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Baek J, Kim S. Effects of Transfusion of Stored Red Blood Cells on Renal Ischemia-Reperfusion–Induced Hepatic Injury in Rats. Transplant Proc 2023; 55:629-636. [PMID: 37005156 DOI: 10.1016/j.transproceed.2023.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/26/2023] [Accepted: 02/24/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Renal ischemia-reperfusion (IR) injures the liver as well as the kidneys. Transfusion of stored red blood cells (RBCs) triggers inflammatory responses, oxidative stress, and activation of innate immunity. In the present study, we investigated the effect of transfusion of stored RBCs on renal IR-induced hepatic injury. METHODS Sprague-Dawley rats were randomly divided into 3 groups based on the following treatments: rats subjected to sham operation (sham group), rats subjected to the induction of renal IR only (RIR group), and rats transfused with stored RBCs 1 hour after the start of reperfusion (RIR-TF group). Renal ischemia was induced for 1 hour, and reperfusion was allowed for 24 hours. After reperfusion, blood and liver tissue samples were obtained. RESULTS Serum levels of aspartate and alanine aminotransferase were increased in the RIR-TF group compared with those in the RIR and sham groups. The hepatic mRNA expression levels of heme oxygenase-1 and neutrophil gelatinase-associated lipocalin were increased in the RIR-TF group compared with those in the RIR and sham groups. The mRNA expression level of high mobility group box-1 was also increased in the RIR-TF group compared with that in the RIR group. CONCLUSION The transfusion of stored RBCs exacerbates renal IR-induced liver damage. Oxidative stress may be responsible for hepatic injury.
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Hann A, Nutu A, Clarke G, Patel I, Sneiders D, Oo YH, Hartog H, Perera MTPR. Normothermic Machine Perfusion—Improving the Supply of Transplantable Livers for High-Risk Recipients. Transpl Int 2022; 35:10460. [PMID: 35711320 PMCID: PMC9192954 DOI: 10.3389/ti.2022.10460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022]
Abstract
The effectiveness of liver transplantation to cure numerous diseases, alleviate suffering, and improve patient survival has led to an ever increasing demand. Improvements in preoperative management, surgical technique, and postoperative care have allowed increasingly complicated and high-risk patients to be safely transplanted. As a result, many patients are safely transplanted in the modern era that would have been considered untransplantable in times gone by. Despite this, more gains are possible as the science behind transplantation is increasingly understood. Normothermic machine perfusion of liver grafts builds on these gains further by increasing the safe use of grafts with suboptimal features, through objective assessment of both hepatocyte and cholangiocyte function. This technology can minimize cold ischemia, but prolong total preservation time, with particular benefits for suboptimal grafts and surgically challenging recipients. In addition to more physiological and favorable preservation conditions for grafts with risk factors for poor outcome, the extended preservation time benefits operative logistics by allowing a careful explant and complicated vascular reconstruction when presented with challenging surgical scenarios. This technology represents a significant advancement in graft preservation techniques and the transplant community must continue to incorporate this technology to ensure the benefits of liver transplant are maximized.
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Affiliation(s)
- Angus Hann
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Centre for Liver and Gastrointestinal Research and NIHR Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Anisa Nutu
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - George Clarke
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Centre for Liver and Gastrointestinal Research and NIHR Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Ishaan Patel
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Dimitri Sneiders
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Ye H. Oo
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Centre for Liver and Gastrointestinal Research and NIHR Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Hermien Hartog
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - M. Thamara P. R. Perera
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Centre for Liver and Gastrointestinal Research and NIHR Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: M. Thamara P. R. Perera,
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Abstract
BACKGROUND Erythrocyte transfusions are independently associated with acute kidney injury. Kidney injury may be consequent to the progressive hematologic changes that develop during storage. This study therefore tested the hypothesis that prolonged erythrocyte storage increases posttransfusion acute kidney injury. METHODS The Informing Fresh versus Old Red Cell Management (INFORM) trial randomized 31,497 patients to receive either the freshest or oldest available matching erythrocyte units and showed comparable mortality with both. This a priori substudy compared the incidence of posttransfusion acute kidney injury in the randomized groups. Acute kidney injury was defined by the creatinine component of the Kidney Disease: Improving Global Outcomes criteria. RESULTS The 14,461 patients included in this substudy received 40,077 erythrocyte units. For patients who received more than one unit, the mean age of the blood units was used as the exposure. The median of the mean age of blood units transfused per patient was 11 days [interquartile range, 8, 15] in the freshest available blood group and 23 days [interquartile range, 17, 30] in the oldest available blood group. In the primary analysis, posttransfusion acute kidney injury was observed in 688 of 4,777 (14.4%) patients given the freshest available blood and 1,487 of 9,684 (15.4%) patients given the oldest available blood, with an estimated relative risk (95% CI) of 0.94 (0.86 to 1.02; P = 0.132). The secondary analysis treated blood age as a continuous variable (defined as duration of storage in days), with an estimated relative risk (95% CI) of 1.00 (0.96 to 1.04; P = 0.978) for a 10-day increase in the mean age of erythrocyte units. CONCLUSIONS In a population of patients without severely impaired baseline renal function receiving fewer than 10 erythrocyte units, duration of blood storage had no effect on the incidence of posttransfusion acute kidney injury. EDITOR’S PERSPECTIVE
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Albagshi MH, Saad M, Aljassem AM, Bushehab AA, Ahmed NH, Alabbad MM, Omer N, Alhamad OA, Sultan TA, Bahgat S. Blood Demand and Challenges for Patients With Beta-Thalassemia Major in Eastern Saudi Arabia. Cureus 2021; 13:e17470. [PMID: 34603865 PMCID: PMC8475924 DOI: 10.7759/cureus.17470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 01/19/2023] Open
Abstract
Background β-thalassemia major is a hereditary disorder of hemoglobin (Hb) that results in defective Hb synthesis, leading to severe chronic anemia. The mainstay of its treatment is lifelong regular packed red cell transfusions associated with iron-chelating therapy. Globally, there is a gap between blood donation and the actual needs of the patients who depend on transfusion. Patients with β-thalassemia major are no exception and have limited access to regular and safe blood transfusions. This study aimed to assess the gap between the demand and supply of blood for transfusion-dependent patients with β-thalassemia major treated at the Hereditary Blood Diseases Center, Al Ahsa, Eastern Saudi Arabia. Methodology This was a retrospective, cross-sectional study conducted at the Hereditary Blood Disease Center, Al Ahsa, Saudi Arabia, including patient data from January 2017 to December 2019. We used Excel 365 from Microsoft Office 2016, version 1706. Results A total of 158 patients were on chronic transfusion. Of the total patients, 65% were adults, while the remaining 35% comprised the pediatric population. The total number of units requested and received during the three-year period was 14,509 and 9,530, respectively, indicating a gap of 4,979 (34%) units. The age of most of the units received was more than 14 days: 36% of those in 2017, 49.9% in 2018, and 61.5% in 2019. Rare blood groups and alloimmunization accounted for <8% of the patients. Prestorage filtration was the policy for all units. Conclusions There was a gap between the demand and supply of blood for patients with β-thalassemia major treated at our center. We suggest raising awareness regarding the high demands for fresh red blood cell components in patients with thalassemia major, encouraging voluntary blood donations, enhancing national blood-banking policies, and reducing the fragmentation of blood services to reduce the gap between demand and supply.
