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Bjurström MF, Linder YC, Kjeldsen-Kragh J, Bengtsson J, Kander T. Adherence to a restrictive red blood cell transfusion strategy in critically ill patients: An observational study. Acta Anaesthesiol Scand 2024; 68:812-820. [PMID: 38453453 DOI: 10.1111/aas.14402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Randomized controlled trials relatively consistently show that restrictive red blood cell (RBC) transfusion strategies are safe and associated with similar outcomes compared to liberal transfusion strategies in critically ill patients. Based on these data, the general threshold for RBC transfusion was changed to 70 g/L at a 9-bed tertiary level intensive care unit in September 2020. Implementation measures included lectures, webinars and feedback during clinical practice. The aim of this study was to investigate how implementation of a restrictive transfusion strategy influenced RBC usage, haemoglobin trigger levels and adherence to prescribed trigger levels. METHODS In this registry-based, observational study, critically ill adult patients without massive bleeding were included and divided into a pre-cohort, with admissions prior to the change of transfusion strategy, and a post-cohort, with admissions following the change of transfusion strategy. These cohorts were compared regarding key RBC transfusion-related variables. RESULTS In total 5626 admissions were included in the analyses (pre-cohort n = 4373, post-cohort n = 1253). The median volume (interquartile range, IQR) of RBC transfusions per 100 admission days, in the pre-cohort was 6120 (4110-8110) mL versus 3010 (2890-4970) mL in the post-cohort (p < .001). This corresponds to an estimated median saving of 1128 € per 100 admission days after a restrictive RBC transfusion strategy was implemented. In total, 26% of the admissions in the pre-cohort and 19% in the post-cohort (p < .001) received RBC transfusion(s) during days 0-10. Both median (IQR) prescribed trigger levels (determined by intensivist) and actual haemoglobin trigger levels (i.e., levels prior to actual administration of transfusion) were higher in the pre- versus post-cohort (90 [80-100] vs. 80 [72-90] g/L, p < .001 and 89 [82-96] g/L vs. 83 [79-94], p < .001, respectively). Percentage of days without compliance with the prescribed transfusion trigger was higher in the pre-cohort than in the post-cohort (23% vs. 14%, p < .001). Sensitivity analyses, excluding patients with traumatic brain injury, ischemic heart disease and COVID-19 demonstrated similar results. CONCLUSIONS Implementation of a restrictive transfusion trigger in a critical care setting resulted in lasting decreased RBC transfusion use and costs, decreased prescribed and actual haemoglobin trigger levels and improved adherence to prescribed haemoglobin trigger levels.
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Affiliation(s)
- Martin F Bjurström
- Department of Intensive and Perioperative Care, Skåne University Hospital and Lund University, Lund, Sweden
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Ylva C Linder
- Department of Clinical Immunology and Transfusion Medicine, Office for Medical Services, Laboratory Medicine and Lund University, Lund, Sweden
| | - Jens Kjeldsen-Kragh
- Department of Clinical Immunology and Transfusion Medicine, Office for Medical Services, Laboratory Medicine and Lund University, Lund, Sweden
| | - Jesper Bengtsson
- Department of Clinical Immunology and Transfusion Medicine, Office for Medical Services, Laboratory Medicine and Lund University, Lund, Sweden
| | - Thomas Kander
- Department of Intensive and Perioperative Care, Skåne University Hospital and Lund University, Lund, Sweden
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Mykhailova O, Brandon-Coatham M, Phan C, Yazdanbakhsh M, Olafson C, Yi QL, Kanias T, Acker JP. Red cell concentrates from teen male donors contain poor-quality biologically older cells. Vox Sang 2024; 119:417-427. [PMID: 38418415 DOI: 10.1111/vox.13602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/27/2024] [Accepted: 01/31/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND AND OBJECTIVES Donor factors influence the quality characteristics of red cell concentrates (RCCs) and the lesions that develop in these heterogeneous blood products during hypothermic storage. Teen male donors' RCCs contain elevated levels of biologically old red blood cells (RBCs). The aim of this study was to interrogate the quality of units of different donor ages and sexes to unravel the complex interplay between donor characteristics, long-term cold storage and, for the first time, RBC biological age. MATERIALS AND METHODS RCCs from teen males, teen females, senior males and senior females were density-separated into less-dense/young (Y-RBCs) and dense/old RBCs (O-RBCs) throughout hypothermic storage for testing. The unseparated and density-separated cells were tested for haematological parameters, stress (oxidative and osmotic) haemolysis and oxygen affinity (p50). RESULTS The O-RBCs obtained from teen donor samples, particularly males, had smaller mean corpuscular volumes and higher mean corpuscular haemoglobin concentrations. While biological age did not significantly affect oxygen affinity, biologically aged O-RBCs from stored RCCs exhibited increased oxidative haemolysis and decreased osmotic fragility, with teenage male RCCs exhibiting the highest propensity to haemolyse. CONCLUSION Previously, donor age and sex were shown to have an impact on the biological age distribution of RBCs within RCCs. Herein, we demonstrated that RBC biological age, particularly O-RBCs, which are found more prevalently in male teens, to be a driving factor of several aspects of poor blood product quality. This study emphasizes that donor factors should continue to be considered for their potential impacts on transfusion outcomes.
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Affiliation(s)
- Olga Mykhailova
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
| | | | - Celina Phan
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Mahsa Yazdanbakhsh
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Carly Olafson
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Qi-Long Yi
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Tamir Kanias
- Vitalant Research Institute, Denver, Colorado, USA
| | - Jason P Acker
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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3
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Obeagu EI. Red blood cells as biomarkers and mediators in complications of diabetes mellitus: A review. Medicine (Baltimore) 2024; 103:e37265. [PMID: 38394525 DOI: 10.1097/md.0000000000037265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Red blood cells (RBCs), traditionally recognized for their oxygen transport role, have garnered increasing attention for their significance as crucial contributors to the pathophysiology of diabetes mellitus. In this comprehensive review, we elucidate the multifaceted roles of RBCs as both biomarkers and mediators in diabetes mellitus. Amidst the intricate interplay of altered metabolic pathways and the diabetic milieu, RBCs manifest distinct alterations in their structure, function, and lifespan. The chronic exposure to hyperglycemia induces oxidative stress, leading to modifications in RBC physiology and membrane integrity. These modifications, including glycation of hemoglobin (HbA1c), establish RBCs as invaluable biomarkers for assessing glycemic control over extended periods. Moreover, RBCs serve as mediators in the progression of diabetic complications. Their involvement in vascular dysfunction, hemorheological changes, and inflammatory pathways contributes significantly to diabetic microangiopathy and associated complications. Exploring the therapeutic implications, this review addresses potential interventions targeting RBC abnormalities to ameliorate diabetic complications. In conclusion, comprehending the nuanced roles of RBCs as biomarkers and mediators in diabetes mellitus offers promising avenues for enhanced diagnostic precision, therapeutic interventions, and improved patient outcomes. This review consolidates the current understanding and emphasizes the imperative need for further research to harness the full potential of RBC-related insights in the realm of diabetes mellitus.
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Obonyo NG, Lu LY, White NM, Sela DP, Rachakonda RH, Teo D, Tunbridge M, Sim B, See Hoe LE, Fanning JP, Tung JP, McKnoulty M, Bassi GL, Suen JY, Fraser JF. Effects of transfusing older red blood cells and platelets on obstetric patient outcomes: A retrospective cohort study. Int J Gynaecol Obstet 2024; 164:184-191. [PMID: 37470165 DOI: 10.1002/ijgo.14997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To investigate associations between transfusion of blood products close to the end of shelf-life and clinical outcomes in obstetric inpatients. METHODS Mortality and morbidity were compared in patients transfused exclusively with red blood cells (RBC) stored for less than 21 days (fresh) versus RBC stored for 35 days or longer (old), and platelets (PLT) stored for 3 days or fewer (fresh) versus 4 days or longer (old) in Queensland, Australia from 2007 to 2013. Multivariable models were used to examine associations between these groups of blood products and clinical end points. RESULTS There were 3371 patients who received RBC and 280 patients who received PLT of the eligible storage durations. Patients transfused with old RBC received fewer transfusions (2.7 ± 1.8 vs. 2.3 ± 1.0 units; P < 0.001). However, a higher rate of single-unit transfusions was also seen in those patients who exclusively received old RBC (252 [9.3%] vs. 92 [13.7%]; P = 0.003). Comparison of fresh vs. old blood products revealed no differences in the quantities of transfused RBC (9.5 ± 5.9 vs. 9.1 ± 5.2 units; P = 0.680) or PLT (1.5 ± 0.8 vs. 1.4 ± 1.1 units; P = 0.301) as well as the length of hospital stay for RBC (3 [2-5] vs. 3 [2-5] days; P = 0.124) or PLT (5 [4-8] vs. 6 [4-9] days; P = 0.120). CONCLUSION Transfusing exclusively older RBC or PLT was not associated with increased morbidity or mortality.
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Affiliation(s)
- Nchafatso G Obonyo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Wellcome Trust Centre for Global Health Research, Imperial College London, London, UK
- Initiative to Develop African Research Leaders (IDeAL)/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Lawrence Y Lu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Nicole M White
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
| | - Declan P Sela
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Reema H Rachakonda
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Derek Teo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Matthew Tunbridge
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Beatrice Sim
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Louise E See Hoe
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
| | - Jonathon P Fanning
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - John-Paul Tung
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Clinical Services and Research, Australian Red Cross Lifeblood, Brisbane, Australia
| | - Matthew McKnoulty
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Obstetrics and Gynaecology, Redcliffe Hospital, Brisbane, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- School of Medicine, Griffith University, Gold Coast, Australia
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Kita VY, Orsi KCSC, de Souza AHP, Tsunemi MH, Avelar AFM. Transfusion Practice: Hemolysis Markers After In Vitro Infusion of Packed Red Blood Cells by the Gravitational Method in Peripheral Catheter. JOURNAL OF INFUSION NURSING 2023; 46:320-331. [PMID: 37920106 DOI: 10.1097/nan.0000000000000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
The objective of this study was to compare hemolysis marker levels after in vitro infusion of red blood cells (RBCs) according to storage time, infusion rate, and peripheral intravenous catheter size. This is an experimental study with randomly administered RBCs in quintuplicate, according to storage time shorter than and longer than 14 days, as well as infusion rate (50 mL/h and 100 mL/h) using catheters with calibers of 14-, 18-, and 20-gauge. Aliquots were collected from RBCs (V1), after equipment and catheter (V2) free-flow filling and after controlled infusion through the catheter (V3). The hemolytic markers analyzed were degree of hemolysis (%), hematocrit (Ht) (%), total hemoglobin (THb) (g/dL), free hemoglobin (FHb) (g/dL), potassium (K) (mmol/L), and lactate dehydrogenase (LDH) (U/L), considering a probability of error ≤5%. Sixty experiments were performed with the analysis of 180 aliquots. When RBCs aged <14 days were used, all catheters tended to increase THb, FHb, and K; while >14 days, RBCs presented increased FHb and degree of hemolysis with catheters of 18-gauge and THb levels at 14-gauge. Among the conditions analyzed, only 20-gauge catheters (the smallest) did not influence changes in hemolysis markers, regardless of RBC storage time.
