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Riley BC, Phuong J, Hasan RA, Stansbury LG, Hess JR, Roubik DJ. Expired blood transfusion and mortality outcomes in combat trauma patients. Transfusion 2024. [PMID: 38965905 DOI: 10.1111/trf.17943] [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: 05/21/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Expired blood can be transfused if clinically indicated but outcome data do not exist. We hypothesized that modestly outdated blood can effectively support a hemorrhaging patient until surgical control is achieved. This study assessed whether expired blood was associated with mortality in combat trauma patients. STUDY DESIGN AND METHODS A retrospective analysis of Armed Services Blood Program and Department of Defense Trauma Registry databases evaluated combat casualty records (2001-2023). The intervention of interest was transfusion of at least one unit of whole blood (WB), red blood cells (RBC), or platelets within one week past expiration. The outcome of interest was mortality at discharge. A control cohort that only received in-date blood was matched to the treatment cohort for logistic regression analysis. RESULTS One hundred patients received expired RBCs (86), WB (11), and platelets (3). Mortality at discharge was 11.6% for expired RBC recipients and 13.4% for the control cohort (p = .97). After adjustment for injury severity, expired RBCs were not associated with mortality (OR = 0.40 [95% CI, 0.14-1.16]; p = .09). Of 10 patients who received the most expired RBCs by volume or storage duration, two were deceased at discharge. All 14 expired WB and platelet recipients were alive at discharge, but sample sizes were underpowered for regression analysis. DISCUSSION Transfusion of modestly outdated RBCs was not associated with mortality in combat trauma patients. Expired WB and platelet recipients did well, but sample sizes were too small to draw significant conclusions. Expired blood should be further investigated for possible use in extenuating circumstances.
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Affiliation(s)
- Brian C Riley
- University of Washington School of Medicine, Seattle, Washington, USA
- Harborview Injury Prevention & Research Center, Seattle, Washington, USA
| | - Jimmy Phuong
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Rida A Hasan
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lynn G Stansbury
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Anesthesia and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - John R Hess
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Daniel J Roubik
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA
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Chae R, Nguyen C, Archdeacon C, Wattley L, Sisak S, Price A, Perez E, Schuster R, Lentsch A, Caldwell C, Goodman M, Pritts T. Whole blood storage duration alters fibrinogen levels and thrombin formation. J Trauma Acute Care Surg 2024; 97:39-47. [PMID: 38531825 PMCID: PMC11199101 DOI: 10.1097/ta.0000000000004317] [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] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Whole blood resuscitation for hemorrhagic shock in trauma represents an opportunity to correct coagulopathy in trauma while also supplying red blood cells. The production of microvesicles in stored whole blood and their effect on its hemostatic parameters have not been described in previous literature. We hypothesized that microvesicles in aged stored whole blood are procoagulant and increase thrombin production via phosphatidylserine. METHODS Whole blood was obtained from male C57BL/6 male mice and stored in anticoagulant solution for up to 10 days. At intervals, stored whole blood underwent examination with rotational thromboelastography, and platelet-poor plasma was prepared for analysis of thrombin generation. Microvesicles were prepared from 10-day-old whole blood aliquots and added to fresh whole blood or platelet-poor plasma to assess changes in coagulation and thrombin generation. Microvesicles were treated with recombinant mouse lactadherin prior to addition to plasma to inhibit phosphatidylserine's role in thrombin generation. RESULTS Aged murine whole blood had decreased fibrin clot formation compared with fresh samples with decreased plasma fibrinogen levels. Thrombin generation in plasma from aged blood increased over time of storage. The addition of microvesicles to fresh plasma resulted in increased thrombin generation compared with controls. When phosphatidylserine on microvesicles was blocked with lactadherin, there was no difference in the endogenous thrombin potential, but the generation of thrombin was blunted with lower peak thrombin levels. CONCLUSION Cold storage of murine whole blood results in decreased fibrinogen levels and fibrin clot formation. Aged whole blood demonstrates increased thrombin generation, and this is due in part to microvesicle production in stored whole blood. One mechanism by which microvesicles are procoagulant is by phosphatidylserine expression on their membranes.
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Affiliation(s)
- Ryan Chae
- From the Department of Surgery, University of Cincinnati, Cincinnati, Ohio
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Coulthard SL, Kaplan LJ, Cannon JW. What's new in whole blood resuscitation? In the trauma bay and beyond. Curr Opin Crit Care 2024; 30:209-216. [PMID: 38441127 DOI: 10.1097/mcc.0000000000001140] [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: 05/02/2024]
Abstract
PURPOSE OF REVIEW Transfusion therapy commonly supports patient care during life-threatening injury and critical illness. Herein we examine the recent resurgence of whole blood (WB) resuscitation for patients in hemorrhagic shock following trauma and other causes of severe bleeding. RECENT FINDINGS A growing body of literature supports the use of various forms of WB for hemostatic resuscitation in military and civilian trauma practice. Different types of WB include warm fresh whole blood (FWB) principally used in the military and low titer O cold stored whole blood (LTOWB) used in a variety of military and civilian settings. Incorporating WB initial resuscitation alongside subsequent component therapy reduces aggregate blood product utilization and improves early mortality without adversely impacting intensive care unit length of stay or infection rate. Applications outside the trauma bay include prehospital WB and use in patients with nontraumatic hemorrhagic shock. SUMMARY Whole blood may be transfused as FWB or LTOWB to support a hemostatic approach to hemorrhagic shock management. Although the bulk of WB resuscitation literature has appropriately focused on hemorrhagic shock following injury, extension to other etiologies of severe hemorrhage will benefit from focused inquiry to address cost, efficacy, approach, and patient-centered outcomes.