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Affiliation(s)
- Muneer H Albagshi
- Pediatric Hematology, Hereditary Blood Diseases Center, Al Ahsa, SAU
| | - Mona Saad
- Internal Medicine/Hematology, Hereditary Blood Diseases Center, Al Ahsa, SAU
| | | | | | - Noura H Ahmed
- Pediatrics, Hereditary Blood Diseases Center, Al Ahsa, SAU
| | | | - Nawal Omer
- Internal Medicine, Hereditary Blood Diseases Center, Al Ahsa, SAU
| | - Osama A Alhamad
- Medical Affairs, Hereditary Blood Diseases Center, Al Ahsa, SAU
| | - Tarig A Sultan
- Integrative Medicine, Hereditary Blood Diseases Center, Al Ahsa, SAU
| | - Samy Bahgat
- Blood Bank, Maternity and Children Hospital, Al Ahsa, SAU
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5
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Nunes Neto OG, de Alencar Silva TS, Sousa RS, Morini AC, Pinto GAS, de Oliveira FLC, Ortolani EL, Portela JM, Barrêto Júnior RA, Minervino AHH. Biochemical and blood gas alterations in buffalo (Bubalus bubalis) whole blood stored in CPDA-1 and CPD/SAG-M bags. J Vet Emerg Crit Care (San Antonio) 2021; 31:269-273. [PMID: 33709630 DOI: 10.1111/vec.13053] [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: 04/04/2019] [Revised: 07/30/2019] [Accepted: 08/24/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the biochemical and blood gas alterations of whole blood of buffaloes that was stored in citrate-phosphate-dextrose with adenine (CPDA-1) and CPD/SAG-M blood bags for 42 days. DESIGN Prospective study. INTERVENTIONS Ten male buffaloes were used in this study. A total volume of 900 mL of blood was collected from each buffalo so that 450 mL was stored in CPDA-1 and 450 mL was stored in CPD/SAG-M bags at 2-6°C for 42 days. The stored blood was evaluated at 7 time points (D): D0 (immediately after blood collection) and 7 (D7), 14 (D14), 21 (D21), 28 (D28), 35 (D35), and 42 (D42) days after collection. Blood gas, biochemical, and microbiological parameters were monitored. MEASUREMENTS AND MAIN RESULTS The overall blood pH decreased from 6.997 ± 0.05 at D0 to 6.784 ± 0.09 at D42, differing from baseline from D14 onward (P < 0.05). There were increases in partial pressure of oxygen (pO2 ), partial pressure of carbon dioxide (pCO2 ), lactate, and potassium (K) and decreases in the concentrations of sodium, bicarbonate, glucose, and pH (P < 0.05) during storage in both bags but no alterations in total protein concentration. Most of the variables were consistently similar between the 2 types of blood bags (P > 0.05) evaluated, with the exception of pCO2 , HCO3, cholesterol, and total protein, which had higher values in the CPDA-1 bag (P < 0.05). The K, pO2 , and lactate had the highest alterations during storage, with increases from baseline to D42 of 563%, 317%, and 169%, respectively. CONCLUSION In general, no significant changes of clinical importance were observed after storage of whole blood samples from buffaloes for 42 days in the 2 types of blood bags that are indicated for use with this species.
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Affiliation(s)
- Osvaldo Gato Nunes Neto
- Laboratory of Animal Health (LARSANA), Federal University of Western Pará (UFOPA), Santarém, Brazil
| | | | - Rejane Santos Sousa
- Department of Clinical Science, College of Veterinary Medicine and Animal Science, University of Sao Paulo (FMVZ/USP), São Paulo, Brazil
| | - Adriana Caroprezo Morini
- Laboratory of Animal Health (LARSANA), Federal University of Western Pará (UFOPA), Santarém, Brazil
| | | | | | - Enrico Lippi Ortolani
- Department of Clinical Science, College of Veterinary Medicine and Animal Science, University of Sao Paulo (FMVZ/USP), São Paulo, Brazil
| | - Juliana Machado Portela
- Laboratory of Animal Health (LARSANA), Federal University of Western Pará (UFOPA), Santarém, Brazil
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Poppe A, Moritz E, Geffken M, Schreiber J, Greiwe G, Amschler K, Wruck M, Schwedhelm E, Daum G, Kluge S, Peine S, Winkler MS. Analyses of sphingosine‐1‐phosphate in the context of transfusion: how much is in stored blood products and in patient blood? Transfusion 2019; 59:3071-3076. [DOI: 10.1111/trf.15494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Annika Poppe
- Clinic and Policlinic for Anesthesiology and Intensive Care MedicineUniversity Medicine Rostock Rostock Germany
| | - Eileen Moritz
- Institute of Pharmacology, Department of General PharmacologyUniversity Medicine Greifswald Greifswald Germany
| | - Maria Geffken
- Institute of Transfusion MedicineUniversity Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Joerg Schreiber
- Center for Anesthesiology, Intensive Care Medicine, Pain Therapy and Palliative MedicineBenedictus Krankenhaus Tutzing Tutzing Germany
| | - Gillis Greiwe
- Center for Anesthesiology and Intensive Care MedicineUniversity Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Katharina Amschler
- Department of Allergology and VenerologyUniversity Medicine Göttingen Göttingen Germany
| | - Marie‐Louise Wruck
- Center for Anesthesiology and Intensive Care MedicineUniversity Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Edzard Schwedhelm
- Institute of Clinical Pharmacology and ToxicologyUniversity Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Günter Daum
- Clinic and Policlinic for Vascular MedicineUniversity Heart Center, University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Stefan Kluge
- Center for Anesthesiology and Intensive Care MedicineUniversity Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Sven Peine
- Institute of Transfusion MedicineUniversity Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Martin Sebastian Winkler
- Center for Anesthesiology and Intensive Care MedicineUniversity Medical Center Hamburg‐Eppendorf Hamburg Germany
- Department of Anesthesiology and Intensive Care MedicineUniversity Medicine Göttingen Göttingen Germany
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7
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An evaluation of methods for producing low-titer group O whole blood to support military trauma resuscitation. J Trauma Acute Care Surg 2019; 82:S79-S86. [PMID: 28328675 DOI: 10.1097/ta.0000000000001437] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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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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9
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Abstract
PURPOSE OF REVIEW In this review, we discuss the latest updates on perioperative acute kidney injury (AKI) and the specific considerations that are relevant to different surgeries and patient populations. RECENT FINDINGS AKI diagnosis is constantly evolving. New biomarkers detect AKI early and shed a light on the possible cause of AKI. Hypotension, even for a short duration, is associated with perioperative AKI. The debate on the deleterious effects of chloride-rich solutions is still far from conclusion. Remote ischemic preconditioning is showing promising results in the possible prevention of perioperative AKI. No definite data show a beneficiary effect of statins, fenoldepam, or sodium bicarbonate in preventing AKI. SUMMARY Perioperative AKI is prevalent and associated with significant morbidity and mortality. Considering the lack of effective preventive or therapeutic interventions, this review focuses on perioperative AKI: measures for early diagnosis, defining risks and possible mechanisms, and summarizing current knowledge for intraoperative fluid and hemodynamic management to reduce risk of AKI.
