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Tran LNT, González-Fernández C, Gomez-Pastora J. Impact of Different Red Blood Cell Storage Solutions and Conditions on Cell Function and Viability: A Systematic Review. Biomolecules 2024; 14:813. [PMID: 39062526 PMCID: PMC11274915 DOI: 10.3390/biom14070813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
Red blood cell (RBC) storage solutions have evolved significantly over the past decades to optimize the preservation of cell viability and functionality during hypothermic storage. This comprehensive review provides an in-depth analysis of the effects of various storage solutions and conditions on critical RBC parameters during refrigerated preservation. A wide range of solutions, from basic formulations such as phosphate-buffered saline (PBS), to advanced additive solutions (ASs), like AS-7 and phosphate, adenine, glucose, guanosine, saline, and mannitol (PAGGSM), are systematically compared in terms of their ability to maintain key indicators of RBC integrity, including adenosine triphosphate (ATP) levels, morphology, and hemolysis. Optimal RBC storage requires a delicate balance of pH buffering, metabolic support, oxidative damage prevention, and osmotic regulation. While the latest alkaline solutions enable up to 8 weeks of storage, some degree of metabolic and morphological deterioration remains inevitable. The impacts of critical storage conditions, such as the holding temperature, oxygenation, anticoagulants, irradiation, and processing methods, on the accumulation of storage lesions are also thoroughly investigated. Personalized RBC storage solutions, tailored to individual donor characteristics, represent a promising avenue for minimizing storage lesions and enhancing transfusion outcomes. Further research integrating omics profiling with customized preservation media is necessary to maximize post-transfusion RBC survival and functions. The continued optimization of RBC storage practices will not only enhance transfusion efficacy but also enable blood banking to better meet evolving clinical needs.
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Affiliation(s)
- Linh Nguyen T. Tran
- Department of Chemical Engineering, Texas Tech University, Lubbock, TX 79409, USA; (L.N.T.T.); (C.G.-F.)
| | - Cristina González-Fernández
- Department of Chemical Engineering, Texas Tech University, Lubbock, TX 79409, USA; (L.N.T.T.); (C.G.-F.)
- Chemical and Biomolecular Engineering Department, Universidad de Cantabria, Avda. Los Castros, s/n, 39005 Santander, Spain
| | - Jenifer Gomez-Pastora
- Department of Chemical Engineering, Texas Tech University, Lubbock, TX 79409, USA; (L.N.T.T.); (C.G.-F.)
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2
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Mykhailova O, Brandon-Coatham M, Phan C, Yazdanbakhsh M, Olafson C, Yi QL, Kanias T, Acker JP. Red cell concentrates from teen male donors contain poor-quality biologically older cells. Vox Sang 2024; 119:417-427. [PMID: 38418415 DOI: 10.1111/vox.13602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/27/2024] [Accepted: 01/31/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND AND OBJECTIVES Donor factors influence the quality characteristics of red cell concentrates (RCCs) and the lesions that develop in these heterogeneous blood products during hypothermic storage. Teen male donors' RCCs contain elevated levels of biologically old red blood cells (RBCs). The aim of this study was to interrogate the quality of units of different donor ages and sexes to unravel the complex interplay between donor characteristics, long-term cold storage and, for the first time, RBC biological age. MATERIALS AND METHODS RCCs from teen males, teen females, senior males and senior females were density-separated into less-dense/young (Y-RBCs) and dense/old RBCs (O-RBCs) throughout hypothermic storage for testing. The unseparated and density-separated cells were tested for haematological parameters, stress (oxidative and osmotic) haemolysis and oxygen affinity (p50). RESULTS The O-RBCs obtained from teen donor samples, particularly males, had smaller mean corpuscular volumes and higher mean corpuscular haemoglobin concentrations. While biological age did not significantly affect oxygen affinity, biologically aged O-RBCs from stored RCCs exhibited increased oxidative haemolysis and decreased osmotic fragility, with teenage male RCCs exhibiting the highest propensity to haemolyse. CONCLUSION Previously, donor age and sex were shown to have an impact on the biological age distribution of RBCs within RCCs. Herein, we demonstrated that RBC biological age, particularly O-RBCs, which are found more prevalently in male teens, to be a driving factor of several aspects of poor blood product quality. This study emphasizes that donor factors should continue to be considered for their potential impacts on transfusion outcomes.
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Affiliation(s)
- Olga Mykhailova
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
| | | | - Celina Phan
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Mahsa Yazdanbakhsh
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Carly Olafson
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Qi-Long Yi
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Tamir Kanias
- Vitalant Research Institute, Denver, Colorado, USA
| | - Jason P Acker
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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3
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Mykhailova O, Brandon-Coatham M, Durand K, Olafson C, Xu A, Yi QL, Kanias T, Acker JP. Estimated median density identifies donor age and sex differences in red blood cell biological age. Transfusion 2024; 64:705-715. [PMID: 38420746 DOI: 10.1111/trf.17749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Donors possess heterogeneous red cell concentrates (RCCs) in terms of the biological age of their red blood cells (RBCs) as a direct result of various donor-dependent factors influencing rates of erythropoiesis. This study aimed to estimate the median biological age of RBCs in RCCs based on donor age and sex to investigate inherent differences in blood products' biological ages over hypothermic storage using estimated median densities (EMDs). STUDY DESIGN Sixty RCCs were collected from four donor groups; male and female teenagers (17-19 years old) and seniors (75+ years old). A Percoll density-based separation approach was used to quantify the EMDs indicative of biological age. EMD and mean corpuscular hemoglobin (MCHC) were compared by correlation analyses. RESULTS Differences in the median biological age of RCC units were observed with male donors having significantly higher EMDs compared to females (p < .001). Teen male donors possessed the highest EMDs with significantly elevated levels of biologically aged RBCs compared to both female donor groups, regardless of storage duration (p < .05). Throughout most of the 42-day storage period, senior donors, particularly senior females, demonstrated the strongest correlation between EMD and MCHC (R2 > 0.5). CONCLUSIONS This study provides further evidence that there are inherent differences between the biological age profiles of RBCs between blood donors of different sex and age. Our findings further highlight that biological age may contribute to RBC quality during storage and that donor characteristics need to be considered when evaluating transfusion safety and efficacy.
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Affiliation(s)
- Olga Mykhailova
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
| | | | - Kiarra Durand
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Carly Olafson
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
| | - April Xu
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Qi-Long Yi
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Tamir Kanias
- Vitalant Research Institute, Denver, Colorado, USA
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jason P Acker
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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4
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Riley BC, Stansbury LG, Hasan RA, Hess JR. Transfusion of red blood cells ≥35 days old: A narrative review of clinical outcomes. Transfusion 2023; 63:2179-2187. [PMID: 37681276 DOI: 10.1111/trf.17536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Brian C Riley
- University of Washington School of Medicine, Seattle, Washington, USA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA
| | - Lynn G Stansbury
- Harborview Injury Prevention & 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
| | - Rida A Hasan
- Harborview Injury Prevention & 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 & 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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5
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Rattanapan Y, Narkpetch S, Chareonsirisuthigul T. Upregulation of miR-20a-5p as the Potential MicroRNA Marker in Red Blood Cell Storage Lesion. BIOMED RESEARCH INTERNATIONAL 2023; 2023:5598590. [PMID: 37829050 PMCID: PMC10567411 DOI: 10.1155/2023/5598590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/29/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
Background Packed red blood cells (PRBCs) can be preserved for 42 days, and stored PRBCs have slow, dangerous changes over time during storage. miRNA is approximately 22 nucleotides long, a small single-stranded noncoding RNA molecule. miRNA guides by pairing bases with their downstream target mRNA to regulate negative expression. They are essential in many life processes, including cell differentiation, proliferation, and apoptosis. Therefore, miRNA alterations may represent possible biomarkers of PRBC storage lesions. This study is aimed at validating the miR-20a-5p in PRBC storage. Study Design and Methods. A total of 20 PRBC samples were divided into day 1 and day 20 storage groups. Total miRNA was extracted and quantified by probe-based RT-qPCR assays to explore the potential role of miRNAs in PRBC storage lesions. Results Upregulated miR-20a-5p in PRBC storage on day 20 compared to day 1. MiR-20a-5p promoted cell survival, which may affect the downstream regulation and decrease PRBC viability in prolonged storage. Conclusion On this basis, this detection may help to assess the quality of stored PRBCs.
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Affiliation(s)
- Yanisa Rattanapan
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand
- Hematology and Transfusion Science Research Center, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Sodsai Narkpetch
- Blood Bank, Maharaj Nakhon Si Thammarat Hospital, Nakhon Si Thammarat 80000, Thailand
| | - Takol Chareonsirisuthigul
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Martin SM, Tucci M, Spinella PC, Ducruet T, Fergusson DA, Freed DH, Lacroix J, Poirier N, Sivarajan VB, Steiner ME, Willems A, Garcia Guerra G. Effect of red blood cell storage time in pediatric cardiac surgery patients: A subgroup analysis of a randomized controlled trial. JTCVS OPEN 2023; 15:454-467. [PMID: 37808065 PMCID: PMC10556812 DOI: 10.1016/j.xjon.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/19/2023] [Accepted: 04/11/2023] [Indexed: 10/10/2023]
Abstract
Objective This study aimed to determine whether or not transfusion of fresh red blood cells (RBCs) reduced the incidence of new or progressive multiple organ dysfunction syndrome compared with standard-issue RBCs in pediatric patients undergoing cardiac surgery. Methods Preplanned secondary analysis of the Age of Blood in Children in Pediatric Intensive Care Unit study, an international randomized controlled trial. This study included children enrolled in the Age of Blood in Children in Pediatric Intensive Care Unit trial and admitted to a pediatric intensive care unit after cardiac surgery with cardiopulmonary bypass. Patients were randomized to receive either fresh (stored ≤7 days) or standard-issue RBCs. The primary outcome measure was new or progressive multiple organ dysfunction syndrome, measured up to 28 days postrandomization or at pediatric intensive care unit discharge, or death. Results One hundred seventy-eight patients (median age, 0.6 years; interquartile range, 0.3-2.6 years) were included with 89 patients randomized to the fresh RBCs group (median length of storage, 5 days; interquartile range, 4-6 days) and 89 to the standard-issue RBCs group (median length of storage, 18 days; interquartile range, 13-22 days). There were no statistically significant differences in new or progressive multiple organ dysfunction syndrome between fresh (43 out of 89 [48.3%]) and standard-issue RBCs groups (38 out of 88 [43.2%]), with a relative risk of 1.12 (95% CI, 0.81 to 1.54; P = .49) and an unadjusted absolute risk difference of 5.1% (95% CI, -9.5% to 19.8%; P = .49). Conclusions In neonates and children undergoing cardiac surgery with cardiopulmonary bypass, the use of fresh RBCs did not reduce the incidence of new or progressive multiple organ dysfunction syndrome compared with the standard-issue RBCs. A larger trial is needed to confirm these results.