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Affiliation(s)
- Vanessa Yukie Kita
- Nursing School, Universidade Federal de São Paulo, São Paulo, Brazil (Drs Kita, Orsi, de Souza, and Avelar); Department of Biostatistics, Universidade Estadual Paulista Júlio de Mesquita Filho - Botucatu, São Paulo, Brazil (Dr Tsunemi)
- Vanessa Yukie Kita, RN, MNSc, earned a nursing degree from the Federal University of São Paulo - UNIFESP (2004) and a master of science degree (UNIFESP - 2019). She has experience in the field of nursing, with an emphasis on intensive care. She is currently professor of intensive care at UNIFESP Paulista School of Nursing
- Kelly Cristina Sbampato Calado Orsi, RN, PhD, earned a degree in nursing from the Federal University of São Paulo (2005), as well as a Master of Science (2015) and PhD in sciences at the Escola Paulista de Enfermagem (2019). She is currently professor at the Pediatric Nursing Department at Escola Paulista de Enfermagem/UNIFESP
- Adja Havreluk Paiva de Souza, RN, MNSc, earned a degree in nursing from the Federal University of São Paulo (2005), specialist in emergency nursing degree from the Federal University of São Paulo (2007), and Master of Science (UNIFESP - 2019)
- Miriam Harumi Tsunemi, PhD, earned a degree in statistics from Universidade Estadual Paulista Júlio de Mesquita Filho (2001), a Master's Degree in statistics from the Federal University of São Carlos (2003), and a PhD from the Institute of Mathematics and Statistics of the University of São Paulo
- Ariane Ferreira Machado Avelar, RN, PhD, graduated from the Albert Einstein College of Nursing (1998), earned a Master's Degree in Federal Nursing from São Paulo (2003), and PhD in Sciences at the Federal University of São Paulo (2009). She is currently an associate professor at the Department of Pediatric Nursing (UNIFESP)
| | - Kelly Cristina Sbampato Calado Orsi
- Nursing School, Universidade Federal de São Paulo, São Paulo, Brazil (Drs Kita, Orsi, de Souza, and Avelar); Department of Biostatistics, Universidade Estadual Paulista Júlio de Mesquita Filho - Botucatu, São Paulo, Brazil (Dr Tsunemi)
- Vanessa Yukie Kita, RN, MNSc, earned a nursing degree from the Federal University of São Paulo - UNIFESP (2004) and a master of science degree (UNIFESP - 2019). She has experience in the field of nursing, with an emphasis on intensive care. She is currently professor of intensive care at UNIFESP Paulista School of Nursing
- Kelly Cristina Sbampato Calado Orsi, RN, PhD, earned a degree in nursing from the Federal University of São Paulo (2005), as well as a Master of Science (2015) and PhD in sciences at the Escola Paulista de Enfermagem (2019). She is currently professor at the Pediatric Nursing Department at Escola Paulista de Enfermagem/UNIFESP
- Adja Havreluk Paiva de Souza, RN, MNSc, earned a degree in nursing from the Federal University of São Paulo (2005), specialist in emergency nursing degree from the Federal University of São Paulo (2007), and Master of Science (UNIFESP - 2019)
- Miriam Harumi Tsunemi, PhD, earned a degree in statistics from Universidade Estadual Paulista Júlio de Mesquita Filho (2001), a Master's Degree in statistics from the Federal University of São Carlos (2003), and a PhD from the Institute of Mathematics and Statistics of the University of São Paulo
- Ariane Ferreira Machado Avelar, RN, PhD, graduated from the Albert Einstein College of Nursing (1998), earned a Master's Degree in Federal Nursing from São Paulo (2003), and PhD in Sciences at the Federal University of São Paulo (2009). She is currently an associate professor at the Department of Pediatric Nursing (UNIFESP)
| | - Adja Havreluk Paiva de Souza
- Nursing School, Universidade Federal de São Paulo, São Paulo, Brazil (Drs Kita, Orsi, de Souza, and Avelar); Department of Biostatistics, Universidade Estadual Paulista Júlio de Mesquita Filho - Botucatu, São Paulo, Brazil (Dr Tsunemi)
- Vanessa Yukie Kita, RN, MNSc, earned a nursing degree from the Federal University of São Paulo - UNIFESP (2004) and a master of science degree (UNIFESP - 2019). She has experience in the field of nursing, with an emphasis on intensive care. She is currently professor of intensive care at UNIFESP Paulista School of Nursing
- Kelly Cristina Sbampato Calado Orsi, RN, PhD, earned a degree in nursing from the Federal University of São Paulo (2005), as well as a Master of Science (2015) and PhD in sciences at the Escola Paulista de Enfermagem (2019). She is currently professor at the Pediatric Nursing Department at Escola Paulista de Enfermagem/UNIFESP
- Adja Havreluk Paiva de Souza, RN, MNSc, earned a degree in nursing from the Federal University of São Paulo (2005), specialist in emergency nursing degree from the Federal University of São Paulo (2007), and Master of Science (UNIFESP - 2019)
- Miriam Harumi Tsunemi, PhD, earned a degree in statistics from Universidade Estadual Paulista Júlio de Mesquita Filho (2001), a Master's Degree in statistics from the Federal University of São Carlos (2003), and a PhD from the Institute of Mathematics and Statistics of the University of São Paulo
- Ariane Ferreira Machado Avelar, RN, PhD, graduated from the Albert Einstein College of Nursing (1998), earned a Master's Degree in Federal Nursing from São Paulo (2003), and PhD in Sciences at the Federal University of São Paulo (2009). She is currently an associate professor at the Department of Pediatric Nursing (UNIFESP)
| | - Miriam Harumi Tsunemi
- Nursing School, Universidade Federal de São Paulo, São Paulo, Brazil (Drs Kita, Orsi, de Souza, and Avelar); Department of Biostatistics, Universidade Estadual Paulista Júlio de Mesquita Filho - Botucatu, São Paulo, Brazil (Dr Tsunemi)
- Vanessa Yukie Kita, RN, MNSc, earned a nursing degree from the Federal University of São Paulo - UNIFESP (2004) and a master of science degree (UNIFESP - 2019). She has experience in the field of nursing, with an emphasis on intensive care. She is currently professor of intensive care at UNIFESP Paulista School of Nursing
- Kelly Cristina Sbampato Calado Orsi, RN, PhD, earned a degree in nursing from the Federal University of São Paulo (2005), as well as a Master of Science (2015) and PhD in sciences at the Escola Paulista de Enfermagem (2019). She is currently professor at the Pediatric Nursing Department at Escola Paulista de Enfermagem/UNIFESP
- Adja Havreluk Paiva de Souza, RN, MNSc, earned a degree in nursing from the Federal University of São Paulo (2005), specialist in emergency nursing degree from the Federal University of São Paulo (2007), and Master of Science (UNIFESP - 2019)
- Miriam Harumi Tsunemi, PhD, earned a degree in statistics from Universidade Estadual Paulista Júlio de Mesquita Filho (2001), a Master's Degree in statistics from the Federal University of São Carlos (2003), and a PhD from the Institute of Mathematics and Statistics of the University of São Paulo
- Ariane Ferreira Machado Avelar, RN, PhD, graduated from the Albert Einstein College of Nursing (1998), earned a Master's Degree in Federal Nursing from São Paulo (2003), and PhD in Sciences at the Federal University of São Paulo (2009). She is currently an associate professor at the Department of Pediatric Nursing (UNIFESP)
| | - Ariane Ferreira Machado Avelar
- Nursing School, Universidade Federal de São Paulo, São Paulo, Brazil (Drs Kita, Orsi, de Souza, and Avelar); Department of Biostatistics, Universidade Estadual Paulista Júlio de Mesquita Filho - Botucatu, São Paulo, Brazil (Dr Tsunemi)
- Vanessa Yukie Kita, RN, MNSc, earned a nursing degree from the Federal University of São Paulo - UNIFESP (2004) and a master of science degree (UNIFESP - 2019). She has experience in the field of nursing, with an emphasis on intensive care. She is currently professor of intensive care at UNIFESP Paulista School of Nursing
- Kelly Cristina Sbampato Calado Orsi, RN, PhD, earned a degree in nursing from the Federal University of São Paulo (2005), as well as a Master of Science (2015) and PhD in sciences at the Escola Paulista de Enfermagem (2019). She is currently professor at the Pediatric Nursing Department at Escola Paulista de Enfermagem/UNIFESP
- Adja Havreluk Paiva de Souza, RN, MNSc, earned a degree in nursing from the Federal University of São Paulo (2005), specialist in emergency nursing degree from the Federal University of São Paulo (2007), and Master of Science (UNIFESP - 2019)
- Miriam Harumi Tsunemi, PhD, earned a degree in statistics from Universidade Estadual Paulista Júlio de Mesquita Filho (2001), a Master's Degree in statistics from the Federal University of São Carlos (2003), and a PhD from the Institute of Mathematics and Statistics of the University of São Paulo
- Ariane Ferreira Machado Avelar, RN, PhD, graduated from the Albert Einstein College of Nursing (1998), earned a Master's Degree in Federal Nursing from São Paulo (2003), and PhD in Sciences at the Federal University of São Paulo (2009). She is currently an associate professor at the Department of Pediatric Nursing (UNIFESP)
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Mulatie Z, Aynalem M, Getawa S. MicroRNAs as Quality Assessment Tool in Stored Packed Red Blood Cell in Blood Banks. J Blood Med 2023; 14:99-106. [PMID: 36789373 PMCID: PMC9922504 DOI: 10.2147/jbm.s397139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
Micro-ribonucleic acids are control gene expression in cells. They represent the changed cellular states that occur can be employed as biomarkers. Red blood cells alter biochemically and morphologically while they are being stored, which could be detrimental to transfusion. The effect of storage on the erythrocyte transcriptome is not mostly investigated. Because adult erythrocytes lack a nucleus, it has long been assumed that they lack deoxyribonucleic acid and ribonucleic acid. On the other hand, erythrocytes contain a diverse range of ribonucleic acids, of which micro-ribonucleic acids are key component. Changes in this micro-ribonucleic acid protect cells from death and adenine triphosphate depletion, and they are linked to specific storage lesions. As a result, changes in micro-ribonucleic acid in stored erythrocytes may be used as a marker to assess the quality and safety of stored erythrocytes. Therefore, this review ams to review the role of microRNA in stored packed red blood cells as quality indicator. Google Scholar, PubMed, Scopus, and Z-libraries are used for searching articles and books. The article included in this paper was written in the English language and had the full article. During long storage of RBCs, miR-16-2-3p, miR-1260a, miR-1260b, miR-4443, miR-4695-3p, miR-5100, let-7b, miR-16, miRNA-1246, MiR-31-5p, miR-203a, miR-654-3p, miR-769-3p, miR-4454, miR-451a and miR-125b- 5p are up regulated. However, miR-96, miR-150, miR-196a, miR-197, miR-381 and miR-1245a are down regulated after long storage of RBCs. The changes of this microRNAs are linked to red blood cell lesions. Therefore, micro-ribonucleic acids are the potential quality indicator in stored packed red blood cells in the blood bank. Particularly, micro-ribonucleic acid-96 is the most suitable biomarker for monitoring red blood cell quality in stored packed red blood units.