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10
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Green RS, Erdogan M, Lacroix J, Hébert PC, Tinmouth AT, Sabri E, Zhang T, Fergusson DA, Turgeon AF. Age of transfused blood in critically ill adult trauma patients: a prespecified nested analysis of the Age of Blood Evaluation randomized trial. Transfusion 2018; 58:1846-1854. [PMID: 29672869 DOI: 10.1111/trf.14640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/02/2018] [Accepted: 03/02/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Blood transfusion is common in the resuscitation of patients with traumatic injury. However, the clinical impact of the length of storage of transfused blood is unclear in this population. STUDY DESIGN AND METHODS We undertook a prespecified nested analysis of 372 trauma victims of the 2510 critically ill patients from 64 centers treated as part of the Age of Blood Evaluation (ABLE) randomized controlled trial. Patients were randomized according to their trauma status to receive either a transfusion of fresh blood stored not more than 7 days or standard-issue blood. Our primary outcome was 90-day all-cause mortality. RESULTS Overall, 186 trauma patients received fresh blood and 186 received standard-issue blood. Adherence to transfusion protocol was 94% (915/971) for all fresh blood transfused and 100% (753/753) for all standard-issue blood transfused. Mean ± SD blood storage duration was 5.6 ± 3.8 days in the fresh group and 22.7 ± 8.4 days in the standard-issue group (p < 0.001). Ninety-day mortality in the fresh group was 21% (38/185), compared to 16% (29/184) in the standard-issue group, with an unadjusted absolute risk difference of 5% (95% confidence interval [CI], -3.1 to 12.6) and an adjusted absolute risk difference of 2% (95% CI, -3.5 to 6.8). CONCLUSION In critically ill trauma patients, transfusion of fresh blood did not decrease 90-day mortality or secondary outcomes, a finding similar to the overall population of the ABLE trial.
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Affiliation(s)
- Robert S Green
- Department of Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada.,Trauma Nova Scotia, NS Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Mete Erdogan
- Trauma Nova Scotia, NS Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Jacques Lacroix
- Department of Pediatrics, Division of Critical Care Medicine, Université de Montréal, Centre Hospitalier Universitaire (CHU) Sainte Justine
| | - Paul C Hébert
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Alan T Tinmouth
- Departments of Medicine and Laboratory Medicine & Pathology, University of Ottawa, Ottawa, Ontario, Canada
| | - Elham Sabri
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Tinghua Zhang
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alexis F Turgeon
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec City, Quebec, Canada.,Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Quebec, Canada
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11
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Preoperative Anemia in Cardiac Operation: Does Hemoglobin Tell the Whole Story? Ann Thorac Surg 2018; 105:100-107. [DOI: 10.1016/j.athoracsur.2017.06.074] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 06/05/2017] [Accepted: 06/28/2017] [Indexed: 01/26/2023]
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12
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Huang H, Liu B, Wu G, Xu G, Sun BD, Gao YQ. Hematological Risk Factors for High-Altitude Headache in Chinese Men Following Acute Exposure at 3,700 m. Front Physiol 2017; 8:801. [PMID: 29089901 PMCID: PMC5651045 DOI: 10.3389/fphys.2017.00801] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/29/2017] [Indexed: 12/20/2022] Open
Abstract
Background: High-altitude headache (HAH) is a notably common disorder affecting the daily life of travelers ascending to high altitude. Hematological parameters are important clinical examinations for various diseases. Today, hematological characteristics of HAH remain unrevealed. Above all, we aimed to ascertain hematological characteristics and independent risk factors/predictors associated with HAH before and after exposure at 3,700 m. Methods: Forty five healthy men were enrolled in present study. Demographic and clinical data, physiological and hematological parameters were collected 3 days before the ascent and after acute exposure at 3,700 m. Results: HAH patients featured significantly lower white blood cell count (WBC), neutrophil count (NEU#) and percentage (NEU%), and higher percentage of lymphocyte (LYM%) at 3,700 m and significantly lower NEU#, reticulocyte count (RET#) and percentage (RET%) at sea level (all P < 0.05). HAH severity was significantly and negatively associated with WBC, NEU#, and NEU% at 3,700 m and RET# at sea level, whereas was positively associated with LYM% at 3,700 m (all P < 0.05). Moreover, we have found that RET# at sea level and NEU% at 3,700 m was an independent predictor and risk factor for HAH, respectively. Conclusion: The present study is the first to examine the hematological characteristics of HAH. Furthermore, lower RET# at sea level and lower NEU% at 3,700 m is a novel independent predictor and risk factor for HAH, respectively.