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Affiliation(s)
- Sophie M. Martin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
| | - Marisa Tucci
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
| | - Philip C. Spinella
- Departments of Surgery and Critical Care Medicine, Pittsburgh University, Pittsburgh, Pa
| | - Thierry Ducruet
- Unité de recherche clinique appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
| | - Dean A. Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Darren H. Freed
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jacques Lacroix
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
| | - Nancy Poirier
- Department of Cardiac Surgery, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
| | - Venkatesan B. Sivarajan
- Pediatric Cardiac Intensive Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Marie E. Steiner
- Divisions of Hematology/Oncology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, Minn
| | - Ariane Willems
- Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Hospital, Leiden, The Netherlands
| | - Gonzalo Garcia Guerra
- Pediatric Intensive Care, Department of Pediatrics, Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada
| | - Age of Blood in Children in Pediatric Intensive Care Unit Trial Investigators
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Departments of Surgery and Critical Care Medicine, Pittsburgh University, Pittsburgh, Pa
- Unité de recherche clinique appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Cardiac Surgery, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Pediatric Cardiac Intensive Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
- Divisions of Hematology/Oncology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, Minn
- Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Hospital, Leiden, The Netherlands
- Pediatric Intensive Care, Department of Pediatrics, Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada
| | - the Canadian Critical Care Trials Group
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Departments of Surgery and Critical Care Medicine, Pittsburgh University, Pittsburgh, Pa
- Unité de recherche clinique appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Cardiac Surgery, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Pediatric Cardiac Intensive Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
- Divisions of Hematology/Oncology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, Minn
- Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Hospital, Leiden, The Netherlands
- Pediatric Intensive Care, Department of Pediatrics, Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada
| | - the Pediatric Acute Lung Injury and Sepsis Investigators Network
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Departments of Surgery and Critical Care Medicine, Pittsburgh University, Pittsburgh, Pa
- Unité de recherche clinique appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Cardiac Surgery, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Pediatric Cardiac Intensive Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
- Divisions of Hematology/Oncology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, Minn
- Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Hospital, Leiden, The Netherlands
- Pediatric Intensive Care, Department of Pediatrics, Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada
| | - the BloodNet Pediatric Critical Care Blood Research Network
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Departments of Surgery and Critical Care Medicine, Pittsburgh University, Pittsburgh, Pa
- Unité de recherche clinique appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Cardiac Surgery, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Pediatric Cardiac Intensive Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
- Divisions of Hematology/Oncology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, Minn
- Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Hospital, Leiden, The Netherlands
- Pediatric Intensive Care, Department of Pediatrics, Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada
| | - the Groupe Francophone de Réanimation et Urgences Pédiatriques∗
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Departments of Surgery and Critical Care Medicine, Pittsburgh University, Pittsburgh, Pa
- Unité de recherche clinique appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Cardiac Surgery, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Pediatric Cardiac Intensive Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
- Divisions of Hematology/Oncology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, Minn
- Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Hospital, Leiden, The Netherlands
- Pediatric Intensive Care, Department of Pediatrics, Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada
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Mulatie Z, Aynalem M, Getawa S. MicroRNAs as Quality Assessment Tool in Stored Packed Red Blood Cell in Blood Banks. J Blood Med 2023; 14:99-106. [PMID: 36789373 PMCID: PMC9922504 DOI: 10.2147/jbm.s397139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
Micro-ribonucleic acids are control gene expression in cells. They represent the changed cellular states that occur can be employed as biomarkers. Red blood cells alter biochemically and morphologically while they are being stored, which could be detrimental to transfusion. The effect of storage on the erythrocyte transcriptome is not mostly investigated. Because adult erythrocytes lack a nucleus, it has long been assumed that they lack deoxyribonucleic acid and ribonucleic acid. On the other hand, erythrocytes contain a diverse range of ribonucleic acids, of which micro-ribonucleic acids are key component. Changes in this micro-ribonucleic acid protect cells from death and adenine triphosphate depletion, and they are linked to specific storage lesions. As a result, changes in micro-ribonucleic acid in stored erythrocytes may be used as a marker to assess the quality and safety of stored erythrocytes. Therefore, this review ams to review the role of microRNA in stored packed red blood cells as quality indicator. Google Scholar, PubMed, Scopus, and Z-libraries are used for searching articles and books. The article included in this paper was written in the English language and had the full article. During long storage of RBCs, miR-16-2-3p, miR-1260a, miR-1260b, miR-4443, miR-4695-3p, miR-5100, let-7b, miR-16, miRNA-1246, MiR-31-5p, miR-203a, miR-654-3p, miR-769-3p, miR-4454, miR-451a and miR-125b- 5p are up regulated. However, miR-96, miR-150, miR-196a, miR-197, miR-381 and miR-1245a are down regulated after long storage of RBCs. The changes of this microRNAs are linked to red blood cell lesions. Therefore, micro-ribonucleic acids are the potential quality indicator in stored packed red blood cells in the blood bank. Particularly, micro-ribonucleic acid-96 is the most suitable biomarker for monitoring red blood cell quality in stored packed red blood units.
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Affiliation(s)
- Zewudu Mulatie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Desie, Ethiopia,Correspondence: Zewudu Mulatie, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, P.O.box: 1145, Desie, Ethiopia, Tel +251945274251, Email
| | - Melak Aynalem
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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8
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Amico F, Efird JT, Briggs GD, Lott NJ, King KL, Hirani R, Balogh ZJ. Association Between Blood Donor Demographics and Post-injury Multiple Organ Failure after Polytrauma. Ann Surg 2023; 277:e170-e174. [PMID: 33491976 PMCID: PMC9762716 DOI: 10.1097/sla.0000000000004754] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test the hypothesis that blood donor demographics are associated with transfused polytrauma patients' post-injury multiple organ failure (MOF) status. SUMMARY OF BACKGROUND DATA Traumatic shock and MOF are preventable causes of death and post-traumatic hemorrhage is a frequent indication for transfusion. The role of blood donor demographics on transfusion recipients is not well known. METHODS A log-linear analysis accounting for the correlated structure of the data based on our prospective MOF database was utilized. Tests for trend and interaction were computed using a likelihood ratio procedure. RESULTS A total of 229 critically injured transfused trauma patients were included, with 68% of them being males and a mean age of 45 years. On average 10 units of blood components were transfused per patient. A total of 4379 units of blood components were donated by donors aged 46 years on average, 74% of whom were males. Blood components used were red blood cells (47%), cryoprecipitate (29%), fresh frozen plasma (24%), and platelets (less than 1%). Donor-recipient sex mismatched red blood cells transfusions were more likely to be associated with MOF ( P = 0.0012); fresh frozen plasma and cryoprecipitate recipients were more likely to experience MOF when transfused with a male (vs female) component ( P = 0.0014 and <0.0001, respectively). Donor age was not significantly associated with MOF for all blood components. CONCLUSIONS Blood components donor sex, but not age, may be an important factor associated with post-injury MOF. Further validation of our findings will help guide future risk mitigation strategies specific to blood donor demographics.
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Affiliation(s)
- Francesco Amico
- Department of Traumatology, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jimmy T Efird
- Center for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gabrielle D Briggs
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Natalie J Lott
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Kate L King
- Department of Traumatology, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Rena Hirani
- Research and Development, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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9
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Vijayan V, Greite R, Schott S, Doricic J, Madyaningrana K, Pradhan P, Martens J, Blasczyk R, Janciauskiene S, Immenschuh S. Determination of free heme in stored red blood cells with an apo-horseradish peroxidase-based assay. Biol Chem 2022; 403:1091-1098. [PMID: 36054292 DOI: 10.1515/hsz-2022-0184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/15/2022] [Indexed: 12/19/2022]
Abstract
Transfusion effectiveness of red blood cells (RBCs) has been associated with duration of the storage period. Storage-dependent RBC alterations lead to hemolysis and release of toxic free heme, but the increase of free heme levels over time is largely unknown. In the current study, an apo-horseradish peroxidase (apoHRP)-based assay was applied to measure levels of free heme at regular intervals or periodically in supernatants of RBCs until a maximum storage period of 42 days. Free heme levels increased with linear time-dependent kinetics up to day 21 and accelerated disproportionally after day 28 until day 42, as determined with the apoHRP assay. Individual time courses of free heme in different RBC units exhibited high variability. Notably, levels of free hemoglobin, an established indicator of RBC damage, and those of total heme increased with continuous time-dependent linear kinetics over the entire 42 day storage period, respectively. Supernatants from RBC units with high levels of free heme led to inflammatory activation of human neutrophils. In conclusion, determining free heme in stored RBCs with the applied apoHRP assay may become feasible for testing of RBC storage quality in clinical transfusion medicine.
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Affiliation(s)
- Vijith Vijayan
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - Robert Greite
- Department of Nephrology, Hannover Medical School, D-30625 Hannover, Germany
| | - Sebastian Schott
- Department of Nephrology, Hannover Medical School, D-30625 Hannover, Germany
| | - Julian Doricic
- Department of Nephrology, Hannover Medical School, D-30625 Hannover, Germany
| | - Kukuh Madyaningrana
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.,Faculty of Biotechnology, Universitas Kristen Duta Wacana, 55224 Yogyakarta, Indonesia
| | - Pooja Pradhan
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - Jörg Martens
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - Rainer Blasczyk
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | | | - Stephan Immenschuh
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
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10
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Jung C, Rezar R, Wischmann P, Masyuk M, Datz C, Bruno RR, Kelm M, Wernly B. The role of anemia on admission in acute coronary syndrome - An umbrella review of systematic reviews and meta-analyses. Int J Cardiol 2022; 367:1-10. [PMID: 36055474 DOI: 10.1016/j.ijcard.2022.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/10/2022] [Accepted: 08/24/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The role of erythrocytes in the acute coronary syndrome (ACS) is complex. The aim of this review in terms of PICO (P: patients; I: intervention; C: comparison; O: outcome) was to summarize systematic reviews in patients (P) with acute coronary syndrome, evaluating the effects of (I) 1) iron deficiency, 2) administration of an erythropoiesis-stimulating agent (ESA), 3) anemia on admission, 4) red blood cell transfusion, 5) a restrictive transfusion strategy in comparison (C) to 1) no iron deficiency, 2) no ESA 3) no anemia on admission, 4) no red blood cell transfusion, 5) a liberal transfusion strategy on mortality (O). METHODS We used AMSTAR2 to assess the methodological quality of systematic reviews and grade the available research. The primary endpoint was all-cause mortality. RESULTS Using the data from 2,787,005 patients, the following conditions were associated with worse outcome in patients with ACS: anemia on admission (RR 2.08 95%CI 1.70-2.55) and transfusion (1.93 95%CI 1.12-3.34) of red blood cells. A liberal transfusion (RR 0.86 95%CI 0.70-1-05), administration of ESA (RR 0.55 95%CI 0.22-1.33) and iron deficiency (OR 1.24 95%CI 0.12-13.13) were not associated with altered all-cause mortality. CONCLUSION Patients suffering from ACS and anemia on admission are at particular risk for adverse outcome. There is evidence of associations between adverse outcomes and receiving red blood cell transfusions.
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Affiliation(s)
- Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany.
| | - Richard Rezar
- Department of Cardiology and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria.
| | - Patricia Wischmann
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Maryna Masyuk
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Christian Datz
- Department of Internal Medicine, Teaching Hospital of the Paracelsus Medical University Salzburg, General Hospital Oberndorf, Paracelsus Medical University Salzburg, Oberndorf, Austria.
