective and efficient blood-warming device intended for health care institutions in resource-
limited settings has been designed, fabricated from readily available materials and tested on blood.
Work is ongoing to further refine the design and to produce a prototype to meet the objective of
warming blood in less than 15 minutes. The device will be invaluable in resource-limited settings,
where quick blood transfusions are required to save lives.

Acknowledgements
Professor Kathleen Sienko and the African Studies Center at the University of Michigan are gratefully
acknowledged for academic direction and financial support, respectively during the problem-scoping
phase of this work. Mrs. Sheila Allotey of Korle-Bu Teaching hospital and Mr. Paul Obeng of Ghana
Atomic Energy Commission are also acknowledged for their priceless suggestions and professional
advice.

References
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[3] D’Angelo, Eileen M., 1995. “Fluid warmer leakage into bloodstream”. Journal of the American
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