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Affiliation(s)
- He Huang
- Institute of Medicine and Hygienic Equipment for High Altitude Region, College of High Altitude Military Medicine, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Third Military Medical University, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Medicine, Chinese People's Liberation Army, Chongqing, China
| | - Bao Liu
- Institute of Medicine and Hygienic Equipment for High Altitude Region, College of High Altitude Military Medicine, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Third Military Medical University, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Medicine, Chinese People's Liberation Army, Chongqing, China.,The 12th Hospital of Chinese People's Liberation Army, Kashi Xinjiang, China
| | - Gang Wu
- Institute of Medicine and Hygienic Equipment for High Altitude Region, College of High Altitude Military Medicine, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Third Military Medical University, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Medicine, Chinese People's Liberation Army, Chongqing, China
| | - Gang Xu
- Institute of Medicine and Hygienic Equipment for High Altitude Region, College of High Altitude Military Medicine, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Third Military Medical University, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Medicine, Chinese People's Liberation Army, Chongqing, China
| | - Bing-Da Sun
- Institute of Medicine and Hygienic Equipment for High Altitude Region, College of High Altitude Military Medicine, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Third Military Medical University, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Medicine, Chinese People's Liberation Army, Chongqing, China
| | - Yu-Qi Gao
- Institute of Medicine and Hygienic Equipment for High Altitude Region, College of High Altitude Military Medicine, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Third Military Medical University, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Medicine, Chinese People's Liberation Army, Chongqing, China
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13
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Meersch M, Volmering S, Zarbock A. Prevention of acute kidney injury. Best Pract Res Clin Anaesthesiol 2017; 31:361-370. [DOI: 10.1016/j.bpa.2017.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/03/2017] [Indexed: 01/07/2023]
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14
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Red Cell Storage Duration Does Not Affect Outcome after Massive Blood Transfusion in Trauma and Nontrauma Patients: A Retrospective Analysis of 305 Patients. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3718615. [PMID: 28589139 PMCID: PMC5446873 DOI: 10.1155/2017/3718615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/23/2017] [Accepted: 04/05/2017] [Indexed: 02/05/2023]
Abstract
Background Prolonged storage of packed red blood cells (PRBCs) may increase morbidity and mortality, and patients having massive transfusion might be especially susceptible. We therefore tested the hypothesis that prolonged storage increases mortality in patients receiving massive transfusion after trauma or nontrauma surgery. Secondarily, we considered the extent to which storage effects differ for trauma and nontrauma surgery. Methods We considered surgical patients given more than 10 units of PRBC within 24 hours and evaluated the relationship between mean PRBC storage duration and in-hospital mortality using multivariable logistic regression. Potential nonlinearities in the relationship were assessed via restricted cubic splines. The secondary hypothesis was evaluated by considering whether there was an interaction between the type of surgery (trauma versus nontrauma) and the effect of storage duration on outcomes. Results 305 patients were given a total of 8,046 units of PRBCs, with duration ranging from 8 to 36 days (mean ± SD: 22 ± 6 days). The odds ratio [95% confidence interval (CI)] for in-hospital mortality corresponding to a one-day in mean PRBC storage duration was 0.99 (0.95, 1.03, P = 0.77). The relationship did not differ for trauma and nontrauma patients (P = 0.75). Results were similar after adjusting for multiple potential confounders. Conclusions Mortality after massive blood transfusion was no worse in patients transfused with PRBC stored for long periods. Trauma and nontrauma patients did not differ in their susceptibility to prolonged PRBC storage.
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16
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Abstract
Increasing evidence supports the existence of a close relationship between immunotransfusion, hemostasis, and thrombosis. The best example of such linkage is given by the influence of the ABO blood group antigens on von Willebrand factor (VWF) plasma levels and activity. It is well known, for instance, that individuals with non-O blood type (i.e., A, B, and AB) have higher VWF and factor VIII plasma levels than O blood type subjects and are consequently exposed to an increased thrombotic risk. There is also a close relationship between immunotransfusion, hemostasis, and thrombosis testing. The first part of this narrative review is dedicated to the issue of the relationship between immunotransfusion, hemostasis, and thrombosis, while the second part is focused on the relationship between immunotransfusion and hemostasis and thrombosis testing, as well as the effects on hemostasis of the transfusion of blood components (i.e., red blood cells, platelet concentrates, and fresh frozen plasma) and plasma-derived products.
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Caram-Deelder C, Kreuger AL, Jacobse J, van der Bom JG, Middelburg RA. Effect of platelet storage time on platelet measurements: a systematic review and meta-analyses. Vox Sang 2016; 111:374-382. [DOI: 10.1111/vox.12443] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/06/2016] [Accepted: 07/14/2016] [Indexed: 12/29/2022]
Affiliation(s)
- C. Caram-Deelder
- Center for Clinical Transfusion Research; Sanquin Research; Leiden The Netherlands
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden The Netherlands
| | - A. L. Kreuger
- Center for Clinical Transfusion Research; Sanquin Research; Leiden The Netherlands
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden The Netherlands
| | - J. Jacobse
- Center for Clinical Transfusion Research; Sanquin Research; Leiden The Netherlands
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden The Netherlands
| | - J. G. van der Bom
- Center for Clinical Transfusion Research; Sanquin Research; Leiden The Netherlands
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden The Netherlands
| | - R. A. Middelburg
- Center for Clinical Transfusion Research; Sanquin Research; Leiden The Netherlands
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden The Netherlands
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Chapin J, Terry HS, Kleinert D, Laurence J. The role of complement activation in thrombosis and hemolytic anemias. Transfus Apher Sci 2016; 54:191-8. [PMID: 27156108 DOI: 10.1016/j.transci.2016.04.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this study was to describe complement activation in hemostatic and pathologic states of coagulation and in the acquired and congenital hemolytic anemias. METHODS AND RESULTS We review published and emerging data on the involvement of the classic, alternative and lectin-based complement pathways in coagulation and the hemolytic anemias. The alternative pathway in particular is always "on," at low levels, and is particularly sensitive to hyper-activation in a variety of physiologic and pathologic states including infection, autoimmune disorders, thrombosis and pregnancy, requiring tight control predicated on a variety of soluble and membrane bound regulatory proteins. In acquired hemolytic anemias such as paroxysmal nocturnal hemoglobinuria (PNH) and cold agglutinin disease (CAD), the complement system directly induces red blood cell injury, resulting in intravascular and extravascular hemolysis. In congenital hemolytic anemias such as sickle cell disease and β-thalassemia, the complement system may also contribute to thrombosis and vascular disease. Complement activation may also lead to a storage lesion in red blood cells prior to transfusion. CONCLUSION Complement pathways are activated in hemolytic anemias and are closely linked with thrombosis. In acquired disorders such as PNH and possibly CAD, inhibition of the alternative complement pathway improves clinical outcomes and reduces thrombosis risk. Whether complement inhibition has a similar role in congenital hemolytic anemias apart from the atypical hemolytic-uremic (aHUS)-type thrombotic microangiopathies remains to be determined.
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Affiliation(s)
- John Chapin
- Department of Medicine, Division of Hematology-Oncology, Weill Cornell Medicine-New York Presbyterian, New York, NY, USA.
| | - Hunter S Terry
- Department of Medicine, Division of Hematology-Oncology, Weill Cornell Medicine-New York Presbyterian, New York, NY, USA
| | - Dorothy Kleinert
- Department of Medicine, Division of Hematology-Oncology, Weill Cornell Medicine-New York Presbyterian, New York, NY, USA
| | - Jeffrey Laurence
- Department of Medicine, Division of Hematology-Oncology, Weill Cornell Medicine-New York Presbyterian, New York, NY, USA
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Abstract
Objective: Blood transfusion saves lives but may also increase the risk of injury. The objective of this review was to evaluate the possible adverse effects related to transfusion of red blood cell (RBC) concentrates stored for prolonged periods. Data Sources: The data used in this review were mainly from PubMed articles published in English up to February 2015. Study Selection: Clinical and basic research articles were selected according to their relevance to this topic. Results: The ex vivo changes to RBC that occur during storage are collectively called storage lesion. It is still inconclusive if transfusion of RBC with storage lesion has clinical relevance. Multiple ongoing prospective randomized controlled trials are aimed to clarify this clinical issue. It was observed that the adverse events related to stored RBC transfusion were prominent in certain patient populations, including trauma, critical care, pediatric, and cardiac surgery patients, which leads to the investigation of underlying mechanisms. It is demonstrated that free hemoglobin toxicity, decreasing of nitric oxide bioavailability, and free iron-induced increasing of inflammation may play an important role in this process. Conclusion: It is still unclear whether transfusion of older RBC has adverse effects, and if so, which factors determine such clinical effects. However, considering the magnitude of transfusion and the widespread medical significance, potential preventive strategies should be considered, especially for the susceptible recipients.