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Internal Medicine, Teaching Hospital of the Paracelsus Medical University Salzburg, General Hospital Oberndorf, Paracelsus Medical University Salzburg, Oberndorf, Austria; Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Strubergasse 21, 5020 Salzburg, Austria
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11
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Vardaki MZ, Georg Schulze H, Serrano K, Blades MW, Devine DV, F B Turner R. Assessing the quality of stored red blood cells using handheld Spatially Offset Raman spectroscopy with multisource correlation analysis. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2022; 276:121220. [PMID: 35395462 DOI: 10.1016/j.saa.2022.121220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
In this work we employ Spatially Offset Raman Spectroscopy (SORS) to non-invasively identify storage-related changes in red blood cell concentrate (RCC) in-situ within standard plastic transfusion bags. To validate the measurements, we set up a parallel study comparing both bioanalytical data (obtained by blood-gas analysis, hematology analysis and spectrophotometric assays), and Raman spectrometry data from the same blood samples. We then employ Multisource Correlation Analysis (MuSCA) to correlate the different types of data in RCC. Our analysis confirmed a strong correlation of glucose, methemoglobin and oxyhemoglobin with their respective bioassay values in RCC units. Finally, by combining MuSCA with k-means clustering, we assessed changes in all Raman wavenumbers during cold storage in both RCC Raman data from the current study and parallel RCC supernatant Raman data previously acquired from the same units. Direct RCC quality monitoring during storage, would help to establish a basis for improved inventory management of blood products in blood banks and hospitals based on analytical data.
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Affiliation(s)
- Martha Z Vardaki
- Institute of Chemical Biology, National Hellenic Research Foundation, 48 Vassileos Constantinou Avenue, Athens 11635, Greece
| | - H Georg Schulze
- Monte do Tojal, Caixa Postal 128, Hortinhas, Terena 7250-069, Portugal
| | - Katherine Serrano
- Department of Pathology and Laboratory Medicine, The University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6 T 2B5, Canada; Centre for Blood Research, The University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC V6 T 1Z3, Canada; Centre for Innovation, Canadian Blood Services
| | - Michael W Blades
- Department of Chemistry, The University of British Columbia, 2036 Main Mall, Vancouver, BC V6 T 1Z1, Canada
| | - Dana V Devine
- Department of Pathology and Laboratory Medicine, The University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6 T 2B5, Canada; Centre for Blood Research, The University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC V6 T 1Z3, Canada; Centre for Innovation, Canadian Blood Services
| | - Robin F B Turner
- Michael Smith Laboratories, The University of British Columbia, 2185 East Mall, Vancouver, BC V6 T 1Z4, Canada; Department of Chemistry, The University of British Columbia, 2036 Main Mall, Vancouver, BC V6 T 1Z1, Canada; Department of Electrical and Computer Engineering, The University of British Columbia, 2332 Main Mall, Vancouver, BC V6 T 1Z4, Canada
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12
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Hosgood SA, Elliott TR, Jordan NP, Nicholson ML. The Effects of Free Heme on Functional and Molecular Changes During Ex Vivo Normothermic Machine Perfusion of Human Kidneys. Front Immunol 2022; 13:849742. [PMID: 35585981 PMCID: PMC9108696 DOI: 10.3389/fimmu.2022.849742] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022] Open
Abstract
Normothermic machine perfusion (NMP) is a technique of kidney preservation designed to restore cellular metabolism after cold ischemia. Kidneys are perfused with an oxygenated banked red blood cell (RBC) based solution for 1h at 36°C. During NMP, RBCs can become damaged, releasing free heme into the perfusate. This can act as a damage-associated molecular pattern (DAMP) activating inflammatory signalling pathways. The aim of this study was to measure the levels of free heme during NMP, assess the effect on kidney function and determine any association with inflammatory and stress related gene expression. Levels of free heme were measured in perfusate samples from a series of donation after circulatory death (DCD) kidneys undergoing NMP as part of a randomised controlled trial (RCT). The age of RBCs and levels of free heme were correlated with perfusion parameters. Changes in gene expression were analysed in a series of kidneys declined for transplantation using the NanoString nCounter Organ Transplant Panel and qRT-PCR. Older units of RBCs were associated with higher levels of free heme and levels increased significantly during NMP (Pre 8.56 ± 7.19µM vs 26.29 ± 15.18µM, P<0.0001). There was no association with levels of free heme and perfusion parameters during NMP (P > 0.05). Transcriptional and qPCR analysis demonstrated the upregulation of differentially expressed genes associated with apoptosis (FOS and JUN), inflammatory cytokines (IL-6, SOCS3, ATF3), chemokines (CXCL8, CXCL2, CC3/L1) and oxidative stress (KLF4) after NMP. However, these did not correlate with levels of free heme (P >0.05). A significant amount of free heme can be detected in the perfusate before and after NMP particularly when older units of red cells are used. Although transcriptional analysis demonstrated significant upregulation of genes involved with apoptotic, inflammatory and oxidative pathways these were not associated with high levels of free heme.
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13
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Pittman RN, Yoshida T, Omert LA. Effect of Hypoxic Blood Infusion on Pulmonary Physiology. Front Physiol 2022; 13:842510. [PMID: 35309066 PMCID: PMC8931507 DOI: 10.3389/fphys.2022.842510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/28/2022] [Indexed: 12/02/2022] Open
Abstract
The ability to store red blood cells (RBCs) and other components for extended periods of time has expanded the availability and use of transfusion as a life-saving therapy. However, conventional RBC storage has a limited window of effective preservation and is accompanied by the progressive accumulation of a series of biochemical and morphological modifications, collectively referred to as “storage lesions.” These lesions have been associated with negative clinical outcomes (i.e., postoperative complications as well as reduced short-term and long-term survival) in patients transfused with conventionally stored blood with older and deteriorated transfused red cells. Hence, there is an increased unmet need for improved RBC storage. Hypoxic storage of blood entails the removal of large amounts of oxygen to low levels prior to refrigeration and maintenance of hypoxic levels through the entirety of storage. As opposed to conventionally stored blood, hypoxic storage can lead to a reduction of oxidative damage to slow storage lesion development and create a storage condition expected to result in enhanced efficacy of stored RBCs without an effect on oxygen exchange in the lung. Hypoxic blood transfusions appear to offer minimal safety concerns, even in patients with hypoxemia. This review describes the physiology of hypoxically stored blood, how it differs from conventionally stored blood, and its use in potential clinical application, such as massively transfused and critically ill patients with oxygenation/ventilation impairments.
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Affiliation(s)
- Roland N. Pittman
- Department of Physiology and Biophysics, Virginia Commonwealth University, Richmond, VA, United States
- *Correspondence: Roland N. Pittman,
| | - Tatsuro Yoshida
- Research and Development, Hemanext Inc., Lexington, MA, United States
| | - Laurel A. Omert
- Medical Affairs, Hemanext Inc., Lexington, MA, United States
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14
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Davidow EB, Montgomery H, Mensing M. The influence of leukoreduction on the acute transfusion-related complication rate in 455 dogs receiving 730 packed RBCs: 2014-2017. J Vet Emerg Crit Care (San Antonio) 2022; 32:479-490. [PMID: 35043550 DOI: 10.1111/vec.13175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/22/2020] [Accepted: 07/25/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the influence of prestorage leukoreduction of packed RBCs (pRBCs) on acute transfusion-related complication rate in dogs. SETTING Two private referral hospitals. DESIGN Retrospective case study. ANIMALS Four hundred and fifty-five dogs receiving nonleukoreduced (nLR) or leukoreduced (LR) pRBC between January 1, 2014 and July 31, 2017. MEASUREMENTS AND MAIN RESULTS Transfusions were retrospectively reviewed to record data about the patient, donor, unit, transfusion event, acute complications, hospital discharge, and cause of death. Of 730 transfusion events in 455 dogs, 288 used LR pRBC and 442 used nLR pRBC. There was a 18.9% (138/730) overall complication rate. Seven (0.96%) complications were life-threatening. The most common complications were pyrexia (5.6%), gastrointestinal signs (4.9%), and hemolysis with no other signs (4.1%). Pyrexia with no other clinical signs, consistent with a febrile nonhemolytic transfusion reaction (FNHTR), occurred in 3.2% of transfusion events. There was a significant (P = 0.03) decrease in the rate of FNHTR with LR pRBC (1%) versus nLR pRBC (4.5%). Use of LR pRBC did not decrease in-hospital mortality. The odds of any complication, hemolysis only, FNHTR, and more severe complications increased with pRBC age. Leukoreduction did not decrease the impact of pRBC age on these complications. Use of older pRBC did not increase the incidence of life-threatening complications or mortality. Dogs receiving pRBC for blood loss were more likely to have gastrointestinal and more severe complications than those dogs that had hemolysis. The effect of pRBC unit age on complications was not influenced by the underlying reason for transfusion. Dogs that received a previous transfusion were more likely to have respiratory complications. CONCLUSION In this study, the use of LR pRBC was associated with a decreased rate of FNHTR but no other complications. Unit age was associated with the incidence of hemolysis, FNHTR, and complication severity but not the rate of life-threatening complications or mortality.
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Affiliation(s)
| | - Heather Montgomery
- ACCES Blood Bank, BluePearl Veterinary Partners, Seattle, Washington, USA
| | - Michelle Mensing
- ACCES Blood Bank, BluePearl Veterinary Partners, Seattle, Washington, USA
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15
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Martin M, Perez-Guaita D, Wood BR. ATR-FTIR spectroscopy as a quality control system for monitoring the storage of blood products. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2021; 13:5756-5763. [PMID: 34816272 DOI: 10.1039/d1ay01242h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Blood screening is a fundamental part of disease diagnosis and monitoring health. Attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy offers an innovative solution to streamlining the process, especially for multianalyte detection in aqueous samples. However, samples always undergo a storage phase before they are processed for testing and blood transfusion. In this study, we investigated the effect of standard storage procedures on the macromolecular composition of whole blood, and plasma collected in blood tubes for diagnostic purposes and initial screening of blood products. Periphery blood samples were collected from 10 volunteers and then stored for 14 days at 4 °C. Samples were stored as isolated plasma and whole blood to provide three different datasets, namely: (1) plasma stored independently, (2) plasma stored with other blood components and (3) whole blood. ATR-FTIR spectra of aqueous blood were acquired every 24 h from the time of collection on a portable ATR-FTIR spectrophotometer to monitor the evolution of the macromolecular composition in each blood component. Principal component analysis (PCA), partial least squares regression (PLS-R) and multi-curve resolution alternate least squares (MCR-ALS) models were built to study changes in the spectra with the storage time and identify the key bands. Isolated plasma stored without red blood cells (RBCs) showed no changes over the 14 day period indicating limited degradation. By contrast, plasma stored with the other blood components showed visual and spectroscopic signs of degradation including increasing lipid bands and the amide I and II bands from haemoglobin (Hb). Ideally, for the application of IR spectroscopy in blood diagnostics and for initial screening of blood products, whole blood and isolated red blood cells can be stored for a maximum of 4 days at 4 °C in lithium-heparin anticoagulant tubes prior to spectral analysis before any signs of degradation. Isolated plasma, on the other hand, can be stored for much longer periods and shows no evidence of degradation in the spectra after 14 days.
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Affiliation(s)
- Miguela Martin
- Centre for Biospectroscopy, Monash University, Clayton, 3800, Victoria, Australia.
| | - David Perez-Guaita
- Department of Analytical Chemistry, University of Valencia, Burjassot, Spain
| | - Bayden R Wood
- Centre for Biospectroscopy, Monash University, Clayton, 3800, Victoria, Australia.