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Affiliation(s)
- Zewudu Mulatie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Desie, Ethiopia,Correspondence: Zewudu Mulatie, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, P.O.box: 1145, Desie, Ethiopia, Tel +251945274251, Email
| | - Melak Aynalem
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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7
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Wang Y, Gao S, Zhu K, Ren L, Yuan X. Integration of Trehalose Lipids with Dissociative Trehalose Enables Cryopreservation of Human RBCs. ACS Biomater Sci Eng 2023; 9:498-507. [PMID: 36577138 DOI: 10.1021/acsbiomaterials.2c01154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cryopreservation of red blood cells (RBCs) is imperative for transfusion therapy, while cryoprotectants are essential to protect RBCs from cryoinjury under freezing temperatures. Trehalose has been considered as a biocompatible cryoprotectant that naturally accumulates in organisms to tolerate anhydrobiosis and cryobiosis. Herein, we report a feasible protocol that enables glycerol-free cryopreservation of human RBCs by integration of the synthesized trehalose lipids and dissociative trehalose through ice tuning and membrane stabilization. Typically, in comparison with sucrose monolaurate or trehalose only, trehalose monolaurate was able to protect cell membranes against freeze stress, achieving 96.9 ± 2.0% cryosurvival after incubation and cryopreservation of human RBCs with 0.8 M trehalose. Moreover, there were slight changes in cell morphology and cell functions. It was further confirmed by isothermal titration calorimetry and osmotic fragility tests that the moderate membrane-binding activity of trehalose lipids exerted cell stabilization for high cryosurvival. The aforementioned study is likely to provide an alternative way for glycerol-free cryopreservation of human RBCs and other types of cells.
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Affiliation(s)
- Yan Wang
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin300350, China
| | - Shuhui Gao
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin300350, China
| | - Kongying Zhu
- Analysis and Measurement Center, Tianjin University, Tianjin300072, China
| | - Lixia Ren
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin300350, China
| | - Xiaoyan Yuan
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin300350, China
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8
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Bellach L, Eigenschink M, Hassanein A, Savran D, Salzer U, Müllner EW, Repa A, Klebermass-Schrehof K, Wisgrill L, Giordano V, Berger A. Packed red blood cell transfusion in preterm infants. Lancet Haematol 2022; 9:e615-e626. [PMID: 35901846 DOI: 10.1016/s2352-3026(22)00207-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
Premature infants commonly receive adult packed red blood cells (pRBCs) during their hospital stay. As adult erythrocytes differ substantially from those of preterm infants, transfusion of adult pRBCs into preterm infants can be considered inappropriate for the physiology of a preterm infant. An absence of standardisation of transfusion protocols makes it difficult to compare and interpret pertinent clinical data, as reflected by unclear associations between pRBC transfusion and complications related to prematurity, such as bronchopulmonary dysplasia, neurodevelopmental impairment, retinopathy of prematurity, or necrotising enterocolitis. The difficulty in interpreting clinical data is further increased by differences in study designs that either overestimate pRBC-associated complications of prematurity or have not yet been designed to directly link pRBC transfusions to their respective complications. Thus, neonatal transfusion practice has become an ongoing difficulty, in which differences in transfusion guidelines hinder the ability to generate comparable clinical data, and heterogeneity in clinical data prevents the implementation of standardised transfusion protocols. To overcome these issues, novel approaches with biochemical-clinical translational designs could enable clinicians to gather causal evidence instead of circumstantial correlation.
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Affiliation(s)
- Luise Bellach
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Michael Eigenschink
- Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria
| | - Abtin Hassanein
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Danylo Savran
- Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria
| | - Ulrich Salzer
- Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria
| | - Ernst W Müllner
- Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria
| | - Andreas Repa
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Lukas Wisgrill
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Vito Giordano
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
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9
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Tzounakas VL, Anastasiadi AT, Karadimas DG, Velentzas AD, Anastasopoulou VI, Papageorgiou EG, Stamoulis K, Papassideri IS, Kriebardis AG, Antonelou MH. Early and Late-Phase 24 h Responses of Stored Red Blood Cells to Recipient-Mimicking Conditions. Front Physiol 2022; 13:907497. [PMID: 35721567 PMCID: PMC9198496 DOI: 10.3389/fphys.2022.907497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
The 24-hour (24 h) post-transfusion survival of donor red blood cells (RBCs) is an important marker of transfusion efficacy. Nonetheless, within that period, donated RBCs may encounter challenges able to evoke rapid stress-responses. The aim of the present study was to assess the effect of exposure to plasma and body temperature upon stored RBCs under recipient-mimicking conditions in vitro from the first hours "post-transfusion" up to 24 h. For this purpose, packed RBCs from seven leukoreduced CPD/SAGM units were reconstituted with plasma of twenty-seven healthy individuals and incubated for 24 h at 37oC. Three units were additionally used to examine stress-responses in 3-hour intervals post mixing with plasma (n = 5) until 24 h. All experiments were performed in shortly-, medium-, and long-stored RBCs. Hemolysis, redox, morphology, membrane protein binding and vesiculation parameters were assessed. Even though spontaneous hemolysis was minimal post-reconstitution, it presented a time-dependent increase. A similar time-course profile was evident for the concentration of procoagulant extracellular vesicles and the osmotic fragility (shortly-stored RBCs). On the contrary, mechanical fragility and reactive oxygen species accumulation were characterized by increases in medium-stored RBCs, evident even from the first hours in the recipient-mimicking environment. Finally, exposure to plasma resulted in rapid improvement of morphology, especially in medium-stored RBCs. Overall, some RBC properties vary significantly during the first 24 h post-mixing, at levels different from both the storage ones and the standard end-of-24 h. Such findings may be useful for understanding the performance of RBCs and their possible clinical effects -especially on susceptible recipients- during the first hours post-transfusion.
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Affiliation(s)
- Vassilis L Tzounakas
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Alkmini T Anastasiadi
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Dimitrios G Karadimas
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Athanassios D Velentzas
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Violetta I Anastasopoulou
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Effie G Papageorgiou
- Laboratory of Reliability and Quality Control in Laboratory Hematology (HemQcR), Department of Biomedical Sciences, School of Health and Welfare Sciences, University of West Attica (UniWA), Egaleo, Greece
| | | | - Issidora S Papassideri
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Anastasios G Kriebardis
- Laboratory of Reliability and Quality Control in Laboratory Hematology (HemQcR), Department of Biomedical Sciences, School of Health and Welfare Sciences, University of West Attica (UniWA), Egaleo, Greece
| | - Marianna H Antonelou
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
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Bebesi T, Kitka D, Gaál A, Szigyártó IC, Deák R, Beke-Somfai T, Koprivanacz K, Juhász T, Bóta A, Varga Z, Mihály J. Storage conditions determine the characteristics of red blood cell derived extracellular vesicles. Sci Rep 2022; 12:977. [PMID: 35046483 PMCID: PMC8770621 DOI: 10.1038/s41598-022-04915-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/21/2021] [Indexed: 12/18/2022] Open
Abstract
Extracellular vesicles (EVs) are released during the storage of red blood cell (RBC) concentrates and might play adverse or beneficial roles throughout the utilization of blood products (transfusion). Knowledge of EV release associated factors and mechanism amends blood product management. In the present work the impact of storage time and medium (blood preserving additive vs isotonic phosphate buffer) on the composition, size, and concentration of EVs was studied using attenuated total reflection infrared (ATR-IR) spectroscopy, microfluidic resistive pulse sensing (MRPS) and freeze-fraction combined transmission electron micrography (FF-TEM). The spectroscopic protein-to-lipid ratio based on amide and the C-H stretching band intensity ratio indicated the formation of various vesicle subpopulations depending on storage conditions. After short storage, nanoparticles with high relative protein content were detected. Spectral analysis also suggested differences in lipid and protein composition, too. The fingerprint region (from 1300 to 1000 cm-1) of the IR spectra furnishes additional information about the biomolecular composition of RBC-derived EVs (REVs) such as adenosine triphosphate (ATP), lactose, glucose, and oxidized hemoglobin. The difference between the vesicle subpopulations reveals the complexity of the REV formation mechanism. IR spectroscopy, as a quick, cost-effective, and label-free technique provides valuable novel biochemical insight and might be used complementary to traditional omics approaches on EVs.
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Affiliation(s)
- Tímea Bebesi
- grid.425578.90000 0004 0512 3755Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences (RCNS), Magyar tudósok körútja 2, 1117 Budapest, Hungary ,grid.5591.80000 0001 2294 6276Hevesy György PhD School of Chemistry, ELTE Eötvös Loránd University, Pázmány Péter sétány 1/A, 1117 Budapest, Hungary
| | - Diána Kitka
- grid.425578.90000 0004 0512 3755Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences (RCNS), Magyar tudósok körútja 2, 1117 Budapest, Hungary ,grid.5591.80000 0001 2294 6276Hevesy György PhD School of Chemistry, ELTE Eötvös Loránd University, Pázmány Péter sétány 1/A, 1117 Budapest, Hungary
| | - Anikó Gaál
- grid.425578.90000 0004 0512 3755Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences (RCNS), Magyar tudósok körútja 2, 1117 Budapest, Hungary
| | - Imola Csilla Szigyártó
- grid.425578.90000 0004 0512 3755Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences (RCNS), Magyar tudósok körútja 2, 1117 Budapest, Hungary
| | - Róbert Deák
- grid.425578.90000 0004 0512 3755Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences (RCNS), Magyar tudósok körútja 2, 1117 Budapest, Hungary
| | - Tamás Beke-Somfai
- grid.425578.90000 0004 0512 3755Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences (RCNS), Magyar tudósok körútja 2, 1117 Budapest, Hungary
| | - Kitti Koprivanacz
- grid.425578.90000 0004 0512 3755Institute of Enzymology, Research Centre for Natural Sciences (RCNS), Magyar tudósok körútja 2, 1117 Budapest, Hungary
| | - Tünde Juhász
- grid.425578.90000 0004 0512 3755Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences (RCNS), Magyar tudósok körútja 2, 1117 Budapest, Hungary
| | - Attila Bóta
- grid.425578.90000 0004 0512 3755Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences (RCNS), Magyar tudósok körútja 2, 1117 Budapest, Hungary
| | - Zoltán Varga
- Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences (RCNS), Magyar tudósok körútja 2, 1117, Budapest, Hungary.
| | - Judith Mihály
- Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences (RCNS), Magyar tudósok körútja 2, 1117, Budapest, Hungary.