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Affiliation(s)
| | - Li-Ze Xiong
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
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20
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Dekker AM, Wiggers JK, Coelen RJ, van Golen RF, Besselink MG, Busch OR, Verheij J, Hollmann MW, van Gulik TM. Perioperative blood transfusion is not associated with overall survival or time to recurrence after resection of perihilar cholangiocarcinoma. HPB (Oxford) 2016; 18:262-70. [PMID: 27017166 PMCID: PMC4814620 DOI: 10.1016/j.hpb.2015.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 08/31/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Perioperative blood transfusions have been associated with worse oncological outcome in several types of cancer. The objective of this study was to assess the effect of perioperative blood transfusions on time to recurrence and overall survival (OS) in patients who underwent curative-intent resection of perihilar cholangiocarcinoma (PHC). METHODS This retrospective cohort study included consecutive patients with resected PHC between 1992 and 2013 in a specialized center. Patients with 90-day mortality after surgery were excluded. Patients who did and did not receive perioperative blood transfusions were compared using univariable Kaplan-Meier analysis and multivariable Cox regression. RESULTS Of 145 included patients, 80 (55.2%) received perioperative blood transfusions. The median OS was 49 months for patients without and 41 months for patients with blood transfusions (P = 0.46). In risk-adjusted multivariable Cox regression analysis, blood transfusion was not associated with OS (HR 1.00, 95% CI 0.59-1.68, P = 0.99) or time to recurrence (HR 1.00, 95% CI 0.57-1.78, P = 0.99). In addition, no differences in effect were found between different types of blood products transfused. CONCLUSION Blood transfusion was not associated with survival or time to recurrence after curative resection of PHC in this series. The alleged association is presumably related to the circumstances necessitating blood transfusions.
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Affiliation(s)
- Annemiek M. Dekker
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Jimme K. Wiggers
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Robert J. Coelen
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Rowan F. van Golen
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Marc G.H. Besselink
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Olivier R.C. Busch
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Joanne Verheij
- Department of Pathology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Markus W. Hollmann
- Department of Anaesthesiology, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Thomas M. van Gulik
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands,Correspondence T.M. van Gulik, AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Kawase H, Egi M, Kanazawa T, Shimizu K, Toda Y, Iwasaki T, Morita K. Storage duration of transfused red blood cells is not significantly associated with postoperative adverse events in pediatric cardiac surgery patients. Transfus Apher Sci 2016; 54:111-6. [PMID: 26856639 DOI: 10.1016/j.transci.2016.01.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/29/2015] [Accepted: 01/20/2016] [Indexed: 01/08/2023]
Abstract
The aim of this study was to evaluate the association of storage duration of transfused red blood cells with the risk of postoperative serious adverse events in pediatric cardiac surgery patients. We studied 517 patients and found that 22 patients (4.3%) had at least one serious adverse event. The maximum and mean storage duration of transfused red blood cells did not differ significantly between patients with and without serious adverse events (maximum, p = 0.89; mean, p = 0.81). In our study of pediatric cardiac surgery patients, the storage duration of transfused red blood cells was not significantly associated with the risk of serious adverse events.
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Affiliation(s)
- Hirokazu Kawase
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama 700-8558, Japan
| | - Moritoki Egi
- Department of Anesthesiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo 650-0017, Japan.
| | - Tomoyuki Kanazawa
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama 700-8558, Japan
| | - Kazuyoshi Shimizu
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama 700-8558, Japan
| | - Yuichiro Toda
- Department of Anesthesiology and Intensive Care Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama 701-0192, Japan
| | - Tatsuo Iwasaki
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama 700-8558, Japan
| | - Kiyoshi Morita
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama 700-8558, Japan
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Sowers N, Froese PC, Erdogan M, Green RS. Impact of the age of stored blood on trauma patient mortality: a systematic review. Can J Surg 2015; 58:335-42. [PMID: 26384149 DOI: 10.1503/cjs.011314] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The impact of the age of stored red blood cells on mortality in patients sustaining traumatic injuries requiring transfusion of blood products is unknown. The objective of this systematic review was to identify and describe the available literature on the use of older versus newer blood in trauma patient populations. METHODS We searched PubMed, Embase, Lilac and the Cochrane Database for published studies comparing the transfusion of newer versus older red blood cells in adult patients sustaining traumatic injuries. Studies included for review reported on trauma patients receiving transfusions of packed red blood cells, identified the age of stored blood that was transfused and reported patient mortality as an end point. We extracted data using a standardized form and assessed study quality using the Newcastle-Ottawa Scale. RESULTS Seven studies were identified (6780 patients) from 3936 initial search results. Four studies reported that transfusion of older blood was independently associated with increased mortality in trauma patients, while 3 studies did not observe any increase in patient mortality with the use of older versus newer blood. Three studies associated the transfusion of older blood with adverse patient outcomes, including longer stay in the intensive care unit, complicated sepsis, pneumonia and renal dysfunction. Studies varied considerably in design, volumes of blood transfused and definitions applied for old and new blood.. CONCLUSION The impact of the age of stored packed red blood cells on mortality in trauma patients is inconclusive. Future investigations are warranted.