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16
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Kanda T, Wakiya T, Ishido K, Kimura N, Nagase H, Kubota S, Fujita H, Hagiwara Y, Hakamada K. Intraoperative Allogeneic Red Blood Cell Transfusion Negatively Influences Prognosis After Radical Surgery for Pancreatic Cancer: A Propensity Score Matching Analysis. Pancreas 2021; 50:1314-1325. [PMID: 34860818 DOI: 10.1097/mpa.0000000000001913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE We aimed to investigate the real impact of allogeneic red blood cell transfusion (ABT) on postoperative outcomes in resectable pancreatic ductal adenocarcinoma (PDAC) patients. METHODS Of 128 patients undergoing resectable PDAC surgery at our facility, 24 (18.8%) received ABT. Recurrence-free survival (RFS) and disease-specific survival (DSS), before and after propensity score matching (PSM), were compared among patients who did and did not receive ABT. RESULTS In the entire cohort, ABT was significantly associated with decreased RFS (P = 0.002) and DSS (P = 0.014) before PSM. Cox regression analysis identified ABT (risk ratio, 1.884; 95% confidence interval, 1.015-3.497; P = 0.045) as an independent prognostic factor for RFS. Univariate and multivariate analysis identified preoperative hemoglobin value, preoperative total bilirubin value, and intraoperative blood loss as significant independent risk factors for ABT. Using these 3 variables, PSM analysis created 16 pairs of patients. After PSM, the ABT group had significantly poorer RFS rates than the non-ABT group (median, 9.8 vs 15.8 months, P = 0.022). Similar tendencies were found in DSS rates (median, 19.4 vs 40.0 months, P = 0.071). CONCLUSIONS This study revealed certain negative effects of intraoperative ABT on postoperative survival outcomes in patients with resectable PDAC.
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Affiliation(s)
- Taishu Kanda
- From the Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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17
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Vardaki MZ, Schulze HG, Serrano K, Blades MW, Devine DV, Turner RFB. Non-invasive monitoring of red blood cells during cold storage using handheld Raman spectroscopy. Transfusion 2021; 61:2159-2168. [PMID: 33969894 DOI: 10.1111/trf.16417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/02/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The current best practices allow for the red blood cells (RBCs) to be stored for prolonged periods in blood banks worldwide. However, due to the individual-related variability in donated blood and RBCs continual degradation within transfusion bags, the quality of stored blood varies considerably. There is currently no method for assessing the blood product quality without compromising the sterility of the unit. This study demonstrates the feasibility of monitoring storage lesion of RBCs in situ while maintaining sterility using an optical approach. STUDY DESIGN AND METHODS A handheld spatially offset Raman spectroscopy (RS) device was employed to non-invasively monitor hemolysis and metabolic changes in 12 red cell concentrate (RCC) units within standard sealed transfusion bags over 7 weeks of cold storage. The donated blood was analyzed in parallel by biochemical (chemical analysis, spectrophotometry, hematology analysis) and RS measurements, which were then correlated through multisource correlation analysis. RESULTS Raman bands of lactate (857 cm-1 ), glucose (787 cm-1 ), and hemolysis (1003 cm-1 ) were found to correlate strongly with bioanalytical data over the length of storage, with correlation values 0.98 (95% confidence interval [CI]: 0.86-1.00; p = .0001), 0.95 (95% CI: 0.71-0.99; p = .0008) and 0.97 (95% CI: 0.79-1.00; p = .0004) respectively. DISCUSSION This study demonstrates the potential of collecting information on the clinical quality of blood units without breaching the sterility using Raman technology. This could significantly benefit quality control of RCC units, patient safety and inventory management in blood banks and hospitals.
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Affiliation(s)
- Martha Z Vardaki
- Michael Smith Laboratories, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Hans Georg Schulze
- Michael Smith Laboratories, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Serrano
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, The University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Blood Services, Centre for Innovation, Ottawa, Ontario, Canada
| | - Michael W Blades
- Department of Chemistry, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Dana V Devine
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, The University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Blood Services, Centre for Innovation, Ottawa, Ontario, Canada
| | - Robin F B Turner
- Michael Smith Laboratories, The University of British Columbia, Vancouver, British Columbia, Canada.,Department of Chemistry, The University of British Columbia, Vancouver, British Columbia, Canada.,Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
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18
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Current Understanding of the Relationship between Blood Donor Variability and Blood Component Quality. Int J Mol Sci 2021; 22:ijms22083943. [PMID: 33920459 PMCID: PMC8069744 DOI: 10.3390/ijms22083943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/19/2022] Open
Abstract
While differences among donors has long challenged meeting quality standards for the production of blood components for transfusion, only recently has the molecular basis for many of these differences become understood. This review article will examine our current understanding of the molecular differences that impact the quality of red blood cells (RBC), platelets, and plasma components. Factors affecting RBC quality include cytoskeletal elements and membrane proteins associated with the oxidative response as well as known enzyme polymorphisms and hemoglobin variants. Donor age and health status may also be important. Platelet quality is impacted by variables that are less well understood, but that include platelet storage sensitive metabolic parameters, responsiveness to agonists accumulating in storage containers and factors affecting the maintenance of pH. An increased understanding of these variables can be used to improve the quality of blood components for transfusion by using donor management algorithms based on a donors individual molecular and genetic profile.
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19
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Chen S, Wu L, Ren J, Bemmer V, Zajicek R, Chen R. Comb-like Pseudopeptides Enable Very Rapid and Efficient Intracellular Trehalose Delivery for Enhanced Cryopreservation of Erythrocytes. ACS APPLIED MATERIALS & INTERFACES 2020; 12:28941-28951. [PMID: 32496048 DOI: 10.1021/acsami.0c03260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cell cryopreservation plays a key role in the development of reproducible and cost-effective cell-based therapies. Trehalose accumulated in freezing- and desiccation-tolerant organisms in nature has been sought as an attractive nontoxic cryoprotectant. Herein, we report a coincubation method for very rapid and efficient delivery of membrane-impermeable trehalose into ovine erythrocytes through reversible membrane permeabilization using pH-responsive, comb-like pseudopeptides. The pseudopeptidic polymers containing relatively long alkyl side chains were synthesized to mimic membrane-anchoring fusogenic proteins. The intracellular trehalose delivery efficiency was optimized by manipulating the side chain length, degree of substitution, and concentration of the pseudopeptides with different hydrophobic alkyl side chains, the pH, temperature, and time of incubation, as well as the polymer-to-cell ratio and the concentration of extracellular trehalose. Treatment of erythrocytes with the comb-like pseudopeptides for only 15 min yielded an intracellular trehalose concentration of 177.9 ± 8.6 mM, which resulted in 90.3 ± 0.7% survival after freeze-thaw. The very rapid and efficient delivery was found to be attributed to the reversible, pronounced membrane curvature change as a result of strong membrane insertion of the comb-like pseudopeptides. The pseudopeptides can enable efficient intracellular delivery of not only trehalose for improved cell cryopreservation but also other membrane-impermeable cargos.
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Affiliation(s)
- Siyuan Chen
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, U.K
| | - Liwei Wu
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, U.K
| | - Jie Ren
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, U.K
| | - Victoria Bemmer
- Department of Materials, Imperial College London, South Kensington Campus, London SW7 2AZ, U.K
| | - Richard Zajicek
- Cell & Gene Therapy Platform CMC, Platform Technology & Sciences, GlaxoSmithKline plc R&D, Gunnels Wood, Stevenage, Hertfordshire SG1 2NY, U.K
| | - Rongjun Chen
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, U.K
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20
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To study the effect of oxygen carrying capacity on expressed changes of erythrocyte membrane protein in different storage times. Biosci Rep 2020; 40:225182. [PMID: 32501470 PMCID: PMC7317602 DOI: 10.1042/bsr20200799] [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] [Received: 03/30/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/17/2022] Open
Abstract
Erythrocyte membrane is crucial to maintain the stability of erythrocyte structure. The membrane protein on the surface of erythrocyte membrane enables erythrocyte to have plasticity and pass through the microcirculation without being blocked or destroyed. Decreased deformability of erythrocyte membrane protein will lead to a series of pathological and physiological changes such as tissue and organ ischemia and hypoxia. Therefore, this research collected 30 cases of healthy blood donors, and explored erythrocyte stored at different times relating indicators including effective oxygen uptake (Q), P50, 2,3-DPG, Na+-k+-ATP. Erythrocyte morphology was observed by electron microscopy. Western blot and immunofluorescence assay were used to detect membrane protein EPB41, S1P, GLTP, SPPL2A expression changes of erythrocyte. To explore the effective carry oxygen capacity of erythrocyte at different storage time resulting in the expression change of erythrocyte surface membrane protein.
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21
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Fisher AD, Dunn J, Pickett JR, Garza J, Miles EA, Diep V, Escott M. Implementation of a low titer group O whole blood program for a law enforcement tactical team. Transfusion 2020; 60 Suppl 3:S36-S44. [DOI: 10.1111/trf.15625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/19/2019] [Accepted: 11/19/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Andrew D. Fisher
- Medical Command, Texas Army National Guard Austin Texas
- Texas A&M College of Medicine Temple Texas
- Prehospital Research in Military and Expeditionary Environments (PRIME2) San Antonio Texas
| | - John Dunn
- Texas Department of Public Safety Austin Texas
| | - Jason R. Pickett
- Texas Department of Public Safety Austin Texas
- Austin‐Travis County Office of the Medical Director Austin Texas
| | | | | | | | - Mark Escott
- Texas Department of Public Safety Austin Texas
- Austin‐Travis County Office of the Medical Director Austin Texas
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22
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Timm B, Abdulmalik O, Chakrabarti A, Elmer J. Purification of Lumbricus terrestris erythrocruorin (LtEc) with anion exchange chromatography. J Chromatogr B Analyt Technol Biomed Life Sci 2020; 1150:122162. [PMID: 32505113 DOI: 10.1016/j.jchromb.2020.122162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Abstract
The naturally extracellular hemoglobin (erythrocruorin) of the Canadian nightcrawler, Lumbricus terrestris (LtEc), is a unique oxygen transport protein that may be an effective substitute for donated human blood. Indeed, this ultra-high molecular weight (~3.6 MDa) hemoglobin has already been shown to avoid the side effects associated with previous hemoglobin-based oxygen carriers and its high thermal stability (Tm = 56°C) and resistance to heme oxidation (kox = 0.04 hr-1 × 103 at 20°C) allow it to be stored for long periods of time without refrigeration. However, before it can be tested in human clinical trials, an effective and scalable purification process for LtEc must be developed. We have previously purified LtEc for animal studies with tangential flow filtration (TFF), which allows rapid and scalable purification of LtEc based on its relatively large size, but that type of size-based purification may not be able to specifically remove some impurities and high MW (>500 kDa) contaminants like endotoxin (MW = ~1-4 MDa). Anion exchange (AEX) and immobilized metal affinity chromatography (IMAC) are two purification methods that have been previously used to purify mammalian hemoglobins, but they have not yet been used to purify large invertebrate hemoglobins like LtEc. Therefore, the goal of this study was to determine if AEX and IMAC resins could successfully purify LtEc from crude earthworm homogenate, while also preserving its macromolecular structure and function. Both processes were able to produce purified LtEc with low levels of endotoxin, but IMAC purification induced significantly higher levels of heme oxidation and subunit dissociation than AEX. In addition, the IMAC process required an additional desalting step to enable LtEc binding. In contrast, AEX produced highly pure LtEc that was not dissociated. LtEc purified by AEX also exhibits similar oxygen binding characteristics (P50 = 27.33 ± 1.82 mm Hg, n = 1.58 ± 0.17) to TFF-purified LtEc (P50 = 28.84 ± 0.40 mm Hg, n = 1.93 ± 0.02). Therefore, AEX appears to be the optimal method for LtEc purification.