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Affiliation(s)
- Stacy L Coulthard
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Lewis J Kaplan
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Surgical Critical Care, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Jeremy W Cannon
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Riley BC, Stansbury LG, Roubik DJ, Hasan RA, Hess JR. Intentional transfusion of expired blood products. Transfusion 2024; 64:733-741. [PMID: 38380889 DOI: 10.1111/trf.17754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Brian C Riley
- University of Washington School of Medicine, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Lynn G Stansbury
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Anesthesia and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Daniel J Roubik
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Joint Base Lewis-McChord, Washington, USA
| | - Rida A Hasan
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - John R Hess
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
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Lv Y, Wu J, He Y, Liu J, Zhang W, Yan Z. Diseased Erythrocyte Enrichment Based on I-Shaped Pillar DLD Arrays. MICROMACHINES 2024; 15:214. [PMID: 38398943 PMCID: PMC10892238 DOI: 10.3390/mi15020214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Enrichment of erythrocytes is a necessary step in the diagnosis of blood diseases. Due to the high deformability and viscosity of erythrocytes, they cannot be regarded as stable point-like solids, so the influence of their deformability on fluid dynamics must be considered. Therefore, by using the special effect of an I-shaped pillar (I-pillar) on erythrocytes, erythrocytes with different deformability can be made to produce different provisional distances in the chip, so as to achieve the separation of the two kinds of erythrocytes. In this study, a microfluidic chip was designed to conduct a control test between erythrocytes stored for a long time and fresh erythrocytes. At a specific flow rate, the different deformable erythrocytes in the chip move in different paths. Then, the influence of erythrocyte deformability on its movement trajectory was analyzed by two-dimensional finite element flow simulation. DLD sorting technology provides a new method for the sorting and enrichment of diseased erythrocytes.
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Affiliation(s)
- Yao Lv
- School of Energy and Power Engineering, Lanzhou University of Technology, Lanzhou 730050, China; (Y.L.); (J.L.); (W.Z.); (Z.Y.)
| | - Jiangbo Wu
- School of Energy and Power Engineering, Lanzhou University of Technology, Lanzhou 730050, China; (Y.L.); (J.L.); (W.Z.); (Z.Y.)
| | - Yongqing He
- Chongqing Key Laboratory of Micro-Nano System and Intelligent Sensing, Chongqing Technology and Business University, Chongqing 400067, China
| | - Jie Liu
- School of Energy and Power Engineering, Lanzhou University of Technology, Lanzhou 730050, China; (Y.L.); (J.L.); (W.Z.); (Z.Y.)
| | - Wenyu Zhang
- School of Energy and Power Engineering, Lanzhou University of Technology, Lanzhou 730050, China; (Y.L.); (J.L.); (W.Z.); (Z.Y.)
| | - Zihan Yan
- School of Energy and Power Engineering, Lanzhou University of Technology, Lanzhou 730050, China; (Y.L.); (J.L.); (W.Z.); (Z.Y.)
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Zingg SW, Schuster R, Joseph B, Caldwell CC, Lentsch AB, Goodman MD, Pritts TA. Storage with ethanol attenuates the red blood cell storage lesion. Surgery 2022; 172:1829-1836. [PMID: 36109200 PMCID: PMC10979325 DOI: 10.1016/j.surg.2022.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Current management of hemorrhagic shock relies on control of surgical bleeding along with resuscitation with packed red blood cells and plasma in a 1-to-1 ratio. Transfusion, however, is not without consequence as red blood cells develop a series of biochemical and physical changes during storage termed "the red blood cell storage lesion." Previous data has suggested that ethanol may stabilize the red blood cell membrane, resulting in improved deformability. We hypothesized that storage of packed red blood cells with ethanol would alter the red blood cell storage lesion. METHODS Mice underwent donation and storage of red blood cells with standard storage conditions in AS-3 alone or ethanol at concentrations of 0.07%, 0.14%, and 0.28%. The red blood cell storage lesion parameters of microvesicles, Band-3, free hemoglobin, annexin V, and erythrocyte osmotic fragility were measured and compared. In additional experiments, the mice underwent hemorrhage and resuscitation with stored packed red blood cells to further evaluate the in vivo inflammatory impact. RESULTS Red blood cells stored with ethanol demonstrated decreased microvesicle accumulation and Band-3 levels. There were no differences in phosphatidylserine or cell-free hemoglobin levels. After hemorrhage and resuscitation with packed red blood cells stored with 0.07% ethanol, mice demonstrated decreased serum levels of interleukin-6, macrophage inflammatory protein-1α, keratinocyte chemokine, and tumor necrosis factor α compared to those mice receiving packed red blood cells stored with additive solution-3. CONCLUSION Storage of murine red blood cells with low-dose ethanol results in decreased red blood cell storage lesion severity. Resuscitation with packed red blood cells stored with 0.07% ethanol also resulted in a decreased systemic inflammatory response in a murine model of hemorrhage.
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Affiliation(s)
| | | | | | | | | | - Michael D Goodman
- Department of Surgery, University of Cincinnati, OH. https://twitter.com/Mdgoodmanmd
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What's New in Shock, April 2021? Shock 2021; 55:419-422. [PMID: 33730006 DOI: 10.1097/shk.0000000000001760] [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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