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Affiliation(s)
- Nicholas Sowers
- From the Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada (Sowers, Froese, Green); the Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada (Green); and Trauma Nova Scotia, Halifax, NS, Canada (Erdogan, Green)
| | - Patrick C Froese
- From the Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada (Sowers, Froese, Green); the Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada (Green); and Trauma Nova Scotia, Halifax, NS, Canada (Erdogan, Green)
| | - Mete Erdogan
- From the Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada (Sowers, Froese, Green); the Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada (Green); and Trauma Nova Scotia, Halifax, NS, Canada (Erdogan, Green)
| | - Robert S Green
- From the Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada (Sowers, Froese, Green); the Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada (Green); and Trauma Nova Scotia, Halifax, NS, Canada (Erdogan, Green)
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24
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Peters AL, van Bruggen R, de Korte D, Van Noorden CJ, Vlaar AP. Glucose-6-phosphate dehydrogenase activity decreases during storage of leukoreduced red blood cells. Transfusion 2015; 56:427-32. [DOI: 10.1111/trf.13378] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/10/2015] [Accepted: 09/10/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Anna L. Peters
- Laboratory of Experimental Intensive Care and Anesthesia/Intensive Care; Academic Medical Centre
| | - Robin van Bruggen
- Department of Blood Cell Research; Sanquin Blood Bank; Amsterdam the Netherlands
| | - Dirk de Korte
- Department of Blood Cell Research; Sanquin Blood Bank; Amsterdam the Netherlands
- Department Product and Process Development; Sanquin Blood Bank; Amsterdam the Netherlands
| | | | - Alexander P.J. Vlaar
- Laboratory of Experimental Intensive Care and Anesthesia/Intensive Care; Academic Medical Centre
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25
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Patterson JA, Irving DO, Isbister JP, Morris JM, Mayson E, Roberts CL, Ford JB. Age of blood and adverse outcomes in a maternity population. Transfusion 2015; 55:2730-7. [PMID: 26177784 DOI: 10.1111/trf.13230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/01/2015] [Accepted: 06/04/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND In recent times there has been debate around whether longer storage time of blood is associated with increased rates of adverse outcomes after transfusion. It is unclear whether results focused on cardiac or critically ill patients apply to a maternity population. This study investigates whether older blood is associated with increased morbidity and readmission in women undergoing obstetric transfusion. STUDY DESIGN AND METHODS Women giving birth in hospitals in New South Wales, Australia, between July 2006 and December 2010 were included in the study population if they had received between 1 and 4 red blood cell units during the birth admission. Information on women's characteristics, transfusions, and outcomes were obtained from five routinely collected data sets including blood collection, birth, and hospitalization data. Generalized propensity score methods were used to determine the effect of age of blood on rates of severe morbidity and readmission, independent of confounding factors. RESULTS Transfusion data were available for 2990 women, with a median age of blood transfused of 20 days (interquartile range, 14-27 days). There were no differences in the maximum age of blood transfused between women with and without severe morbidity (21 [14-28] days vs. 22 [15-30] days) and in women readmitted or not (22 [14-28] days vs. 22 [16-30] days). After potential confounding factors were considered, no relationship was found between the age of blood transfused and rates of severe morbidity and readmission. CONCLUSION Among women receiving low-volume transfusions during a birth admission, there was no evidence of increased rates of adverse outcomes after transfusion with older blood.
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Affiliation(s)
- Jillian A Patterson
- Clinical and Population Perinatal Health, Kolling Institute, University of Sydney, Sydney
| | - David O Irving
- Research and Development, Australian Red Cross Blood Service, Melbourne
| | - James P Isbister
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Jonathan M Morris
- Clinical and Population Perinatal Health, Kolling Institute, University of Sydney, Sydney
| | - Eleni Mayson
- Clinical and Population Perinatal Health, Kolling Institute, University of Sydney, Sydney
| | - Christine L Roberts
- Clinical and Population Perinatal Health, Kolling Institute, University of Sydney, Sydney
| | - Jane B Ford
- Clinical and Population Perinatal Health, Kolling Institute, University of Sydney, Sydney
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26
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Martí‐Carvajal AJ, Simancas‐Racines D, Peña‐González BS. Prolonged storage of packed red blood cells for blood transfusion. Cochrane Database Syst Rev 2015; 2015:CD009330. [PMID: 26171902 PMCID: PMC11055608 DOI: 10.1002/14651858.cd009330.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND A blood transfusion is an acute intervention, used to address life- and health-threatening conditions on a short-term basis. Packed red blood cells are most often used for blood transfusion. Sometimes blood is transfused after prolonged storage but there is continuing debate as to whether transfusion of 'older' blood is as beneficial as transfusion of 'fresher' blood. OBJECTIVES To assess the clinical benefits and harms of prolonged storage of packed red blood cells, in comparison with fresh, on recipients of blood transfusion. SEARCH METHODS We ran the search on 1st May 2014. We searched the Cochrane Injuries Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (OvidSP), Embase (OvidSP), CINAHL (EBSCO Host) and two other databases. We also searched clinical trials registers and screened reference lists of the retrieved publications and reviews. We updated this search in June 2015 but these results have not yet been incorporated. SELECTION CRITERIA Randomised clinical trials including participants assessed as requiring red blood cell transfusion were eligible for inclusion. Prolonged storage was defined as red blood cells stored for ≥ 21 days in a blood bank. We did not apply limits regarding the duration of follow-up, or country where the study took place. We excluded trials where patients received a combination of short- and long-stored blood products, and also trials without a clear definition of prolonged storage. DATA COLLECTION AND ANALYSIS We independently performed study selection, risk of bias assessment and data extraction by at least two review authors. The major outcomes were death from any cause, transfusion-related acute lung injury, and adverse events. We estimated relative risk for dichotomous outcomes. We measured statistical heterogeneity using I(2). We used a random-effects model to synthesise the findings. MAIN RESULTS We identified three randomised clinical trials, involving a total of 120 participants, comparing packed red blood cells with ≥ 21 days storage ('prolonged' or 'older') versus packed red blood cells with < 21 days storage ('fresh'). We pooled data to assess the effect of prolonged storage on death from any cause. The confidence in the results from these trials was very low, due to the bias in their design and their limited sample sizes.The estimated effect of packed red blood cells with ≥ 21 days storage versus packed red blood cells with < 21 days storage for the outcome death from any cause was imprecise (5/45 [11.11%] versus 2/46 [4.34%]; RR 2.36; 95% CI 0.65 to 8.52; I(2): 0%, P = 0.26, very low quality of evidence). Trial sequential analysis, with only two trials, shows that we do not yet have convincing evidence that older packed red blood cells induce a 20% relative risk reduction of death from any cause compared with fresher packed red blood cells. No trial included other outcomes of interest specified in this review, namely transfusion-related acute lung injury, postoperative infections, and adverse events. The safety profile is unknown. AUTHORS' CONCLUSIONS Recognising the limitations of the review, relating to the size and nature of the included trials, this Cochrane Review provides no evidence to support or reject the use of packed red blood cells for blood transfusion which have been stored for ≥ 21 days ('prolonged' or 'older') compared with those stored for < 21 days ('fresh'). These results are based on three small single centre trials with high risks of bias. There is insufficient evidence to determine the effects of fresh or older packed red blood cells for blood transfusion. Therefore, we urge readers to interpret the trial results with caution. The results from four large ongoing trials will help to inform future updates of this review.