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Affiliation(s)
- Brandon Timm
- Department of Chemical and Biological Engineering, Villanova University, 800 East Lancaster Avenue, Villanova, PA 19085, USA
| | - Osheiza Abdulmalik
- Div. of Hematology, Abramson Building, The Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Atis Chakrabarti
- Tosoh Bioscience, LLC, 3604 Horizon Drive, King of Prussia, PA 19406, USA
| | - Jacob Elmer
- Department of Chemical and Biological Engineering, Villanova University, 800 East Lancaster Avenue, Villanova, PA 19085, USA.
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23
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Hult A, Toss F, Malm C, Oldenborg PA. In vitro phagocytosis of liquid-stored red blood cells requires serum and can be inhibited with fucoidan and dextran sulphate. Vox Sang 2020; 115:647-654. [PMID: 32350880 DOI: 10.1111/vox.12922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/03/2020] [Accepted: 03/26/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Red-blood-cells (RBCs) undergo structural and metabolic changes with prolonged storage, which ultimately may decrease their survival after transfusion. Although the storage-induced damage to RBCs has been rather well described biochemically, little is known about the mechanisms underlying the recognition and rapid clearance of the damaged cells by macrophages. MATERIALS AND METHODS We, here, used a murine model for cold (+4°C) RBC storage and transfusion. Phagocytosis of human or murine RBCs, liquid stored for 6-8 weeks or 10-14 days, respectively, was investigated in murine peritoneal macrophages. RESULTS The effects of storage on murine RBCs resembled that described for stored human RBCs with regard to decreased adenosine triphosphate (ATP) levels, accumulation of microparticles (MPs) during storage, and RBC recovery kinetics after transfusion. Under serum-free conditions, phagocytosis of stored human or murine RBCs in vitro was reduced by 70-75%, as compared with that in the presence of heat-inactivated fetal calf serum (FCS). Human serum promoted phagocytosis of stored human RBCs similar to that seen with FCS. By adding fucoidan or dextran sulphate (blockers of scavenger receptors class A (SR-A)), phagocytosis of human or murine RBCs was reduced by more than 90%. Phagocytosis of stored human RBCs was also sensitive to inhibition by the phosphatidylinositol 3 kinase-inhibitor LY294002, the ERK1/2-inhibitor PD98059, or the p38 MAPK-inhibitor SB203580. CONCLUSION RBCs damaged during liquid storage may be recognized by macrophage SR-A and serum-dependent mechanisms. This species-independent recognition mechanism may help to further understand the rapid clearance of stored RBCs shortly after transfusion.
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Affiliation(s)
- Andreas Hult
- Section for Sports Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Fredrik Toss
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden.,Division of Clinical Immunology, Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Christer Malm
- Section for Sports Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Per-Arne Oldenborg
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
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24
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Applefeld WN, Wang J, Solomon SB, Sun J, Klein HG, Natanson C. RBC Storage Lesion Studies in Humans and Experimental Models of Shock. APPLIED SCIENCES (BASEL, SWITZERLAND) 2020; 10:1838. [PMID: 38362479 PMCID: PMC10868675 DOI: 10.3390/app10051838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
The finding of toxicity in a meta-analysis of observational clinical studies of transfused longer stored red blood cells (RBC) and ethical issues surrounding aging blood for human studies prompted us to develop an experimental model of RBC transfusion. Transfusing older RBCs during canine pneumonia increased mortality rates. Toxicity was associated with in vivo hemolysis with release of cell-free hemoglobin (CFH) and iron. CFH can scavenge nitric oxide, causing vasoconstriction and endothelial injury. Iron, an essential bacterial nutrient, can worsen infections. This toxicity was seen at commonly transfused blood volumes (2 units) and was altered by the severity of pneumonia. Washing longer-stored RBCs mitigated these detrimental effects, but washing fresh RBCs actually increased them. In contrast to septic shock, transfused longer stored RBCs proved beneficial in hemorrhagic shock by decreasing reperfusion injury. Intravenous iron was equivalent in toxicity to transfusion of longer stored RBCs and both should be avoided during infection. Storage of longer-stored RBCs at 2 °C instead of higher standard temperatures (4-6 °C) minimized the release of CFH and iron. Haptoglobin, a plasma protein that binds CFH and increases its clearance, minimizes the toxic effects of longer-stored RBCs during infection and is a biologically plausible novel approach to treat septic shock.
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Affiliation(s)
- Willard N. Applefeld
- Critical Care Medicine Department, National Institutes of Health, Bethesda, MD 20892-1662, USA
| | - Jeffrey Wang
- Critical Care Medicine Department, National Institutes of Health, Bethesda, MD 20892-1662, USA
| | - Steven B. Solomon
- Critical Care Medicine Department, National Institutes of Health, Bethesda, MD 20892-1662, USA
| | - Junfeng Sun
- Critical Care Medicine Department, National Institutes of Health, Bethesda, MD 20892-1662, USA
| | - Harvey G. Klein
- Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD 20892-1184, USA
| | - Charles Natanson
- Critical Care Medicine Department, National Institutes of Health, Bethesda, MD 20892-1662, USA
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25
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Byrne KM, Paige TD, Flegel WA. An outcome-based review of an accredited Specialist in Blood Banking (SBB) program: 25 years and counting. Immunohematology 2020; 36:7-13. [PMID: 32324039 PMCID: PMC7219471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CONCLUSIONS Specialist in Blood Banking (SBB) programs play an important role in preparing technologists to become leaders and contributors to the field of transfusion medicine through dedicated education and training. The SBB program at the National Institutes of Health (NIH) Clinical Center has graduated 55 students since 1994 with an overall pass rate of 96 percent for the American Society for Clinical Pathology (ASCP) SBB examination. Graduates hold positions in a variety of transfusion medicine-related fields, with hospitals, blood centers, and Immunohematology Reference Laboratories being the most common categories of employer. Projects completed as part of the program added to transfusion medicine knowledge as evidenced by publications and awards. Almost half of all projects completed led to publications (49%), and greater than 50 percent of submissions have been selected for the AABB Future Leaders Scholarship (previously known as AABB Fenwal Scholarship Award). The students have completed over 40 program value-added opportunities. This information was available for retrieval and review. In this review, we analyzed data for the last 25 years from the SBB program at the NIH Clinical Center on program statistics, student accomplishments (such as publications in peer-reviewed journals), program value-added opportunities (such as other publications and audits performed with our Quality Assurance office), and job procurement. The collected, reviewed, and organized data provided a useful internal self-assessment to review the history of our program and head into the future.
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Affiliation(s)
- Karen M Byrne
- Education Coordinator, Department of Transfusion Medicine, Clinical Center, National Institutes of Health
| | - Traci D Paige
- Supervisor, Transfusion Services Laboratory, Department of Transfusion Medicine, Clinical Center, National Institutes of Health
| | - Willy A Flegel
- Laboratory Services Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health
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26
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Atreya C, Glynn S, Busch M, Kleinman S, Snyder E, Rutter S, AuBuchon J, Flegel W, Reeve D, Devine D, Cohn C, Custer B, Goodrich R, Benjamin RJ, Razatos A, Cancelas J, Wagner S, Maclean M, Gelderman M, Cap A, Ness P. Proceedings of the Food and Drug Administration public workshop on pathogen reduction technologies for blood safety 2018 (Commentary, p. 3026). Transfusion 2019; 59:3002-3025. [PMID: 31144334 PMCID: PMC6726584 DOI: 10.1111/trf.15344] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Chintamani Atreya
- US Food and Drug Administration, Center for Biologics Evaluation and ResearchOffice of Blood Research and ReviewSilver SpringMaryland
| | - Simone Glynn
- National Heart Lung and Blood InstituteBethesdaMarylandUSA
| | | | | | - Edward Snyder
- Blood BankYale‐New Haven HospitalNew HavenConnecticut
| | - Sara Rutter
- Department of Pathology and Laboratory MedicineYale School of MedicineNew HavenConnecticut
| | - James AuBuchon
- Department of PathologyDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
| | - Willy Flegel
- Department of Transfusion MedicineNIH Clinical CenterBethesdaMaryland
| | - David Reeve
- Blood ComponentsAmerican Red CrossRockvilleMaryland
| | - Dana Devine
- Department of Lab Medicine and PathologyUniversity of Minnesota Medical CenterMinneapolisMinnesota
| | - Claudia Cohn
- Department of Lab Medicine and PathologyUniversity of Minnesota Medical CenterMinneapolisMinnesota
| | - Brian Custer
- Vitalant Research InstituteSan FranciscoCalifornia
| | - Raymond Goodrich
- Department of Microbiology, Immunology and PathologyColorado State UniversityFort CollinsColorado
| | | | | | - Jose Cancelas
- Hoxworth Blood CenterUniversity of Cincinnati HealthCincinnatiOhio
| | | | - Michelle Maclean
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies (ROLEST)University of StrathclydeGlasgowScotland
| | - Monique Gelderman
- Department of HematologyCenter for Biologics Evaluation and Research, US Food and Drug AdministrationSilver SpringMaryland
| | - Andrew Cap
- U.S. Army Institute of Surgical ResearchSan AntonioTexas
| | - Paul Ness
- Blood BankJohns Hopkins HospitalBaltimoreMaryland
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27
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Zhang J, Chen S, Yan Y, Zhu X, Qi Q, Zhang Y, Zhang Q, Xia R. Extracellular Ubiquitin is the Causal Link between Stored Blood Transfusion Therapy and Tumor Progression in a Melanoma Mouse Model. J Cancer 2019; 10:2822-2835. [PMID: 31258790 PMCID: PMC6584930 DOI: 10.7150/jca.31360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/28/2019] [Indexed: 12/14/2022] Open
Abstract
Background: The transfusion of blood that has been stored for some time was found to be associated with transfusion-related immune modulation (TRIM) responses in cancer patients, which could result in poor clinical outcomes, such as tumor recurrence, metastasis and reduced survival rate. Given the prior observation of the positive correlation between ubiquitin content in whole blood and storage duration by the investigators of the present study, it was hypothesized that this could be the causal link behind the association between the transfusion of stored blood and poor cancer prognosis. Methods: In the present study, a melanoma mouse model was used to study the potential clinical impact of ubiquitin present in stored blood on cancer prognosis through a variety of cell biology methods, such as flow cytometry and immunohistochemistry. Results: Both extracellular ubiquitin and the infusion of stored mice blood that comprised of ubiquitin reduced the apoptotic rate of melanoma cells, promoted lung tumor metastasis and tumor progression, and reduced the long-term survival rate of melanoma mice. In addition, the upregulation of tumor markers and tumorigenic TH2 cytokine generation, as well as reduced immune cell numbers, were observed in the presence of ubiquitin. Conclusions: The present findings provide novel insights into the role of ubiquitin in immune regulation in a melanoma mouse model, and suggest ubiquitin as the causal link between allogeneic blood transfusion therapy and poor cancer prognosis.