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11
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Ma X, Liu Y, Han Q, Han Y, Wang J, Zhang H. Transfusion‑related immunomodulation in patients with cancer: Focus on the impact of extracellular vesicles from stored red blood cells (Review). Int J Oncol 2021; 59:108. [PMID: 34841441 DOI: 10.3892/ijo.2021.5288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/05/2021] [Indexed: 01/28/2023] Open
Abstract
Red blood cell (RBC) transfusions may have a negative impact on the prognosis of patients with cancer, where transfusion‑related immunomodulation (TRIM) may be a significant contributing factor. A number of components have been indicated to be associated with TRIM. Among these, the impact of extracellular vesicles (EVs) has been garnering increasing attention from researchers. EVs are defined as nano‑scale, cell‑derived vesicles that carry a variety of bioactive molecules, including proteins, nucleic acids and lipids, to mediate cell‑to‑cell communication and exert immunoregulatory functions. RBCs in storage constitutively secrete EVs, which serve an important role in TRIM in patients with cancer receiving a blood transfusion. Therefore, the present review aimed to first summarize the available information on the biogenesis and characterization of EVs. Subsequently, the possible mechanisms of TRIM in patients with cancer and the impact of EVs on TRIM were discussed, aiming to provide an outlook for future studies, specifically for formulating recommendations for managing patients with cancer receiving RBC transfusions.
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Affiliation(s)
- Xingyu Ma
- Class 2018 Medical Inspection Technology, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Yanxi Liu
- Class 2018 Medical Inspection Technology, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Qianlan Han
- Class 2018 Medical Inspection Technology, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Yunwei Han
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Jing Wang
- Department of Blood Transfusion, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Hongwei Zhang
- Department of Blood Transfusion, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
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12
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Livshits L, Barshtein G, Arbell D, Gural A, Levin C, Guizouarn H. Do We Store Packed Red Blood Cells under "Quasi-Diabetic" Conditions? Biomolecules 2021; 11:biom11070992. [PMID: 34356616 PMCID: PMC8301930 DOI: 10.3390/biom11070992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/21/2021] [Accepted: 07/01/2021] [Indexed: 01/28/2023] Open
Abstract
Red blood cell (RBC) transfusion is one of the most common therapeutic procedures in modern medicine. Although frequently lifesaving, it often has deleterious side effects. RBC quality is one of the critical factors for transfusion efficacy and safety. The role of various factors in the cells’ ability to maintain their functionality during storage is widely discussed in professional literature. Thus, the extra- and intracellular factors inducing an accelerated RBC aging need to be identified and therapeutically modified. Despite the extensively studied in vivo effect of chronic hyperglycemia on RBC hemodynamic and metabolic properties, as well as on their lifespan, only limited attention has been directed at the high sugar concentration in RBCs storage media, a possible cause of damage to red blood cells. This mini-review aims to compare the biophysical and biochemical changes observed in the red blood cells during cold storage and in patients with non-insulin-dependent diabetes mellitus (NIDDM). Given the well-described corresponding RBC alterations in NIDDM and during cold storage, we may regard the stored (especially long-stored) RBCs as “quasi-diabetic”. Keeping in mind that these RBC modifications may be crucial for the initial steps of microvascular pathogenesis, suitable preventive care for the transfused patients should be considered. We hope that our hypothesis will stimulate targeted experimental research to establish a relationship between a high sugar concentration in a storage medium and a deterioration in cells’ functional properties during storage.
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Affiliation(s)
- Leonid Livshits
- Red Blood Cell Research Group, Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zürich, CH-8057 Zurich, Switzerland;
| | - Gregory Barshtein
- Biochemistry Department, The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91905, Israel
- Correspondence: ; Tel.: +972-2-6758309
| | - Dan Arbell
- Pediatric Surgery Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel;
| | - Alexander Gural
- Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel;
| | - Carina Levin
- Pediatric Hematology Unit, Emek Medical Center, Afula 1834111, Israel;
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel
| | - Hélène Guizouarn
- Institut de Biologie Valrose, Université Côte d’Azur, CNRS, Inserm, 28 Av. Valrose, 06100 Nice, France;
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13
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Effects of whole blood storage in a polyolefin blood bag on platelets for acute normovolemic hemodilution. Sci Rep 2021; 11:12201. [PMID: 34108583 PMCID: PMC8190119 DOI: 10.1038/s41598-021-91725-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/31/2021] [Indexed: 12/04/2022] Open
Abstract
Acute normovolemic hemodilution (ANH) is a potential transfusion method for platelets, as well as for red blood cells. However, previous studies have shown that whole blood storage in ANH decreases platelet aggregability by 14.7–76.3% and that this decrease is not recovered by reinfusion. We investigated whether a new whole blood storage method for 6 h using a polyolefin bag, based on the platelet concentrates storage method, would maintain platelet function better than the conventional method using a polyvinyl chloride bag. We demonstrated that storage of whole blood in a polyolefin bag maintained ADP-induced aggregation rates at more than twofold higher than those in a polyvinyl chloride bag, and also significantly suppressed P-selectin expression, a platelet activation marker (ADP-induced aggregation rates: 24.6 ± 5.1% vs. 51.7 ± 11.5%, p = 0.002; P-selectin expression; 50.3 ± 8.4MFI vs. 31.6 ± 9.3MFI, p = 0.018). These results could be attributed to the high gas permeability of polyolefin, which lowered PCO2 and maintained a high pH with or without agitation. There were no significant changes in platelet count and red blood cell parameters due to the storage methods. Our results suggest that ANH using polyolefin bags is advantageous in improving hemostatic function compared to the conventional method.
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14
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López-Canizales AM, Angulo-Molina A, Garibay-Escobar A, Silva-Campa E, Mendez-Rojas MA, Santacruz-Gómez K, Acosta-Elías M, Castañeda-Medina B, Soto-Puebla D, Álvarez-Bajo O, Burgara-Estrella A, Pedroza-Montero M. Nanoscale Changes on RBC Membrane Induced by Storage and Ionizing Radiation: A Mini-Review. Front Physiol 2021; 12:669455. [PMID: 34149450 PMCID: PMC8213202 DOI: 10.3389/fphys.2021.669455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022] Open
Abstract
The storage lesions and the irradiation of blood cellular components for medical procedures in blood banks are events that may induce nanochanges in the membrane of red blood cells (RBCs). Alterations, such as the formation of pores and vesicles, reduce flexibility and compromise the overall erythrocyte integrity. This review discusses the alterations on erythrocytic lipid membrane bilayer through their characterization by confocal scanning microscopy, Raman, scanning electron microscopy, and atomic force microscopy techniques. The interrelated experimental results may address and shed light on the correlation of biomechanical and biochemical transformations induced in the membrane and cytoskeleton of stored and gamma-irradiated RBC. To highlight the main advantages of combining these experimental techniques simultaneously or sequentially, we discuss how those outcomes observed at micro- and nanoscale cell levels are useful as biomarkers of cell aging and storage damage.
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Affiliation(s)
| | - Aracely Angulo-Molina
- Departamento de Ciencias Químico-Biológicas, Universidad de Sonora, Hermosillo, Mexico
| | | | - Erika Silva-Campa
- Departamento de Investigación en Física, Universidad de Sonora, Hermosillo, Mexico
| | - Miguel A. Mendez-Rojas
- Departamento de Ciencias Químico-Biológicas, Universidad de las Américas, Puebla, Mexico
| | | | - Mónica Acosta-Elías
- Departamento de Investigación en Física, Universidad de Sonora, Hermosillo, Mexico
| | | | - Diego Soto-Puebla
- Departamento de Investigación en Física, Universidad de Sonora, Hermosillo, Mexico
| | - Osiris Álvarez-Bajo
- Departamento de Investigación en Física, Universidad de Sonora, Hermosillo, Mexico
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15
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Zare S, Mousavi Hosseini K, Maghsudlu M, Shahabi M. miRNA96 expression level within red blood cells is probably associated with RSL indicators during the storage of red blood cell units. Transfus Apher Sci 2021; 60:103122. [PMID: 33766457 DOI: 10.1016/j.transci.2021.103122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Many biochemical and hematological changes occur during the storage of RBC units. Collectively, these changes are known as RSLs. Previous studies found miRNA96 as non-coding RNA that its expression level changed during RBC storage. However, its correlation with mechanical and biochemical RSL indicators is not yet determined. Therefore, this study aimed to assess possible correlations between miRNA96a and some RSLs indicators to clarify its biomarker capability for evaluating the storage quality of RBC units. MATERIALS AND METHODS Samples were collected from ten leuko-reduced RBC units on days 0, 14, 28, and 42 of storage. miRNA96 gene expression level and RSLs indicators including hemolysis, mechanical fragility index (MFI), total antioxidant capacity (TAC), lipid peroxidation (TBARs), thiol groups, and RBC indices were measured on the days mentioned above. RESULTS Significant correlations were found between the changes in miRNA96 expression level and the levels of hemolysis, TAC, TBARs, and MFI indices (p values < 0.05). The donors were classified into the high risk group and low risk group, according to four important characteristics and lifestyle habits (smoking, physical activity, age, and BMI). The high risk group had a significantly lower rate of hemolysis, free hemoglobin, MFI, TAC, and a higher rate of lipid peroxidation compared to low risk group (p values < 0.05). CONCLUSION The finding suggested that upregulation of miRNA96 could prevent hemolysis of RBCs, despite the accumulation of oxidative injuries in them. The miRNA96 expression level was probably a potential predictor for mechanical and biochemical RSL indicators.
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Affiliation(s)
- Somayeh Zare
- High Institute for Research and Education in Transfusion Medicine, Blood Transfusion Research Center, Hemmat Expressway, IBTO Building, Tehran, Iran.
| | - Kamran Mousavi Hosseini
- High Institute for Research and Education in Transfusion Medicine, Blood Transfusion Research Center, Hemmat Expressway, IBTO Building, Tehran, Iran.
| | - Mahtab Maghsudlu
- High Institute for Research and Education in Transfusion Medicine, Blood Transfusion Research Center, Hemmat Expressway, IBTO Building, Tehran, Iran.
| | - Majid Shahabi
- High Institute for Research and Education in Transfusion Medicine, Blood Transfusion Research Center, Hemmat Expressway, IBTO Building, Tehran, Iran.
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Cai L, Zhang J, Hongyun W, Zhu Y, Zhang X, Liang W. Rab11B participates in erythrocyte storage lesion of under-collected whole blood. Transfus Apher Sci 2020; 60:103034. [PMID: 33341364 DOI: 10.1016/j.transci.2020.103034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The storage lesion of the red blood cell affects the life span of RBC and the quality of blood component. The elucidation of this mechanism is helpful to reduce the storage damage of RBC and improve the efficacy and safety of blood transfusion. The aim of this study was to discover the potential molecular mechanism of erythrocyte storage lesion with Under-collected whole blood (UC-WB) model. METHODS The label-free MS/MS quantitative method was used to identify the differential proteins of erythrocyte membrane proteins and the difference of Rab11B, V-ATPase and plasma GDI2 protein expression were further verified by western blot at the end of blood storage. RESULTS A total of 12 Rab proteins and 3 interacting effector proteins were identified among the membrane protein of normal WB and UC-WB, including 5 differential Rab proteins and 2 interacting effector proteins. Compared with normal WB, the expression of membrane Rab11B protein and ATP6V1B1/2 subunit of V-ATPases protein as well as the plasma GDI2 protein of UC-WB increased at the end of storage period. CONCLUSION Rab protein might be related to RBC storage lesions, Rab11B participates in the RBC storage lesion through Rab11B/V-ATPases pathways.