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Affiliation(s)
| | - Daniel Simancas‐Racines
- Universidad Tecnológica EquinoccialFacultad de Ciencias de la Salud Eugenio EspejoAvenida República de El Salvador 733 y PortugalEdificio Gabriela 3. Of. 403Quito (Pichincha)PichinchaEcuadorCasilla Postal 17‐17‐525
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Mittag D, Sran A, Chan KS, Boland MP, Bandala-Sanchez E, Huet O, Xu W, Sparrow RL. Stored red blood cell susceptibility to in vitro transfusion-associated stress conditions is higher after longer storage and increased by storage in saline-adenine-glucose-mannitol compared to AS-1. Transfusion 2015; 55:2197-206. [PMID: 25968419 DOI: 10.1111/trf.13138] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 02/23/2015] [Accepted: 02/28/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Biochemical changes induced in red blood cells (RBCs) during storage may impair their function upon transfusion. Transfusion-associated stresses may further amplify storage lesion effects including increased phosphatidylserine (PS) exposure at the RBC membrane, microparticle (MP) release, and adhesion to endothelial cells (ECs). RBC stress susceptibility in vitro was investigated in relation to storage time and additive solution. STUDY DESIGN AND METHODS Leukoreduced whole blood donations (n = 18) were paired, mixed, and resplit before separating the RBCs for storage in saline-adenine-glucose-mannitol (SAGM) or AS-1. Samples were taken after 3, 21, or 35 days. For oxidative stress treatment, RBCs were exposed to 0.5 mmol/L tert-butylhydroperoxide. Transfusion-associated stress was simulated by overnight culture at 37 °C with plasma containing inflammatory mediators. PS exposure and MPs were measured by flow cytometry and adhesion to ECs was tested under flow conditions. PS specificity of adhesion was tested by blocking with PS-containing lipid vesicles. RESULTS Oxidative stress induced significantly higher PS exposure and adhesion to ECs in RBCs stored for 35 days compared to 3 days (p < 0.04). PS-containing vesicles blocked RBC-EC adhesion. After overnight culture with or without plasma, PS exposure and EC adhesion were significantly increased (p < 0.05). MP numbers increased with longer RBC storage and after RBC culture with plasma. Culture conditions influenced MP numbers from Day 35 RBCs. RBCs stored in SAGM had significantly higher PS exposure after stress treatment than AS-1 RBCs (p < 0.02). CONCLUSION Storage for 35 days significantly increased RBC susceptibility to oxidative and in vitro transfusion-associated stresses and was higher for RBCs stored in SAGM compared to AS-1.
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Affiliation(s)
- Diana Mittag
- formerly Research and Development, Australian Red Cross Blood Service, West Melbourne, Victoria, Australia
| | - Amrita Sran
- formerly Research and Development, Australian Red Cross Blood Service, West Melbourne, Victoria, Australia
| | - Kasey S Chan
- formerly Research and Development, Australian Red Cross Blood Service, West Melbourne, Victoria, Australia
| | - Martin P Boland
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Esther Bandala-Sanchez
- Department of Medical Biology, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Olivier Huet
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria
| | - William Xu
- formerly Research and Development, Australian Red Cross Blood Service, West Melbourne, Victoria, Australia
| | - Rosemary L Sparrow
- formerly Research and Development, Australian Red Cross Blood Service, West Melbourne, Victoria, Australia.,Department of Immunology, Monash University, Melbourne, Victoria, Australia
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28
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Hansen AL, Kurach JDR, Turner TR, Jenkins C, Busch MP, Norris PJ, Dugger J, Tomasulo PA, Devine DV, Acker JP. The effect of processing method on the in vitro characteristics of red blood cell products. Vox Sang 2015; 108:350-8. [PMID: 25678039 DOI: 10.1111/vox.12233] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/28/2014] [Accepted: 11/13/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES While the clinical impact of differences in red blood cell (RBC) component processing methods is unknown, there are concerns they may be confounding variables in studies such as the ongoing 'age of blood' investigations. Here, we compare the in vitro characteristics of red cell concentrates (RCCs) produced by several different processing methods. MATERIALS AND METHODS Nine processing methods were examined: three apheresis methods (Alyx, MCS+ and Trima), as well as leucoreduced whole blood-derived RCCs produced by buffy coat and whole blood filtration and non-leucoreduced RCCs. RCCs were stored in saline-adenine-glucose-mannitol or additive solutions (AS) 1 or 3 for 42 days, with quality tested on day 5 and day 42. RESULTS Many significant product differences were observed both early in and at the end of storage. Mean haemoglobin (Hb) ranged from 52 to 71 g/unit and mean Hct from 59·5 to 64·8%. Most RCC passed regulated quality control criteria according to Canadian Standards Association guidelines, although there were some failures relating to Hb content and residual WBC counts. CONCLUSION Processing method impacts RCC characteristics throughout storage; better understanding of these differences and reporting of processing method details is critical.
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Affiliation(s)
- A L Hansen
- Canadian Blood Services, Centre for Innovation, Edmonton, AB, Canada
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29
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Transfusion de concentrés globulaires en réanimation : moins, c’est mieux ! MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-014-1015-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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30
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D'Alessandro A, Nemkov T, Kelher M, West FB, Schwindt RK, Banerjee A, Moore EE, Silliman CC, Hansen KC. Routine storage of red blood cell (RBC) units in additive solution-3: a comprehensive investigation of the RBC metabolome. Transfusion 2014; 55:1155-68. [PMID: 25556331 DOI: 10.1111/trf.12975] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/08/2014] [Accepted: 11/10/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND In most countries, red blood cells (RBCs) can be stored up to 42 days before transfusion. However, observational studies have suggested that storage duration might be associated with increased morbidity and mortality. While clinical trials are under way, impaired metabolism has been documented in RBCs stored in several additive solutions (ASs). Here we hypothesize that, despite reported beneficial effects, storage in AS-3 results in metabolic impairment weeks before the end of the unit shelf life. STUDY DESIGN AND METHODS Five leukofiltered AS-3 RBC units were sampled before, during, and after leukoreduction Day 0 and then assayed on a weekly basis from storage Day 1 through Day 42. RBC extracts and supernatants were assayed using a ultra-high-performance liquid chromatography separations coupled online with mass spectrometry detection metabolomics workflow. RESULTS Blood bank storage significantly affects metabolic profiles of RBC extracts and supernatants by Day 14. In addition to energy and redox metabolism impairment, intra- and extracellular accumulation of amino acids was observed proportionally to storage duration, suggesting a role for glutamine and serine metabolism in aging RBCs. CONCLUSION Metabolomics of stored RBCs could drive the introduction of alternative ASs to address some of the storage-dependent metabolic lesions herein reported, thereby increasing the quality of transfused RBCs and minimizing potential links to patient morbidity.