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Affiliation(s)
- Jingjun Zhang
- Department of Transfusion, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuying Chen
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuzhong Yan
- Department of Transfusion, Huashan Hospital, Fudan University, Shanghai, China
| | - Xinfang Zhu
- Department of Transfusion, Huashan Hospital, Fudan University, Shanghai, China
| | - Qi Qi
- Department of Transfusion, Huashan Hospital, Fudan University, Shanghai, China
| | - Yang Zhang
- Department of Oncology, People's Hospital of Pudong District, Shanghai, China
| | - Qi Zhang
- Department of Transfusion, Huashan Hospital, Fudan University, Shanghai, China
| | - Rong Xia
- Department of Transfusion, Huashan Hospital, Fudan University, Shanghai, China
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28
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Weatherall A, Gill M, Milligan J, Tetlow C, Harris C, Garner A, Lee A. Comparison of portable blood-warming devices under simulated pre-hospital conditions: a randomised in-vitro blood circuit study. Anaesthesia 2019; 74:1026-1032. [PMID: 31062351 DOI: 10.1111/anae.14680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2019] [Indexed: 11/27/2022]
Abstract
Pre-hospital transfusion of blood products is a vital component of many advanced pre-hospital systems. Portable fluid warmers may be utilised to help prevent hypothermia, but the limits defined by manufacturers often do not reflect their clinical use. The primary aim of this randomised in-vitro study was to assess the warming performance of four portable blood warming devices (Thermal Angel, Hypotherm X LG, °M Warmer, Buddy Lite) against control at different clinically-relevant flow rates. The secondary aim was to assess haemolysis rates between devices at different flow rates. We assessed each of the four devices and the control, at flow rates of 50 ml.min-1 , 100 ml.min-1 and 200 ml.min-1 , using a controlled perfusion circuit with multisite temperature monitoring. Free haemoglobin concentration, a marker of haemolysis, was measured at multiple points during each initial study run with spectrophotometry. At all flow rates, the four devices provided superior warming performance compared with the control (p < 0.001). Only the °M Warmer provided a substantial change in temperature at all flow rates (mean (95%CI) temperature change of 21.1 (19.8-22.4) °C, 20.4 (19.1-21.8) °C and 19.4 (17.7-21.1) °C at 50 ml.min-1 , 100 ml.min-1 and 200 ml.min-1 , respectively). There was no association between warming and haemolysis with any device (p = 0.949) or flow rate (p = 0.169). Practical issues, which may be relevant to clinical use, also emerged during testing. Our results suggest that there were significant differences in the performance of portable blood warming devices used at flow rates encountered in clinical practice.
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Affiliation(s)
- A Weatherall
- CareFlight, Sydney, NSW, Australia.,Faculty of Medicine, University of Sydney, NSW, Australia
| | - M Gill
- Department of Perfusion, Children's Hospital at Westmead, Sydney, NSW, Australia
| | | | - C Tetlow
- CareFlight, Sydney, NSW, Australia
| | - C Harris
- Department of Haematology, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - A Garner
- CareFlight, Sydney, NSW, Australia
| | - A Lee
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong
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29
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Development of Zinc Chelating Resin Polymer Beads for the Removal of Cell-Free Hemoglobin. Ann Biomed Eng 2019; 47:1470-1478. [PMID: 30919138 DOI: 10.1007/s10439-019-02249-6] [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: 12/18/2018] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
Red blood cell (RBC) hemolysis is one of the most common storage lesions in packed RBCs (pRBC). Older units of pRBCs, especially those > 21 days old, have increasing levels of hemolysis leading to increased oxidative stress and premature platelet activation. This effect can mostly be attributed to the increase of cell-free hemoglobin (Hb). Therefore, removal of cell-free Hb from pRBCs prior to transfusion could mitigate these deleterious effects. We propose a new method for the removal of Hb from pRBCs using zinc beads. Prepared Hb solutions and pRBCs were treated with zinc beads using two different protocols. UV-Vis spectrophotometry was used to determine Hb concentrations, before and after treatment. Experiments were run in triplicate and paired t tests were used to determine significant differences between groups. Zinc beads removed on average 94% of cell-free Hb within 15 min and 78% Hb from pRBCs (p < 0.0001), demonstrating a maximum binding capacity ~ 66.2 ± 0.7 mg Hb/mL beads. No differences in RBC morphology or deformability were observed after treatment. This study demonstrates the feasibility of using zinc beads for the rapid and targeted removal of Hb from pRBC units. Further investigation is needed to scale this method for large volume removal.
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30
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Tornero E, Pereira A, Basora M, Lozano L, Morata L, Muñoz-Mahammud E, Combalia A, Soriano A. Intraoperative Transfusion of Red Blood Cell Units Stored >14 Days is Associated with an Increased Risk of Prosthetic Joint Infection. J Bone Jt Infect 2019; 4:85-91. [PMID: 31011513 PMCID: PMC6470657 DOI: 10.7150/jbji.30001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/09/2019] [Indexed: 01/12/2023] Open
Abstract
Background: The aim of the present study was to evaluate the association between prosthetic joint infection (PJI) after joint arthroplasty and the length of red blood cell (RBC) storage, timing of RBC transfusion, and the number of RBC units transfused. Study design and Methods: All patients who underwent a primary or revision joint artrhoplasty between January 2000 and December 2012 were retrospectively reviewed. For this study, only patients who received RBC transfusions during the day of the surgery (early transfusion group) or within the first 4 days after surgery (late transfusion group) were included. Results: A total of 9906 patients were reviewed. In the early transfusion group (n=1153, 11.6%), patients receiving 1 or 2 RBC units (3.5% vs 6.3%, P=0.041), 3 or 4 RBC (1.3% vs 13.3%, P=0.004) or ≥5 RBC units (5.0% vs 37.5%, P=0.026) had a higher PJI rate only when >50% of RBC units transfused had been stored >14 days. In the late transfusion group (n=920, 9.3%) these differences were not significant. Early transfusion of RBCs stored >14 days was an independent variable associated with an increased risk of PJI (OR:2.50, 95%CI:1.44-4.33) Conclusion: Transfusion of RBC within the first 6h after joint arthroplasty was an independent variable associated with PJI risk when RBC units are stored >14 days. The rate of PJI increased with the number of old RBC units transfused within this critical period.
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Affiliation(s)
- Eduard Tornero
- Department of Traumatology and Orthopedic Surgery, Hospital Clinic of Barcelona. IDIBAPS. Universitat de Barcelona.,✉ Corresponding author: Eduard Tornero, Department of Traumatology and Orthopedic Surgery, Hospital Clinic of Barcelona. IDIBAPS. C/Villarroel 170, 08036 Barcelona, Spain. Telph: +34932275533 // Fax: +34934514438;
| | - Arturo Pereira
- Service of Hemotherapy and Hemostasis, Hospital Clinic of Barcelona
| | | | - Luis Lozano
- Department of Traumatology and Orthopedic Surgery, Hospital Clinic of Barcelona. IDIBAPS. Universitat de Barcelona
| | - Laura Morata
- Service of Infectious Diseases. Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS. Barcelona Spain.
| | - Ernesto Muñoz-Mahammud
- Department of Traumatology and Orthopedic Surgery, Hospital Clinic of Barcelona. IDIBAPS. Universitat de Barcelona
| | - Andreu Combalia
- Department of Traumatology and Orthopedic Surgery, Hospital Clinic of Barcelona. IDIBAPS. Universitat de Barcelona
| | - Alex Soriano
- Service of Infectious Diseases. Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS. Barcelona Spain.
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31
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Bouchard BA, Orfeo T, Keith HN, Lavoie EM, Gissel M, Fung M, Mann KG. Microparticles formed during storage of red blood cell units support thrombin generation. J Trauma Acute Care Surg 2019; 84:598-605. [PMID: 29251713 DOI: 10.1097/ta.0000000000001759] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Intact red blood cells (RBCs) appear to support thrombin generation in in vitro models of blood coagulation. During storage of RBC units, biochemical, structural, and physiological changes occur including alterations to RBC membranes and release of microparticles, which are collectively known as storage lesion. The clinical consequences of microparticle formation in RBC units are unclear. This study was performed to assess thrombin generation via the prothrombinase complex by washed RBCs and RBC-derived microparticles as a function of RBC unit age. METHODS Well-characterized kinetic and flow cytometric assays were used to quantify and characterize microparticles isolated from leukocyte-reduced RBC units during storage for 42 days under standard blood banking conditions. RESULTS Stored RBCs exhibited known features of storage lesion including decreasing pH, cell lysis, and release of microparticles demonstrated by scanning electron microscopy. The rate of thrombin formation by RBC units linearly increased during storage, with the microparticle fraction accounting for approximately 70% of the prothrombinase activity after 35 days. High-resolution flow cytometric analyses of microparticle isolates identified phosphatidylserine-positive RBC-derived microparticles; however, their numbers over time did not correlate with thrombin formation in that fraction. CONCLUSION Red blood cell-derived microparticles capable of supporting prothrombinase function accumulate during storage, suggesting an increased potential of transfused units as they age to interact in unplanned ways with ongoing hemostatic processes in injured individuals, especially given the standard blood bank practice of using the oldest units available.
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Affiliation(s)
- Beth A Bouchard
- From the Department of Biochemistry (B.A.B., T.O., H.N.K., E.M.L., M.G., K.G.M.), and Blood Bank and Transfusion Medicine, Department of Pathology (M.F.), The Larner College of Medicine at the University of Vermont, Burlington, Vermont
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32
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Guruprasad P, Mannino RG, Caruso C, Zhang H, Josephson CD, Roback JD, Lam WA. Integrated automated particle tracking microfluidic enables high-throughput cell deformability cytometry for red cell disorders. Am J Hematol 2019; 94:189-199. [PMID: 30417938 DOI: 10.1002/ajh.25345] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 12/17/2022]
Abstract
Investigating individual red blood cells (RBCs) is critical to understanding hematologic diseases, as pathology often originates at the single-cell level. Many RBC disorders manifest in altered biophysical properties, such as deformability of RBCs. Due to limitations in current biophysical assays, there exists a need for high-throughput analysis of RBC deformability with single-cell resolution. To that end, we present a method that pairs a simple in vitro artificial microvasculature network system with an innovative MATLAB-based automated particle tracking program, allowing for high-throughput, single-cell deformability index (sDI) measurements of entire RBC populations. We apply our technology to quantify the sDI of RBCs from healthy volunteers, Sickle cell disease (SCD) patients, a transfusion-dependent beta thalassemia major patient, and in stored packed RBCs (pRBCs) that undergo storage lesion over 4 weeks. Moreover, our system can also measure cell size for each RBC, thereby enabling 2D analysis of cell deformability vs cell size with single cell resolution akin to flow cytometry. Our results demonstrate the clear existence of distinct biophysical RBC subpopulations with high interpatient variability in SCD as indicated by large magnitude skewness and kurtosis values of distribution, the "shifting" of sDI vs RBC size curves over transfusion cycles in beta thalassemia, and the appearance of low sDI RBC subpopulations within 4 days of pRBC storage. Overall, our system offers an inexpensive, convenient, and high-throughput method to gauge single RBC deformability and size for any RBC population and has the potential to aid in disease monitoring and transfusion guidelines for various RBC disorders.