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Affiliation(s)
- Li Cai
- Jiangsu Province Blood Center, China
| | - Jingjing Zhang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, China
| | | | - Yi Zhu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, China
| | - Xiongfei Zhang
- School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, China.
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17
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Modelling of Red Blood Cell Morphological and Deformability Changes during In-Vitro Storage. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10093209] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Storage lesion is a critical issue facing transfusion treatments, and it adversely affects the quality and viability of stored red blood cells (RBCs). RBC deformability is a key indicator of cell health. Deformability measurements of each RBC unit are a key challenge in transfusion medicine research and clinical haematology. In this paper, a numerical study, inspired from the previous research for RBC deformability and morphology predictions, is conducted for the first time, to investigate the deformability and morphology characteristics of RBCs undergoing storage lesion. This study investigates the evolution of the cell shape factor, elongation index and membrane spicule details, where applicable, of discocyte, echinocyte I, echinocyte II, echinocyte III and sphero-echinocyte morphologies during 42 days of in-vitro storage at 4 °C in saline-adenine-glucose-mannitol (SAGM). Computer simulations were performed to investigate the influence of storage lesion-induced membrane structural defects on cell deformability and its recoverability during optical tweezers stretching deformations. The predicted morphology and deformability indicate decreasing quality and viability of stored RBCs undergoing storage lesion. The loss of membrane structural integrity due to the storage lesion further degrades the cell deformability and recoverability during mechanical deformations. This numerical approach provides a potential framework to study the RBC deformation characteristics under varying pathophysiological conditions for better diagnostics and treatments.
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18
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Non-oxidative band-3 clustering agents cause the externalization of phosphatidylserine on erythrocyte surfaces by a calcium-independent mechanism. BIOCHIMICA ET BIOPHYSICA ACTA-BIOMEMBRANES 2020; 1862:183231. [PMID: 32119860 DOI: 10.1016/j.bbamem.2020.183231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 01/17/2023]
Abstract
Aging of red blood cells (RBCs) is associated with alteration in a wide range of RBC features, occurring each on its own timescale. A number of these changes are interrelated and initiate a cascade of biochemical and structural transformations, including band-3 clustering and phosphatidylserine (PS) externalization. Using specific band-3 clustering agents (acridine orange (AO) and ZnCl2), we examined whether treatment of RBCs with these agents may affects PS externalization and whether this process is Ca2+-dependent. RBCs were isolated from the blood of eight healthy donors upon obtaining their informed consent. The suspension was supplemented with increasing concentrations of AO or ZnCl2 (from 0.5 to 2.0 mM) and incubated at 25 °C for 60 min. To detect PS at the RBC surface, we used allophycocyanin-conjugated recombinant human Annexin V. We demonstrated, that treatment of RBCs with both clustering agents caused an elevation in the percent of cells positively labeled by Annexin-V (RBCPS), and that this value was not dependent on the presence of calcium in the buffer: RBCs treated with AO in the presence of either EDTA, EGTA or calcium exhibited similar percentage of RBCPS. Moreover, the active influx of Zn2+ into RBCs induced by their co-incubation with both ZnCl2 and A23187 did not increase the percent of RBCPS as compared to RBCs incubated with ZnCl2 alone. Taken together, these results demonstrate that the band-3 clustering agents (AO or ZnCl2) induce PS externalization in a Ca2+ independent manner, and we hereby suggest a possible scenario for this phenomenon.
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19
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Cata JP, Owusu-Agyemang P, Kapoor R, Lonnqvist PA. Impact of Anesthetics, Analgesics, and Perioperative Blood Transfusion in Pediatric Cancer Patients: A Comprehensive Review of the Literature. Anesth Analg 2019; 129:1653-1665. [PMID: 31743187 DOI: 10.1213/ane.0000000000004314] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cancer is the leading cause of death by disease in developed countries. Children and adolescents with cancer need surgical interventions (ie, biopsy or major surgery) to diagnose, treat, or palliate their malignancies. Surgery is a period of high vulnerability because it stimulates the release of inflammatory mediators, catecholamines, and angiogenesis activators, which coincides with a period of immunosuppression. Thus, during and after surgery, dormant tumors or micrometastasis (ie, minimal residual disease) can grow and become clinically relevant metastasis. Anesthetics (ie, volatile agents, dexmedetomidine, and ketamine) and analgesics (ie, opioids) may also contribute to the growth of minimal residual disease or disease progression. For instance, volatile anesthetics have been implicated in immunosuppression and direct stimulation of cancer cell survival and proliferation. Contrarily, propofol has shown in vitro anticancer effects. In addition, perioperative blood transfusions are not uncommon in children undergoing cancer surgery. In adults, an association between perioperative blood transfusions and cancer progression has been described for some malignancies. Transfusion-related immunomodulation is one of the mechanisms by which blood transfusions can promote cancer progression. Other mechanisms include inflammation and the infusion of growth factors. In the present review, we discuss different aspects of tumorigenesis, metastasis, angiogenesis, the immune system, and the current studies about the impact of anesthetics, analgesics, and perioperative blood transfusions on pediatric cancer progression.
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Affiliation(s)
- Juan P Cata
- From the Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas
| | - Pascal Owusu-Agyemang
- From the Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas
| | - Ravish Kapoor
- From the Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas
| | - Per-Arne Lonnqvist
- Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Koch CG, Sessler DI, Duncan AE, Mascha EJ, Li L, Yang D, Figueroa P, Sabik JF, Mihaljevic T, Svensson LG, Blackstone EH. Effect of red blood cell storage duration on major postoperative complications in cardiac surgery: A randomized trial. J Thorac Cardiovasc Surg 2019; 160:1505-1514.e3. [PMID: 31813538 DOI: 10.1016/j.jtcvs.2019.09.165] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 09/18/2019] [Accepted: 09/29/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although observational studies suggest an association between transfusion of older red blood cell (RBC) units and increased postoperative risk, randomized trials have not supported this. The objective of this randomized trial was to test the effect of RBC storage age on outcomes after cardiac surgery. METHODS From July 2007 to May 2016, 3835 adults undergoing coronary artery bypass grafting, cardiac valve procedures, or ascending aorta repair, either alone or in combination, were randomized to transfusion of RBCs stored for ≤14 days (younger units) or for ≥20 days (older units) intraoperatively and throughout the postoperative hospitalization. According to protocol, 2448 patients were excluded because they did not receive RBC transfusions. Among the remaining 1387 modified intent-to-treat patients, 701 were randomized to receive younger RBC units (median age, 11 days) and the remaining 686 to receive older units (median age, 25 days). The primary endpoint was composite morbidity and mortality, analyzed using a generalized estimating equation (GEE) model. The trial was discontinued midway owing to enrollment constraints. RESULTS A total of 5470 RBC units were transfused, including 2783 in the younger RBC storage group and 2687 in the older RBC storage group. The GEE average relative-effect odds ratio was 0.77 (95% confidence interval [CI], 0.50-1.19; P = .083) for the composite morbidity and mortality endpoint. In-hospital mortality was lower for the younger RBC storage group (2.1% [n = 15] vs 3.4% [n = 23]), as was occurrence of other adverse events except for atrial fibrillation, although all CIs crossed 1.0. CONCLUSIONS This clinical trial, which was stopped at its midpoint owing to enrollment constraints, supports neither the efficacy nor the futility of transfusing either younger or older RBC units. The effects of transfusing RBCs after even more prolonged storage (35-42 days) remains untested.
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Affiliation(s)
- Colleen G Koch
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Md.
| | - Daniel I Sessler
- Department of Outcomes Researc, Cleveland Clinic, Cleveland, Ohio
| | - Andra E Duncan
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Edward J Mascha
- Department of Outcomes Researc, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Liang Li
- Division of Science, Department of Biostatistics, MD Anderson Cancer Center, Houston, Tex
| | - Dongsheng Yang
- Department of Outcomes Researc, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | | | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Tomislav Mihaljevic
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
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21
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Donnenberg AD, Kanias T, Triulzi DJ, Dennis CJ, Meyer EM, Gladwin M. Improved quantitative detection of biotin-labeled red blood cells by flow cytometry. Transfusion 2019; 59:2691-2698. [PMID: 31172532 PMCID: PMC9236723 DOI: 10.1111/trf.15354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/18/2019] [Accepted: 04/20/2019] [Indexed: 07/28/2023]
Abstract
BACKGROUND Biotin-labeled red blood cells (BioRBC) can be tracked after transfusion, providing a convenient and safe way to measure RBC survival in vivo. RBC survival is of interest for determining optimal blood storage conditions and for assessing the impact of genetic and biologic variants in blood donors on the survival of transfused RBCs. Here we present an improved, platform-independent assay for quantifying biotin on BioRBC. This approach is also useful for detecting BioRBC in peripheral blood samples as rare events. STUDY DESIGN AND METHODS We optimized the signal-to-noise ratio of the detecting reagent (phycoerythrin-conjugated streptavidin [SA-PE]) by determining the SA-PE concentration yielding the greatest separation index between BioRBC and unlabeled RBCs. We calibrated the fluorescence intensity measurements to molecules of equivalent soluble fluorochrome (MESF), a quantitative metric of fluorochrome binding and therefore of biotin bound per RBC. We then characterized the limit of blank and limit of quantification (LoQ) for BioRBC labeled at different densities. RESULTS Biotin-labeled RBCs at sulfo-NHS-biotin concentrations of 3 to 30 μg/mL (27-271 nmol/mL RBCs) ranged from approximately 32,000 to 200,000 MESF/RBC. The LoQ ranged from one in 274,000 to one in 649,000, depending on biotin-labeling density. CONCLUSION Increased sensitivity to detect BioRBC may facilitate tracking over longer periods and/or reduction of the BioRBC dose. Total RBC-bound biotin dose has been shown to correlate with the likelihood of developing antibodies to BioRBC. Lowering the dose of labeled cells may help avoid this eventuality.