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Affiliation(s)
- Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Rani K Schwindt
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Anirban Banerjee
- Department of Surgery, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado.,Denver Health Medical Center, Denver, Colorado
| | - Ernest E Moore
- Department of Surgery, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado.,Denver Health Medical Center, Denver, Colorado
| | - Christopher C Silliman
- Department of Surgery, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado.,Department of Pediatrics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado.,Research Laboratory, Bonfils Blood Center, Denver, Colorado
| | - Kirk C Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
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Iyer SS, Shah J. Red blood cell transfusion strategies and Maximum surgical blood ordering schedule. Indian J Anaesth 2014; 58:581-9. [PMID: 25535420 PMCID: PMC4260304 DOI: 10.4103/0019-5049.144660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Blood transfusion is one of the practices that is in vogue because it expands blood volume and purportedly improves the oxygen carrying capacity. Despite this supposed physiological benefit, paradoxically, both anaemia and transfusion are independently associated with organ injury and increased morbidity. Historically, transfusion was used to maintain blood haemoglobin concentration above 10 g/dL and a haematocrit above 30%. There is now a greater emphasis on interventions to reduce the use of transfusion as it is a scarce and expensive resource with many serious adverse effects. Institutional maximum surgical blood ordering schedule algorithm developed with data analysis and consensus of surgeons, anaesthesiologists and blood banks can reduce the overuse of blood. A PubMed search was performed with search words/combination of words 'erythrocyte transfusion, adverse effects, economics, mortality, therapy, therapeutic use and utilisation'. Search yielded a total of 1541 articles that were screened for clinical relevance for the purpose of this review.
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Affiliation(s)
- Shivakumar S Iyer
- Department of Critical Care, Bharati Vidyapeeth University Medical College, Pune, Maharashtra, India
| | - Jignesh Shah
- Department of Critical Care, Bharati Vidyapeeth University Medical College, Pune, Maharashtra, India
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Shander A, Javidroozi M. Apples, oranges, and autotransfusion techniques. Transfusion 2014; 54:2132-3. [PMID: 25130333 DOI: 10.1111/trf.12721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Aryeh Shander
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ.
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Abstract
Many clinical settings are associated with haemolysis, from rare conditions, such as paroxysmal nocturnal haemoglobinuria, to common interventions, such as mechanical circulatory support and blood transfusion. The toxic effects of circulating free haemoglobin, haem, and iron are becoming increasingly understood and include an increased risk of thrombotic complications. This review summarizes the epidemiological evidence for an association between haemolysis and thrombosis and explores potential underlying mechanisms. New insights into the role haem plays in inflammatory signalling and in generating neutrophil extracellular traps (NETs) may provide useful strategies for managing pathological states associated with severe haemolysis. A better understanding of the toxic effects of haemolysis will result in better therapies to prevent the side effect of thrombosis.
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Affiliation(s)
- Camilla L'Acqua
- Department of Medical-Surgical Pathophysiology and Organ Transplantation, Università degli Studi di Milano, Milan, Italy; Columbia University Medical Center - New York Presbyterian Hospital, New York, NY, USA
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Classic and alternative red blood cell storage strategies: seven years of "-omics" investigations. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 13:21-31. [PMID: 25369599 DOI: 10.2450/2014.0053-14] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/13/2014] [Indexed: 12/12/2022]
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D'Alessandro A, Kriebardis AG, Rinalducci S, Antonelou MH, Hansen KC, Papassideri IS, Zolla L. An update on red blood cell storage lesions, as gleaned through biochemistry and omics technologies. Transfusion 2014; 55:205-19. [DOI: 10.1111/trf.12804] [Citation(s) in RCA: 227] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/18/2014] [Accepted: 06/18/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics; University of Colorado Denver-Anschutz Medical Campus; Aurora Colorado
| | - Anastasios G. Kriebardis
- Department of Medical Laboratories, Faculty of Health and Caring Professions; Technological Educational Institute of Athens; Athens Greece
| | - Sara Rinalducci
- Department of Ecological and Biological Sciences; University of Tuscia; Viterbo Italy
| | - Marianna H. Antonelou
- Department of Cell Biology and Biophysics; Faculty of Biology; University of Athens; Athens Greece
| | - Kirk C. Hansen
- Department of Biochemistry and Molecular Genetics; University of Colorado Denver-Anschutz Medical Campus; Aurora Colorado
| | - Issidora S. Papassideri
- Department of Cell Biology and Biophysics; Faculty of Biology; University of Athens; Athens Greece
| | - Lello Zolla
- Department of Ecological and Biological Sciences; University of Tuscia; Viterbo Italy
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Babaev A, Pozzi F, Hare G, Zhang H. Storage of Red Blood Cells and Transfusion-Related Acute Lung Injury. ACTA ACUST UNITED AC 2014; 1. [PMID: 28066804 DOI: 10.15406/jaccoa.2014.01.00002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Transfusion-related acute lung injury (TRALI) is a major complication post-transfusion. A consensus definition of TRALI has been recently established to improve diagnosis but the pathogenesis of TRALI is yet to be understood. Although the antibody-mediated two-hit model of TRALI is the classical narrative, increasing evidence of the probable implications of prolonged storage of blood provides novel mechanisms towards storage lesion- the potentially injurious cellular and biochemical changes that occur in stored red blood cells. Red blood cell-derived lipids and micro vesicles may have been playing an important role in the development of TRALI. This article will provide a brief overview of the current understanding of TRALI and then discuss the implications and the potential mechanisms by which stored red blood cells may lead to TRALI.
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Affiliation(s)
- Arkady Babaev
- Department of Anesthesia and Department of Physiology, University of Toronto, Canada
| | - Federico Pozzi
- Department of Anesthesia and Department of Physiology, University of Toronto, Canada
| | - Gregory Hare
- Department of Anesthesia and Department of Physiology, University of Toronto, Canada
| | - Haibo Zhang
- Department of Anesthesia and Department of Physiology, University of Toronto, Canada
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Hemmings HC, Wlody D, Mahajan R, Webster NR. 2013 BJA/PGA Special Issue: a selection of nine educational reviews. Br J Anaesth 2014; 111 Suppl 1:i1-2. [PMID: 24335394 DOI: 10.1093/bja/aet403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- H C Hemmings
- Editor, British Journal of Anaesthesia, Co-Editor, 2013 BJA/PGA Supplement, New York, NY, USA
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Kiamanesh D, Rumley J, Moitra VK. Monitoring and managing hepatic disease in anaesthesia. Br J Anaesth 2014; 111 Suppl 1:i50-61. [PMID: 24335399 DOI: 10.1093/bja/aet378] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Patients with liver disease have multisystem organ dysfunction that leads to physiological perturbations ranging from hyperbilirubinaemia of no clinical consequence to severe coagulopathy and metabolic disarray. Patient-specific risk factors, clinical scoring systems, and surgical procedures stratify perioperative risk for these patients. The anaesthetic management of patients with hepatic dysfunction involves consideration of impaired drug metabolism, hyperdynamic circulation, perioperative hypoxaemia, bleeding, thrombosis, and hepatic encephalopathy.
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Affiliation(s)
- D Kiamanesh
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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