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Affiliation(s)
- Puneeth Guruprasad
- Wallace H. Coulter Department of Biomedical Engineering; Georgia Institute of Technology and Emory University; Atlanta Georgia
| | - Robert G. Mannino
- Wallace H. Coulter Department of Biomedical Engineering; Georgia Institute of Technology and Emory University; Atlanta Georgia
- Aflac Cancer and Blood Disorder Center of Children's Healthcare of Atlanta, Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Christina Caruso
- Aflac Cancer and Blood Disorder Center of Children's Healthcare of Atlanta, Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | | | - Cassandra D. Josephson
- Department of Pathology and Laboratory Medicine; Emory University School of Medicine, Center for Transfusion and Cellular Therapies; Atlanta Georgia
| | - John D. Roback
- Department of Pathology and Laboratory Medicine; Emory University School of Medicine, Center for Transfusion and Cellular Therapies; Atlanta Georgia
| | - Wilbur A. Lam
- Wallace H. Coulter Department of Biomedical Engineering; Georgia Institute of Technology and Emory University; Atlanta Georgia
- Aflac Cancer and Blood Disorder Center of Children's Healthcare of Atlanta, Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
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33
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Thielen AJF, Meulenbroek EM, Baas I, Bruggen R, Zeerleder SS, Wouters D. Complement Deposition and IgG Binding on Stored Red Blood Cells Are Independent of Storage Time. Transfus Med Hemother 2018; 45:378-384. [PMID: 30574054 DOI: 10.1159/000486759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 01/11/2018] [Indexed: 12/14/2022] Open
Abstract
Background In the Netherlands, red blood cells (RBCs) are allowed to be stored up to 35 days at 2-6 °C in saline-adenine-glucose-mannitol (SAGM). During storage, RBCs undergo several changes that are collectively known as storage lesion. We investigated to what extent complement deposition and antibody binding occurred during RBC storage and investigated phagocytic uptake in vitro. Methods RBCs were stored for different lengths of time at 2-6 °C in SAGM. Complement deposition and antibody binding were assessed upon storage and after incubation with serum. M1- and M2-type macrophages were generated from blood monocytes to investigate RBC phagocytosis. Results No complement deposition was directly observed on stored RBCs, while incubation of RBCs with serum resulted in variable donor-dependent C3 deposition and IgG binding, both independent of storage time. Only 1-4% phagocytosis of stored RBCs by macrophages was observed. Conclusion RBCs are susceptible to complement deposition and antibody binding independent of storage time. Limited phagocytic uptake by macrophages was observed in vitro.
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Affiliation(s)
- Astrid J F Thielen
- Department of Immunopathology, Sanquin Research, Amsterdam, the Netherlands
| | | | - Inge Baas
- Department of Immunopathology, Sanquin Research, Amsterdam, the Netherlands
| | - Robin Bruggen
- Department of Immunopathology, Sanquin Research, Amsterdam, the Netherlands
| | - Sacha S Zeerleder
- Department of Immunopathology, Sanquin Research, Amsterdam, the Netherlands
| | - Diana Wouters
- Department of Immunopathology, Sanquin Research, Amsterdam, the Netherlands
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Taguchi K, Nagao S, Maeda H, Yanagisawa H, Sakai H, Yamasaki K, Wakayama T, Watanabe H, Otagiri M, Maruyama T. Biomimetic carbon monoxide delivery based on hemoglobin vesicles ameliorates acute pancreatitis in mice via the regulation of macrophage and neutrophil activity. Drug Deliv 2018; 25:1266-1274. [PMID: 29847178 PMCID: PMC6058524 DOI: 10.1080/10717544.2018.1477860] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Macrophages play a central role in various inflammatory disorders and are broadly divided into two subpopulations, M1 and M2 macrophage. In the healing process in acute inflammatory disorders, shifting the production of M1 macrophages to M2 macrophages is desirable, because M1 macrophages secrete pro-inflammatory cytokines, whilst the M2 variety secrete anti-inflammatory cytokines. Previous findings indicate that when macrophages are treated with carbon monoxide (CO), the secretion of anti-inflammatory cytokine is increased and the expression of pro-inflammatory cytokines is inhibited, indicating that CO may have a potential to modulate the production of macrophages toward the M2-like phenotype. In this study, we examined the issue of whether CO targeting macrophages using a nanotechnology-based CO donor, namely CO-bound hemoglobin vesicles (CO-HbV), modulates their polarization and show therapeutic effects against inflammatory disorders. The results showed that the CO-HbV treatment polarized a macrophage cell line toward an M2-like phenotype. Furthermore, in an in vivo study using acute pancreatitis model mice as a model of an inflammatory disease, a CO-HbV treatment also tended to polarize macrophages toward an M2-like phenotype and inhibited neutrophil infiltration in the pancreas, resulting in a significant inflammation. In addition to the suppression of acute pancreatitis, CO-HbV diminished a subsequent pancreatitis-associated acute lung injury. This could be due to the inhibition of the systemic inflammation, neutrophil infiltration in the lungs and the production of HMGB-1. These findings suggest that CO-HbV exerts superior anti-inflammatory effects against inflammatory disorders via the regulation of macrophage and neutrophil activity.
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Affiliation(s)
- Kazuaki Taguchi
- a Faculty of Pharmaceutical Sciences , Sojo University , Kumamoto , Japan
| | - Saori Nagao
- b Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences , Kumamoto University , Kumamoto , Japan
| | - Hitoshi Maeda
- b Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences , Kumamoto University , Kumamoto , Japan
| | - Hiroki Yanagisawa
- b Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences , Kumamoto University , Kumamoto , Japan
| | - Hiromi Sakai
- c Department of Chemistry , Nara Medical University , Kashihara , Japan
| | - Keishi Yamasaki
- a Faculty of Pharmaceutical Sciences , Sojo University , Kumamoto , Japan.,d DDS Research Institute , Sojo University , Kumamoto , Japan
| | - Tomohiko Wakayama
- e Department of Histology, Graduate School of Medical Sciences , Kumamoto University , Kumamoto , Japan
| | - Hiroshi Watanabe
- b Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences , Kumamoto University , Kumamoto , Japan.,f Center for Clinical Pharmaceutical Sciences, School of Pharmacy , Kumamoto University , Kumamoto , Japan
| | - Masaki Otagiri
- a Faculty of Pharmaceutical Sciences , Sojo University , Kumamoto , Japan.,d DDS Research Institute , Sojo University , Kumamoto , Japan
| | - Toru Maruyama
- b Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences , Kumamoto University , Kumamoto , Japan.,f Center for Clinical Pharmaceutical Sciences, School of Pharmacy , Kumamoto University , Kumamoto , Japan
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35
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Refaai MA, Conley GW, Henrichs KF, McRae H, Schmidt AE, Phipps RP, Spinelli SL, Masel D, Cholette JM, Pietropaoli A, Eaton MP, Blumberg N. Decreased Hemolysis and Improved Platelet Function in Blood Components Washed With Plasma-Lyte A Compared to 0.9% Sodium Chloride. Am J Clin Pathol 2018; 150:146-153. [PMID: 29878038 DOI: 10.1093/ajcp/aqy036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 03/26/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Washing cellular blood products is accepted to ameliorate repeated severe allergic reactions but is associated with RBC hemolysis and suboptimal platelet function. We compared in vitro hemolysis and platelet function in blood components after washing with Plasma-Lyte A (PL-A) vs normal saline (NS). METHODS RBC (n = 14) were washed/resuspended in NS or PL-A. Free hemoglobin and heme were determined at 0, 24, 48, and 72 hours. Platelet concentrates (PCs; n = 21) were washed with NS or PL-A and resuspended in same washing solution (n = 13) or ABO-identical plasma (n = 8). Platelet aggregation and spreading were evaluated. RESULTS The 24-hour free hemoglobin and heme levels were higher in NS (P < .05). Improved platelet function was observed in PL-A-washed PCs (P < .001). DISCUSSION PL-A showed less RBC hemolysis and better platelet function than NS. Whether such differences would occur in vivo is unknown.
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Affiliation(s)
- Majed A Refaai
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, Rochester, NY
| | - Grace W Conley
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, Rochester, NY
| | - Kelly F Henrichs
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, Rochester, NY
| | - Hannah McRae
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, Rochester, NY
| | - Amy E Schmidt
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, Rochester, NY
| | - Richard P Phipps
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, Rochester, NY
- Departments of Environmental Medicine and Microbiology and Immunology, Rochester, NY
- Department of Pediatrics and Critical Care and Cardiology Division, Golisano Children’s Hospital, Rochester, NY
- Department of Medicine, Pulmonary and Critical Care Division, Rochester, NY
| | - Sherry L Spinelli
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, Rochester, NY
| | - Debra Masel
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, Rochester, NY
| | - Jill M Cholette
- Department of Pediatrics and Critical Care and Cardiology Division, Golisano Children’s Hospital, Rochester, NY
| | | | - Michael P Eaton
- Department of Anesthesia, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY
| | - Neil Blumberg
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, Rochester, NY
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36
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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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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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38
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Cox HD, Miller GD, Lai A, Cushman D, Ganz T, Eichner D. Evaluation of serum markers for improved detection of autologous blood transfusions. Haematologica 2018; 103:e443-e445. [PMID: 29674501 DOI: 10.3324/haematol.2018.190918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Holly D Cox
- Sports Medicine Research and Testing Laboratory, Salt Lake City, UT, USA
| | - Geoffrey D Miller
- Sports Medicine Research and Testing Laboratory, Salt Lake City, UT, USA.,University of Utah School of Medicine - Division of Physical Medicine and Rehabilitation, Salt Lake City, UT, USA
| | - Auriella Lai
- Sports Medicine Research and Testing Laboratory, Salt Lake City, UT, USA
| | - Dan Cushman
- University of Utah School of Medicine - Division of Physical Medicine and Rehabilitation, Salt Lake City, UT, USA
| | - Tomas Ganz
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory, Salt Lake City, UT, USA.,University of Utah School of Medicine - Division of Physical Medicine and Rehabilitation, Salt Lake City, UT, USA
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Time-Course Investigation of Small Molecule Metabolites in MAP-Stored Red Blood Cells Using UPLC-QTOF-MS. Molecules 2018; 23:molecules23040923. [PMID: 29659551 PMCID: PMC6017316 DOI: 10.3390/molecules23040923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 04/08/2018] [Accepted: 04/12/2018] [Indexed: 01/04/2023] Open
Abstract
Red blood cells (RBCs) are routinely stored for 35 to 42 days in most countries. During storage, RBCs undergo biochemical and biophysical changes known as RBC storage lesion, which is influenced by alternative storage additive solutions (ASs). Metabolomic studies have been completed on RBCs stored in a number of ASs, including SAGM, AS-1, AS-3, AS-5, AS-7, PAGGGM, and MAP. However, the reported metabolome analysis of laboratory-made MAP-stored RBCs was mainly focused on the time-dependent alterations in glycolytic intermediates during storage. In this study, we investigated the time-course of alterations in various small molecule metabolites in RBCs stored in commercially used MAP for 49 days using ultra-high performance liquid chromatography quadruple time-of-flight mass spectrometry (UPLC-QTOF-MS). These alterations indicated that RBC storage lesion is related to multiple pathways including glycolysis, pentose phosphate pathway, glutathione homeostasis, and purine metabolism. Thus, our findings might be useful for understanding the complexity of metabolic mechanisms of RBCs in vitro aging and encourage the deployment of systems biology methods to blood products in transfusion medicine.
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40
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McQuilten ZK, French CJ, Nichol A, Higgins A, Cooper DJ. Effect of age of red cells for transfusion on patient outcomes: a systematic review and meta-analysis. Transfus Med Rev 2018. [DOI: 10.1016/j.tmrv.2018.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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41
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Antosik A, Czubak K, Cichon N, Nowak P, Zbikowska H. Vitamin E Analogue Protects Red Blood Cells against Storage-Induced Oxidative Damage. Transfus Med Hemother 2018; 45:347-354. [PMID: 30498413 DOI: 10.1159/000486605] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 01/03/2018] [Indexed: 01/20/2023] Open
Abstract
Background To investigate i) the effects of Trolox® or mannitol, which represent two different classes of antioxidants, on oxidative changes generated in manually isolated red blood cells (RBCs) from citrate-phosphate-dextrose (CPD) preserved whole blood, followed by up to 20 days refrigerated storage, and ii) whether Trolox supplemented to the blood bank-manufactured saline-adenine-glucose-mannitol (SAGM) preserved RBC units would offer better storage conditions compared with SAGM alone. Methods The percentage of hemolysis and extracellular activity of lactate dehydrogenase (LDH) was measured to assess RBC membrane integrity. Lipid peroxidation, reduced glutathione (GSH) levels and total antioxidant capacity (TAC) were quantified by thiobarbituric acid-reactive substances (TBARS), Ellman's reagent and 2, 2'-azinobis-(3-ethylbenzothiazoline-6-sulfonate) (ABTS.+) based assay, respectively. Results Trolox was little more effective than mannitol in protecting against progressive RBC hemolysis. Trolox (0.125-3.125 mmol/l) inhibited storage-induced leakage of LDH, lipid peroxidation, and to a lesser extent GSH depletion. Mannitol at these concentrations neither inhibited TBARS formation nor prevented GSH depletion. RBC units stored in SAGM-Trolox had significantly lower hemolysis, LDH leakage, and lipid peroxidation level compared to RBCs stored in SAGM. Conclusion There is evidence of the beneficial effects of supplementing RBC-additive solutions with membrane-interacting antioxidants such as vitamin E analogues.