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Affiliation(s)
- Albert D. Donnenberg
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Darrell J. Triulzi
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | | | - E. Michael Meyer
- Hillman Cancer Center Cytometry Facility, Pittsburgh, Pennsylvania
| | - Mark Gladwin
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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22
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Seghatchian J. Reflections on current status of blood transfusion transplant viral safety in UK/Europe and on novel strategies for enhancing donors/recipients healthcare in promising era of advanced cell therapy/regenerative medicine. Transfus Apher Sci 2019; 58:532-537. [DOI: 10.1016/j.transci.2019.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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23
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Effect of donor, component, and recipient characteristics on hemoglobin increments following red blood cell transfusion. Blood 2019; 134:1003-1013. [PMID: 31350268 DOI: 10.1182/blood.2019000773] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/17/2019] [Indexed: 01/28/2023] Open
Abstract
Significant research has focused individually on blood donors, product preparation and storage, and optimal transfusion practice. To better understand the interplay between these factors on measures of red blood cell (RBC) transfusion efficacy, we conducted a linked analysis of blood donor and component data with patients who received single-unit RBC transfusions between 2008 and 2016. Hemoglobin levels before and after RBC transfusions and at 24- and 48-hour intervals after transfusion were analyzed. Generalized estimating equation linear regression models were fit to examine hemoglobin increments after RBC transfusion adjusting for donor and recipient demographic characteristics, collection method, additive solution, gamma irradiation, and storage duration. We linked data on 23 194 transfusion recipients who received one or more single-unit RBC transfusions (n = 38 019 units) to donor demographic and component characteristics. Donor and recipient sex, Rh-D status, collection method, gamma irradiation, recipient age and body mass index, and pretransfusion hemoglobin levels were significant predictors of hemoglobin increments in univariate and multivariable analyses (P < .01). For hemoglobin increments 24 hours after transfusion, the coefficient of determination for the generalized estimating equation models was 0.25, with an estimated correlation between actual and predicted values of 0.5. Collectively, blood donor demographic characteristics, collection and processing methods, and recipient characteristics accounted for significant variation in hemoglobin increments related to RBC transfusion. Multivariable modeling allows the prediction of changes in hemoglobin using donor-, component-, and patient-level characteristics. Accounting for these factors will be critical for future analyses of donor and component factors, including genetic polymorphisms, on posttransfusion increments and other patient outcomes.
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24
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Bouchard BA, Orfeo T, Keith HN, Lavoie EM, Gissel M, Fung M, Mann KG. Microparticles formed during storage of red blood cell units support thrombin generation. J Trauma Acute Care Surg 2019; 84:598-605. [PMID: 29251713 DOI: 10.1097/ta.0000000000001759] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Intact red blood cells (RBCs) appear to support thrombin generation in in vitro models of blood coagulation. During storage of RBC units, biochemical, structural, and physiological changes occur including alterations to RBC membranes and release of microparticles, which are collectively known as storage lesion. The clinical consequences of microparticle formation in RBC units are unclear. This study was performed to assess thrombin generation via the prothrombinase complex by washed RBCs and RBC-derived microparticles as a function of RBC unit age. METHODS Well-characterized kinetic and flow cytometric assays were used to quantify and characterize microparticles isolated from leukocyte-reduced RBC units during storage for 42 days under standard blood banking conditions. RESULTS Stored RBCs exhibited known features of storage lesion including decreasing pH, cell lysis, and release of microparticles demonstrated by scanning electron microscopy. The rate of thrombin formation by RBC units linearly increased during storage, with the microparticle fraction accounting for approximately 70% of the prothrombinase activity after 35 days. High-resolution flow cytometric analyses of microparticle isolates identified phosphatidylserine-positive RBC-derived microparticles; however, their numbers over time did not correlate with thrombin formation in that fraction. CONCLUSION Red blood cell-derived microparticles capable of supporting prothrombinase function accumulate during storage, suggesting an increased potential of transfused units as they age to interact in unplanned ways with ongoing hemostatic processes in injured individuals, especially given the standard blood bank practice of using the oldest units available.
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Affiliation(s)
- Beth A Bouchard
- From the Department of Biochemistry (B.A.B., T.O., H.N.K., E.M.L., M.G., K.G.M.), and Blood Bank and Transfusion Medicine, Department of Pathology (M.F.), The Larner College of Medicine at the University of Vermont, Burlington, Vermont
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25
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Zhao M, Zhou Q, He C, Zhang Y, Wang Z, Cai R, Ma C, Li Y, Wang X, Zhan L. Stored red blood cells enhance in vivo migration of dendritic cells by promoting reactive oxygen species-induced cytoskeletal rearrangement. Transfusion 2019; 59:1312-1323. [PMID: 30614543 DOI: 10.1111/trf.15123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 10/27/2018] [Accepted: 10/28/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND A complex array of physicochemical changes occurs in red blood cells (RBCs) during storage, leading to enhanced posttransfusion clearance. Dendritic cells (DCs) play crucial roles in the engulfment of aged RBCs; however, it is unclear how stored RBCs (sRBCs) modulate their responses to inflammatory stimuli and DC migration ability. STUDY DESIGN AND METHODS In this study, we examined whether sRBCs affect the migration ability of DCs and elucidated the detailed mechanisms mediating this process. Murine RBCs were incubated with marrow DCs after removing the storage supernatant. The effects of sRBCs on cytokine secretion from DCs, surface marker expression, and homing ability were examined. RESULTS More sRBCs were internalized by DCs than fresh RBCs (fRBCs), and RBC accumulation significantly promoted the expression of allostimulatory molecules and the secretion of Th1-type cytokines in the presence of lipopolysaccharide (LPS). In particular, the lymphoid-tissue homing ability of transfused DCs treated with sRBCs (sRBC-DCs) was also significantly greater than that of fRBCs. Up regulation of CCR7 and improved organization of the cytoskeleton were observed in sRBC-DCs, and blocking Rho/Rho-associated protein kinase (ROCK), PI3K/Akt, and NF-κB pathways greatly hindered cytoskeletal rearrangement. Moreover, high levels of reactive oxygen species (ROS) were detected in sRBC-DCs, and treatment with N-acetylcysteine simultaneously decreased the lymph node-homing ability of DCs and phosphorylation of RhoA, ROCK1, and cortactin. CONCLUSIONS sRBCs initiated differential immune responses compared to fRBCs, and the presence of LPS augmented this phenomenon. Up regulation of CCR7 and ROS production promotes cytoskeletal reorganization and contributes to the increased homing of sRBCs-DCs.
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Affiliation(s)
- Man Zhao
- Beijing Key Laboratory of Blood Safety and Security, Institute of Health Service and Transfusion Medicine, Beijing, P.R. China.,Department of Blood Transfusion, Chinese PLA General Hospital, Beijing, China
| | - Qianqian Zhou
- Beijing Key Laboratory of Blood Safety and Security, Institute of Health Service and Transfusion Medicine, Beijing, P.R. China
| | - Chulin He
- Beijing Key Laboratory of Blood Safety and Security, Institute of Health Service and Transfusion Medicine, Beijing, P.R. China
| | - Yulong Zhang
- Beijing Key Laboratory of Blood Safety and Security, Institute of Health Service and Transfusion Medicine, Beijing, P.R. China
| | - Zhengjun Wang
- Beijing Key Laboratory of Blood Safety and Security, Institute of Health Service and Transfusion Medicine, Beijing, P.R. China
| | - Ruiying Cai
- Beijing Key Laboratory of Blood Safety and Security, Institute of Health Service and Transfusion Medicine, Beijing, P.R. China
| | - Cong Ma
- Beijing Key Laboratory of Blood Safety and Security, Institute of Health Service and Transfusion Medicine, Beijing, P.R. China
| | - Yuan Li
- Beijing Key Laboratory of Blood Safety and Security, Institute of Health Service and Transfusion Medicine, Beijing, P.R. China
| | - Xiaohui Wang
- Beijing Key Laboratory of Blood Safety and Security, Institute of Health Service and Transfusion Medicine, Beijing, P.R. China
| | - Linsheng Zhan
- Beijing Key Laboratory of Blood Safety and Security, Institute of Health Service and Transfusion Medicine, Beijing, P.R. China.,Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
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26
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Koch CG, Duncan AI, Figueroa P, Dai L, Sessler DI, Frank SM, Ness PM, Mihaljevic T, Blackstone EH. Real Age: Red Blood Cell Aging During Storage. Ann Thorac Surg 2018; 107:973-980. [PMID: 30342044 DOI: 10.1016/j.athoracsur.2018.08.073] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/10/2018] [Accepted: 08/20/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND During cold storage, some red blood cell (RBC) units age more rapidly than others. Yet, the Food and Drug Administration has set a uniform storage limit of 42 days. Objectives of this review are to present evidence for an RBC storage lesion and suggest that functional measures of stored RBC quality-which we call real age-may be more appropriate than calendar age. METHODS During RBC storage, biochemical substances and byproducts accumulate and RBC shape alters. Factors that influence the rate of degradation include donor characteristics, bio-preservation conditions, and vesiculation. Better understanding of markers of RBC quality may lead to standardized, quantifiable, and operationally practical measures to improve donor selection, assess quality of an RBC unit, improve storage conditions, and test efficacy of the transfused product. RESULTS The conundrum is that clinical trials of younger versus older RBC units have not aligned with in vitro aging data; that is, the units transfused were not old enough. In vitro changes are considerable beyond 28 to 35 days, and average storage age for older transfused units was 14 to 21 days. CONCLUSIONS RBC product real age varies by donor characteristics, storage conditions, and biological changes during storage. Metrics to measure temporal changes in quality of the stored RBC product may be more appropriate than the 42-day expiration date. Randomized trials and observational studies are focused on average effect, but, in the evolving age of precision medicine, we must acknowledge that vulnerable populations and individuals may be harmed by aging blood.
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Affiliation(s)
- Colleen G Koch
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland.
| | - Andra I Duncan
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | | | - Lu Dai
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
| | - Steven M Frank
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| | - Paul M Ness
- Department of Transfusion Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| | - Tomislav Mihaljevic
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
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27
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28
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Khan SH, Devnani R, LaPradd M, Landrigan M, Gray A, Kelley A, Eckert GJ, Li X, Khan BA. Age of transfused red blood cells and health outcomes in two surgical cohorts. Heart Lung 2018; 48:131-137. [PMID: 30227992 DOI: 10.1016/j.hrtlng.2018.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/24/2018] [Accepted: 08/22/2018] [Indexed: 12/18/2022]
Abstract
RATIONALE Red blood cells (RBC) undergo morphologic and biochemical changes during storage which may lead to adverse health risks upon transfusion. In prior studies, the effect of RBC age on health outcomes has been conflicting. We designed the study to assess the effects of RBC units' storage duration on health outcomes specifically for hospitalized patients undergoing hip fracture surgery or coronary artery bypass grafting (CABG) surgery. METHODS Using International Classification of Diseases (ICD) 9 codes, hip fracture surgery and CABG surgery patients, who received RBC transfusions between 2008 and 2013, were retrospectively identified from the electronic medical records system. Hip fracture surgery and CABG cohorts were sub-divided into 3 blood age groups based upon RBC unit age at the time of transfusion: young blood (RBC units stored less than or equal to 14 days), old blood (RBC units were stored for greater than or equal to 28 days), or mixed blood for the remaining patients. Outcome variables were 30-day, 90-day, and inpatient mortality as well as hospital length of stay. RESULTS A total of 3,182 patients were identified: 1,121 with hip fractures and 2,061 with CABG. Transfusion of old blood was associated with higher inpatient mortality in the hip fracture surgery cohort (OR 166.8, 95% CI 1.067-26064.7, p = 0.04) and a higher 30-day mortality in the CABG cohort (OR 4.55, 95% CI 1.01-20.49, p = 0.03). CONCLUSIONS Transfusing RBC units stored for greater than or equal to 28 days may be associated with a higher mortality for patients undergoing hip fracture or CABG.
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Affiliation(s)
- Sikandar H Khan
- Indiana University School of Medicine, Department of Medicine, Indianapolis, IN, USA.
| | - Rohit Devnani
- Indiana University School of Medicine, Department of Medicine, Indianapolis, IN, USA
| | - Michelle LaPradd
- Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN, USA
| | | | - Alan Gray
- Zimmer Biomet Inc, Indianapolis, IN, USA
| | | | - George J Eckert
- Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN, USA
| | - Xiaochun Li
- Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN, USA
| | - Babar A Khan
- Indiana University School of Medicine, Department of Medicine, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA
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29
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Tzounakas VL, Valsami SI, Kriebardis AG, Papassideri IS, Seghatchian J, Antonelou MH. Red cell transfusion in paediatric patients with thalassaemia and sickle cell disease: Current status, challenges and perspectives. Transfus Apher Sci 2018; 57:347-357. [PMID: 29880248 DOI: 10.1016/j.transci.2018.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Notwithstanding the high safety level of the currently available blood for transfusion and the decreasing frequency of transfusion-related complications, administration of labile blood products to paediatric patients still poses unique challenges and considerations. The incidence of thalassaemia and sickle cell disease in the paediatric population may be high enough under specific racial and geographical contexts. Red cell transfusion is the cornerstone of β-thalassaemia treatment and one of the most effective ways to prevent or correct specific acute and chronic complications of sickle cell disease. However, this life-saving strategy comes with its own complications, such as additional iron overload, alloimmunization and haemolytic reactions, among others. In paediatrics, the dependency of the transfusion outcome upon disease and other recipient characteristics is more prominent compared with the adults, owing to differences in developmental maturity and physiology that render them more susceptible to common risks, exacerbate the host response to transfused cells, and modify the type or the clinical severity of the transfusion-related morbidity. The adverse branch of red cell transfusion is likely the overall effect of several factors acting synergistically to shape the clinical phenotype of this therapy, including inherent donor/blood unit variables, like antigenicity, red cell deformability and extracellular vesicles, as well as recipient variables, such as history of alloimmunization and inflammation level at time of transfusion. This review focuses on paediatric patients with β-thalassaemia and sickle cell disease as a recipient group with distinct transfusion-related characteristics, and introduces new concepts for consideration, not adequately studied and elucidated so far.
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Affiliation(s)
- Vassilis L Tzounakas
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Serena I Valsami
- Department of Blood Transfusion, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios G Kriebardis
- Department of Medical Laboratories, Technological and Educational Institute of Athens, Athens, Greece
| | - Issidora S Papassideri
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Jerard Seghatchian
- International Consultancy in Blood Component Quality/Safety Improvement, Audit/Inspection and DDR Strategy, London, UK.
| | - Marianna H Antonelou
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece.
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30
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Ng MSY, David M, Middelburg RA, Ng ASY, Suen JY, Tung JP, Fraser JF. Transfusion of packed red blood cells at the end of shelf life is associated with increased risk of mortality - a pooled patient data analysis of 16 observational trials. Haematologica 2018; 103:1542-1548. [PMID: 29794148 PMCID: PMC6119129 DOI: 10.3324/haematol.2018.191932] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 02/22/2018] [Indexed: 12/13/2022] Open
Abstract
Observational studies address packed red blood cell effects at the end of shelf life and have larger sample sizes compared to randomized control trials. Meta-analyses combining data from observational studies have been complicated by differences in aggregate transfused packed red blood cell age and outcome reporting. This study abrogated these issues by taking a pooled patient data approach. Observational studies reporting packed red blood cell age and clinical outcomes were identified and patient-level data sets were sought from investigators. Odds ratios and 95% confidence intervals for binary outcomes were calculated for each study, with mean packed red blood cell age or maximum packed red blood cell age acting as independent variables. The relationship between mean packed red blood cell age and hospital length of stay for each paper was analyzed using zero-inflated Poisson regression. Random effects models combined paper-level effect estimates. Extremes analyses were completed by comparing patients transfused with mean packed red blood cell aged less than ten days to those transfused with mean packed red blood cell aged at least 30 days. sixteen datasets were available for pooled patient data analysis. Mean packed red blood cell age of at least 30 days was associated with an increased risk of in-hospital mortality compared to mean packed red blood cell of less than ten days (odds ratio: 3.25, 95% confidence interval: 1.27–8.29). Packed red blood cell age was not correlated to increased risks of nosocomial infection or prolonged length of hospital stay.
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Affiliation(s)
- Monica S Y Ng
- Critical Care Research Group, Faculty of Medicine, University of Queensland, Brisbane, Australia .,Research and Development, Australian Red Cross Blood Service, Brisbane, Australia
| | - Michael David
- School of Medicine and Population Health, The University of Newcastle, Callaghan, Australia
| | - Rutger A Middelburg
- Centre for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands
| | - Angela S Y Ng
- Critical Care Research Group, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Jacky Y Suen
- Critical Care Research Group, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - John-Paul Tung
- Critical Care Research Group, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Research and Development, Australian Red Cross Blood Service, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, Faculty of Medicine, University of Queensland, Brisbane, Australia
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Red blood cells ageing markers: a multi-parametric analysis. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018; 15:239-248. [PMID: 28518051 DOI: 10.2450/2017.0318-16] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/05/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Red blood cells collected in citrate-phosphate-dextrose can be stored for up to 42 days at 4 °C in saline-adenine-glucose-mannitol additive solution. During this controlled, but nevertheless artificial, ex vivo ageing, red blood cells accumulate lesions that can be reversible or irreversible upon transfusion. The aim of the present study is to follow several parameters reflecting cell metabolism, antioxidant defences, morphology and membrane dynamics during storage. MATERIALS AND METHODS Five erythrocyte concentrates were followed weekly during 71 days. Extracellular glucose and lactate concentrations, total antioxidant power, as well as reduced and oxidised intracellular glutathione levels were quantified. Microvesiculation, percentage of haemolysis and haematologic parameters were also evaluated. Finally, morphological changes and membrane fluctuations were recorded using label-free digital holographic microscopy. RESULTS The antioxidant power as well as the intracellular glutathione concentration first increased, reaching maximal values after one and two weeks, respectively. Irreversible morphological lesions appeared during week 5, where discocytes began to transform into transient echinocytes and finally spherocytes. At the same time, the microvesiculation and haemolysis started to rise exponentially. After six weeks (expiration date), intracellular glutathione was reduced by 25%, reflecting increasing oxidative stress. The membrane fluctuations showed decreased amplitudes during shape transition from discocytes to spherocytes. DISCUSSION Various types of lesions accumulated at different chemical and cellular levels during storage, which could impact their in vivo recovery after transfusion. A marked effect was observed after four weeks of storage, which corroborates recent clinical data. The prolonged follow-up period allowed the capture of deep storage lesions. Interestingly, and as previously described, the severity of the changes differed among donors.
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Barshtein G, Arbell D, Yedgar S. Hemodynamic Functionality of Transfused Red Blood Cells in the Microcirculation of Blood Recipients. Front Physiol 2018; 9:41. [PMID: 29441026 PMCID: PMC5797635 DOI: 10.3389/fphys.2018.00041] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/11/2018] [Indexed: 01/23/2023] Open
Abstract
The primary goal of red blood cell (RBC) transfusion is to supply oxygen to tissues and organs. However, due to a growing number of studies that have reported negative transfusion outcomes, including reduced blood perfusion, there is rising concern about the risks in blood transfusion. RBC are characterized by unique flow-affecting properties, specifically adherence to blood vessel wall endothelium, cell deformability, and self-aggregability, which define their hemodynamic functionality (HF), namely their potential to affect blood circulation. The role of the HF of RBC in blood circulation, particularly the microcirculation, has been documented in numerous studies with animal models. These studies indicate that the HF of transfused RBC (TRBC) plays an important role in the transfusion outcome. However, studies with animal models must be interpreted with reservations, as animal physiology may not reflect human physiology. To test this concept in humans, we have directly examined the effect of the HF of TRBC, as expressed by their deformability and adherence to vascular endothelium, on the transfusion-induced effect on the skin blood flow and hemoglobin increment in β-thalassemia major patients. The results demonstrated, for the first time in humans, that the TRBC HF is a potent effector of the transfusion outcome, expressed by the transfusion-induced increase in the recipients' hemoglobin level, and the change in the skin blood flow, indicating a link between the microcirculation and the survival of TRBC in the recipients' vascular system. The implication of these findings for blood transfusion practice and to vascular function in blood recipients is discussed.
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Affiliation(s)
- Gregory Barshtein
- Department of Biochemistry, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Dan Arbell
- Department of Pediatric Surgery, Hadassah University Hospital, Jerusalem, Israel
| | - Saul Yedgar
- Department of Biochemistry, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Reisz JA, Tzounakas VL, Nemkov T, Voulgaridou AI, Papassideri IS, Kriebardis AG, D'Alessandro A, Antonelou MH. Metabolic Linkage and Correlations to Storage Capacity in Erythrocytes from Glucose 6-Phosphate Dehydrogenase-Deficient Donors. Front Med (Lausanne) 2018; 4:248. [PMID: 29376053 PMCID: PMC5768619 DOI: 10.3389/fmed.2017.00248] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 12/19/2017] [Indexed: 12/16/2022] Open
Abstract
Objective In glucose 6-phosphate dehydrogenase (G6PD) deficiency, decreased NADPH regeneration in the pentose phosphate pathway and subnormal levels of reduced glutathione result in insufficient antioxidant defense, increased susceptibility of red blood cells (RBCs) to oxidative stress, and acute hemolysis following exposure to pro-oxidant drugs and infections. Despite the fact that redox disequilibrium is a prominent feature of RBC storage lesion, it has been reported that the G6PD-deficient RBCs store well, at least in respect to energy metabolism, but their overall metabolic phenotypes and molecular linkages to the storability profile are scarcely investigated. Methods We performed UHPLC-MS metabolomics analyses of weekly sampled RBC concentrates from G6PD sufficient and deficient donors, stored in citrate phosphate dextrose/saline adenine glucose mannitol from day 0 to storage day 42, followed by statistical and bioinformatics integration of the data. Results Other than previously reported alterations in glycolysis, metabolomics analyses revealed bioactive lipids, free fatty acids, bile acids, amino acids, and purines as top variables discriminating RBC concentrates for G6PD-deficient donors. Two-way ANOVA showed significant changes in the storage-dependent variation in fumarate, one-carbon, and sulfur metabolism, glutathione homeostasis, and antioxidant defense (including urate) components in G6PD-deficient vs. sufficient donors. The levels of free fatty acids and their oxidized derivatives, as well as those of membrane-associated plasticizers were significantly lower in G6PD-deficient units in comparison to controls. By using the strongest correlations between in vivo and ex vivo metabolic and physiological parameters, consecutively present throughout the storage period, several interactomes were produced that revealed an interesting interplay between redox, energy, and hemolysis variables, which may be further associated with donor-specific differences in the post-transfusion performance of G6PD-deficient RBCs. Conclusion The metabolic phenotypes of G6PD-deficient donors recapitulate the basic storage lesion profile that leads to loss of metabolic linkage and rewiring. Donor-related issues affect the storability of RBCs even in the narrow context of this donor subgroup in a way likely relevant to transfusion medicine.
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Affiliation(s)
- Julie A Reisz
- Department of Biochemistry and Molecular Genetics, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Vassilis L Tzounakas
- Department of Biology, School of Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Travis Nemkov
- Department of Biochemistry and Molecular Genetics, School of Medicine, University of Colorado, Aurora, CO, United States
| | | | - Issidora S Papassideri
- Department of Biology, School of Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios G Kriebardis
- Department of Medical Laboratories, Faculty of Health and Caring Professions, Technological and Educational Institute of Athens, Athens, Greece
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Marianna H Antonelou
- Department of Biology, School of Science, National and Kapodistrian University of Athens, Athens, Greece
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Affiliation(s)
- Aryeh Shander
- From the *Department of Anesthesiology, Critical Care and Hyperbaric Medicine and TeamHealth Research Institute, †Institute for Patient Blood Management and Bloodless Medicine and Surgery, and ‡The Lefcourt Family Cancer Treatment and Wellness Center and Departments of Surgical Oncology and Hepatobiliary Surgery, Englewood Hospital and Medical Center, Englewood, New Jersey
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Seghatchian J, Goubran H. Transfusion and alternatives therapeutic support for oncology patients with hematological problems: “Are we doing more harm than benefit”? Transfus Apher Sci 2017. [DOI: 10.1016/j.transci.2017.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Goubran H, Seghatchian J, Radosevic J, Ragab G, Burnouf T. The microbiome and transfusion in cancer patients. Transfus Apher Sci 2017. [DOI: 10.1016/j.transci.2017.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Goubran H, Sheridan D, Radosevic J, Burnouf T, Seghatchian J. Transfusion-related immunomodulation and cancer. Transfus Apher Sci 2017; 56:336-340. [PMID: 28606449 DOI: 10.1016/j.transci.2017.05.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Blood and blood-component therapy triggers immunological reactions in recipients. Transfusion-related immunomodulation [TRIM] is an important complex biological immune reaction to transfusion culminating in immunosuppression. The mechanisms underlying TRIM include the presence of residual leukocytes and apoptotic cells, the transfusion of immunosuppressive cytokines either present in donor components or generated during blood processing, the transfer of metabolically active growth factor-loaded microparticles and extracellular vesicles and the presence of free hemoglobin or extracellular vesicle-bound hemoglobin. TRIM variables include donor-specific factors as well as processing variables. TRIM may explain, at least in part, the controversial negative clinical outcomes observed in cancer patients receiving transfusion in the context of curative-intent surgeries. The use of novel technologies including metabolomics and proteomics on stored blood may pave the way for a deeper understanding of TRIM in general and its impact on cancer progression.
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Affiliation(s)
- Hadi Goubran
- Saskatoon Cancer Centre and College of Medicine, University of Saskatchewan, Saskatchewan, Canada.
| | - David Sheridan
- Saskatoon Cancer Centre and College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | | | - Thierry Burnouf
- Graduate Institute of Biological Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection and DDR Strategies, London, UK.
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Tzounakas VL, Seghatchian J, Grouzi E, Kokoris S, Antonelou MH. Red blood cell transfusion in surgical cancer patients: Targets, risks, mechanistic understanding and further therapeutic opportunities. Transfus Apher Sci 2017. [PMID: 28625825 DOI: 10.1016/j.transci.2017.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Anemia is present in more than half of cancer patients and appears to be an independent prognostic factor of short- and long-term adverse outcomes. It increases in the advanced period of cancer and perioperatively, in patients with solid tumors who undergo surgery. As a result, allogeneic red blood cell (RBC) transfusion is an indispensable treatment in cancer. However, its safety remains controversial, based on several laboratory and clinical data reporting a linkage with increased risk for cancer recurrence, infection and cancer-related mortality. Immunological, inflammatory and thrombotic reactions mediated by the residual leukocytes and platelets, the stored RBCs per se, the biological response modifiers and the plasticizer of the unit may underlie infection and tumor-promoting effects. Although the causality between transfusion and infection has been established, the effects of transfusion on cancer recurrence remain confusing; this is mainly due to the extreme biological heterogeneity that characterizes RBC donations and cancer context. In fact, the functional interplay between donation-associated factors and recipient characteristics, including tumor biology per se, inflammation, infection, coagulation and immune activation state and competence may synergistically and individually define the clinical impact of each transfusion in any given cancer patient. Our understanding of how the potential risk is mediated is important to make RBC transfusion safer and to pave the way for novel, promising and highly personalized strategies for the treatment of anemia in surgical cancer patients.
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Affiliation(s)
- Vassilis L Tzounakas
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Jerard Seghatchian
- International Consultancy in Blood Component Quality/Safety Improvement, Audit/Inspection and DDR Strategy, London, UK.
| | - Elissavet Grouzi
- Department of Transfusion Service and Clinical Hemostasis, "Saint Savvas" Oncology Hospital, Athens, Greece
| | - Styliani Kokoris
- Department of Blood Transfusion, Medical School, "Attikon" General Hospital, NKUA, Athens, Greece
| | - Marianna H Antonelou
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece.
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García-Roa M, del Carmen Vicente-Ayuso M, Bobes AM, Pedraza AC, González-Fernández A, Martín MP, Sáez I, Seghatchian J, Gutiérrez L. Red blood cell storage time and transfusion: current practice, concerns and future perspectives. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 15:222-231. [PMID: 28518049 PMCID: PMC5448828 DOI: 10.2450/2017.0345-16] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 12/24/2016] [Indexed: 12/25/2022]
Abstract
Red blood cells (RBCs) units are the most requested transfusion product worldwide. Indications for transfusion include symptomatic anaemia, acute sickle cell crisis, and acute blood loss of more than 30% of the blood volume, with the aim of restoring tissue oxygen delivery. However, stored RBCs from donors are not a qualitative equal product, and, in many ways, this is a matter of concern in the transfusion practice. Besides donor-to-donor variation, the storage time influences the RBC unit at the qualitative level, as RBCs age in the storage bag and are exposed to the so-called storage lesion. Several studies have shown that the storage lesion leads to post-transfusion enhanced clearance, plasma transferrin saturation, nitric oxide scavenging and/or immunomodulation with potential unwanted transfusion-related clinical outcomes, such as acute lung injury or higher mortality rate. While, to date, several studies have claimed the risk or deleterious effects of "old" vs "young" RBC transfusion regimes, it is still a matter of debate, and consideration should be taken of the clinical context. Transfusion-dependent patients may benefit from transfusion with "young" RBC units, as it assures longer inter-transfusion periods, while transfusion with "old" RBC units is not itself harmful. Unbiased Omics approaches are being applied to the characterisation of RBC through storage, to better understand the (patho)physiological role of microparticles (MPs) that are found naturally, and also on stored RBC units. Perhaps RBC storage time is not an accurate surrogate for RBC quality and there is a need to establish which parameters do indeed reflect optimal efficacy and safety. A better Omics characterisation of components of "young" and "old" RBC units, including MPs, donor and recipient, might lead to the development of new therapies, including the use of engineered RBCs or MPs as cell-based drug delivering tools, or cost-effective personalised transfusion strategies.
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Affiliation(s)
- María García-Roa
- Department of Hematology, “Instituto de Investigación Sanitaria San Carlos” (IdISSC), “Hospital Clínico San Carlos”, Madrid, Spain
| | - María del Carmen Vicente-Ayuso
- Department of Hematology, “Instituto de Investigación Sanitaria San Carlos” (IdISSC), “Hospital Clínico San Carlos”, Madrid, Spain
| | - Alejandro M. Bobes
- Department of Hematology, “Instituto de Investigación Sanitaria San Carlos” (IdISSC), “Hospital Clínico San Carlos”, Madrid, Spain
| | - Alexandra C. Pedraza
- Department of Hematology, “Instituto de Investigación Sanitaria San Carlos” (IdISSC), “Hospital Clínico San Carlos”, Madrid, Spain
| | - Ataúlfo González-Fernández
- Department of Hematology, “Instituto de Investigación Sanitaria San Carlos” (IdISSC), “Hospital Clínico San Carlos”, Madrid, Spain
| | - María Paz Martín
- Department of Hematology, “Instituto de Investigación Sanitaria San Carlos” (IdISSC), “Hospital Clínico San Carlos”, Madrid, Spain
| | - Isabel Sáez
- ”Servicio de Hematología y Hemoterapia”, “Hospital Clínico San Carlos”, Madrid, Spain
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement and DDR Strategy, London, United Kingdom
| | - Laura Gutiérrez
- Department of Hematology, “Instituto de Investigación Sanitaria San Carlos” (IdISSC), “Hospital Clínico San Carlos”, Madrid, Spain
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Cumulative erythrocyte damage in blood storage and relevance to massive transfusions: selective insights into serial morphological and biochemical findings. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 15:348-356. [PMID: 28488957 DOI: 10.2450/2017.0312-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/09/2017] [Indexed: 01/22/2023]
Abstract
Elucidating the precise mechanisms of cumulative red cell damages during storage and the potential harmful consequences after transfusion are achievable by exacting laboratory science and well-defined clinical studies in progress. Accordingly, for larger magnitude blood transfusions (i.e. 8-12 U in 24 hours), the quality of the stored blood and its characterisation are of special academic and clinical importance. Our main objectives in this review are to illuminate facets of the red cell storage lesion for prolonged storage (0-42 days) by concentrating on various hallmarks of the disorder: 1) identifying and characterising serial markers of the progressive lesion with respect to red cell dysmorphology, deformability, haemolytic fragility and dysfunction both in storage and the microcirculation; and 2) relevant biochemical findings of redox status correlated to oxidative stress of erythrocyte proteins. This is accomplished in part by reliance on advanced metabolomic and proteomic technologies using various sophisticated tools such as high pressure liquid chromatography in combination with mass spectrometry of proteins and small molecule metabolites. It is anticipated that these sophisticated methodologies and the experimental results therein shall lead to further advances in the quality improvement of red cell storage.
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Seghatchian J. Evolving concepts of the RBC storage lesion using Omics and other novel diagnostic tools. Transfus Apher Sci 2017; 56:245-247. [PMID: 28363590 DOI: 10.1016/j.transci.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Jerard Seghatchian
- International Consultancy in Blood Components Quality and Safety Improvement, Audit/Inspection & DDR Strategies, London, UK.
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