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Affiliation(s)
- Adam Antosik
- Department of General Biochemistry, University of Lodz, Lodz, Poland
| | - Kamila Czubak
- Department of General Biochemistry, University of Lodz, Lodz, Poland
| | - Natalia Cichon
- Department of General Biochemistry, University of Lodz, Lodz, Poland
| | - Pawel Nowak
- Department of General Biochemistry, University of Lodz, Lodz, Poland
| | - Halina Zbikowska
- Department of General Biochemistry, University of Lodz, Lodz, Poland
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42
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Remy KE, Hall MW, Cholette J, Juffermans NP, Nicol K, Doctor A, Blumberg N, Spinella PC, Norris PJ, Dahmer MK, Muszynski JA. Mechanisms of red blood cell transfusion-related immunomodulation. Transfusion 2018; 58:804-815. [PMID: 29383722 DOI: 10.1111/trf.14488] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/13/2017] [Accepted: 12/10/2017] [Indexed: 01/28/2023]
Abstract
Red blood cell (RBC) transfusion is common in critically ill, postsurgical, and posttrauma patients in whom both systemic inflammation and immune suppression are associated with adverse outcomes. RBC products contain a multitude of immunomodulatory mediators that interact with and alter immune cell function. These interactions can lead to both proinflammatory and immunosuppressive effects. Defining clinical outcomes related to immunomodulatory effects of RBCs in transfused patients remains a challenge, likely due to complex interactions between individual blood product characteristics and patient-specific risk factors. Unpacking these complexities requires an in-depth understanding of the mechanisms of immunomodulatory effects of RBC products. In this review, we outline and classify potential mediators of RBC transfusion-related immunomodulation and provide suggestions for future research directions.
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Affiliation(s)
- Kenneth E Remy
- Department of Pediatrics, Division of Pediatric Critical Care, Washington University School of Medicine, St Louis, Missouri
| | - Mark W Hall
- Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio.,The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Jill Cholette
- Pediatric Critical Care and Cardiology, University of Rochester, Rochester, New York
| | - Nicole P Juffermans
- Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Kathleen Nicol
- Department of Pathology, Nationwide Children's Hospital, Columbus, Ohio
| | - Allan Doctor
- Department of Pediatrics, Division of Pediatric Critical Care, Washington University School of Medicine, St Louis, Missouri
| | - Neil Blumberg
- Transfusion Medicine/Blood Bank and Clinical Laboratories, Departments of Pathology and Laboratory Medicine, University of Rochester, Rochester, New York
| | - Philip C Spinella
- Department of Pediatrics, Division of Pediatric Critical Care, Washington University School of Medicine, St Louis, Missouri
| | - Philip J Norris
- Blood Systems Research Institute, San Francisco, California.,Departments of Laboratory Medicine and Medicine, University of California at San Francisco, San Francisco, California
| | - Mary K Dahmer
- Department of Pediatrics, Division of Pediatric Critical Care, University of Michigan, Ann Arbor, Michigan
| | - Jennifer A Muszynski
- Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio.,The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
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Abstract
BACKGROUND During storage, packed red blood cells (pRBCs) undergo a number of biochemical, metabolic, and morphologic changes, collectively known as the "storage lesion." We aimed to determine the effect of cryopreservation on the red blood cell storage lesion compared with traditional 4°C storage. METHODS Previously cryopreserved human pRBCs were compared with age-matched never-frozen pRBCs obtained from the local blood bank. The development of the red cell storage lesion was evaluated after 7, 14, 21, 28, and 42 days of storage at 4°C in AS-3 storage medium. We measured physiological parameters including cell counts, lactic acid, and potassium concentrations as well as signs of eryptosis including loss of phosphatidylserine (PS) asymmetry, microparticle production, and osmotic fragility in hypotonic saline. RESULTS Compared with controls, previously cryopreserved pRBC at 7 days of storage in AS-3 showed lower red cell counts (3.7 vs. 5.3 × 10 cells/μL, P < 0.01), hemoglobin (Hgb) (12.0 vs. 16.5 g/dL, P < 0.01), hematocrit (33.0% vs. 46.5%, P < 0.01), and pH (6.27 vs. 6.72, P < 0.01). Over 28 days of storage, storage cryopreserved pRBC developed increased cell-free Hgb (0.7 vs. 0.3 g/dL, P < 0.01), greater PS exposure (10.1% vs. 3.3%, P < 0.01), and microparticle production (30,836 vs. 1,802 MP/μL, P < 0.01). Previously cryopreserved cells were also less resistant to osmotic stress. CONCLUSION The red blood cell storage lesion is accelerated in previously cryopreserved pRBC after thawing. Biochemical deterioration of thawed and deglycerolized red cells suggests that storage time before transfusion should be limited to achieve similar risk profiles as never-frozen standard liquid storage pRBC units.
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44
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Vardaki MZ, Atkins CG, Schulze HG, Devine DV, Serrano K, Blades MW, Turner RFB. Raman spectroscopy of stored red blood cell concentrate within sealed transfusion blood bags. Analyst 2018; 143:6006-6013. [DOI: 10.1039/c8an01509k] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Spectral information relevant to the quality of stored blood can be obtained in situ through sealed blood transfusion bags using a commercially available instrument.
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Affiliation(s)
- M. Z. Vardaki
- Michael Smith Laboratories
- The University of British Columbia
- Vancouver
- Canada V6 T 1Z4
| | - C. G. Atkins
- Michael Smith Laboratories
- The University of British Columbia
- Vancouver
- Canada V6 T 1Z4
- Department of Chemistry
| | - H. G. Schulze
- Michael Smith Laboratories
- The University of British Columbia
- Vancouver
- Canada V6 T 1Z4
| | - D. V. Devine
- Department of Pathology and Laboratory Medicine
- The University of British Columbia
- Vancouver
- Canada V6 T 2B5
- Centre for Blood Research
| | - K. Serrano
- Department of Pathology and Laboratory Medicine
- The University of British Columbia
- Vancouver
- Canada V6 T 2B5
- Centre for Blood Research
| | - M. W. Blades
- Department of Chemistry
- The University of British Columbia
- Vancouver
- Canada V6 T 1Z1
| | - R. F. B. Turner
- Michael Smith Laboratories
- The University of British Columbia
- Vancouver
- Canada V6 T 1Z4
- Department of Chemistry
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45
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Cooper DJ, McQuilten ZK, Nichol A, Ady B, Aubron C, Bailey M, Bellomo R, Gantner D, Irving DO, Kaukonen KM, McArthur C, Murray L, Pettilä V, French C. Age of Red Cells for Transfusion and Outcomes in Critically Ill Adults. N Engl J Med 2017; 377:1858-1867. [PMID: 28952891 DOI: 10.1056/nejmoa1707572] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is uncertain whether the duration of red-cell storage affects mortality after transfusion among critically ill adults. METHODS In an international, multicenter, randomized, double-blind trial, we assigned critically ill adults to receive either the freshest available, compatible, allogeneic red cells (short-term storage group) or standard-issue (oldest available), compatible, allogeneic red cells (long-term storage group). The primary outcome was 90-day mortality. RESULTS From November 2012 through December 2016, at 59 centers in five countries, 4994 patients underwent randomization and 4919 (98.5%) were included in the primary analysis. Among the 2457 patients in the short-term storage group, the mean storage duration was 11.8 days. Among the 2462 patients in the long-term storage group, the mean storage duration was 22.4 days. At 90 days, there were 610 deaths (24.8%) in the short-term storage group and 594 (24.1%) in the long-term storage group (absolute risk difference, 0.7 percentage points; 95% confidence interval [CI], -1.7 to 3.1; P=0.57). At 180 days, the absolute risk difference was 0.4 percentage points (95% CI, -2.1 to 3.0; P=0.75). Most of the prespecified secondary measures showed no significant between-group differences in outcome. CONCLUSIONS The age of transfused red cells did not affect 90-day mortality among critically ill adults. (Funded by the Australian National Health and Medical Research Council and others; TRANSFUSE Australian and New Zealand Clinical Trials Registry number, ACTRN12612000453886 ; ClinicalTrials.gov number, NCT01638416 .).
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Affiliation(s)
- D James Cooper
- From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (D.J.C., Z.K.M., A.N., B.A., C.A., M.B., R.B., D.G., K.-M.K., L.M., C.F.), the Department of Intensive Care, Alfred Hospital (D.J.C., A.N., D.G.), the Department of Haematology, Monash Health (Z.K.M.), the Department of Intensive Care, Austin Hospital (R.B.), the University of Melbourne (R.B., C.F.), Research and Development, Australian Red Cross Blood Service (D.O.I.), and the Department of Intensive Care, Western Health (C.F.) - all in Melbourne, VIC, Australia; Irish Critical Care Clinical Trials Network, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin (A.N.); the Département de Médecine Intensive Réanimation, Brest University Hospital, Brest, France (C.A.); the Department of Anesthesiology (K.-M.K.) and the Division of Intensive Care, Department of Anesthesiology (V.P.), Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki; and the Medical Research Institute of New Zealand and the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.)
| | - Zoe K McQuilten
- From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (D.J.C., Z.K.M., A.N., B.A., C.A., M.B., R.B., D.G., K.-M.K., L.M., C.F.), the Department of Intensive Care, Alfred Hospital (D.J.C., A.N., D.G.), the Department of Haematology, Monash Health (Z.K.M.), the Department of Intensive Care, Austin Hospital (R.B.), the University of Melbourne (R.B., C.F.), Research and Development, Australian Red Cross Blood Service (D.O.I.), and the Department of Intensive Care, Western Health (C.F.) - all in Melbourne, VIC, Australia; Irish Critical Care Clinical Trials Network, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin (A.N.); the Département de Médecine Intensive Réanimation, Brest University Hospital, Brest, France (C.A.); the Department of Anesthesiology (K.-M.K.) and the Division of Intensive Care, Department of Anesthesiology (V.P.), Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki; and the Medical Research Institute of New Zealand and the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.)
| | - Alistair Nichol
- From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (D.J.C., Z.K.M., A.N., B.A., C.A., M.B., R.B., D.G., K.-M.K., L.M., C.F.), the Department of Intensive Care, Alfred Hospital (D.J.C., A.N., D.G.), the Department of Haematology, Monash Health (Z.K.M.), the Department of Intensive Care, Austin Hospital (R.B.), the University of Melbourne (R.B., C.F.), Research and Development, Australian Red Cross Blood Service (D.O.I.), and the Department of Intensive Care, Western Health (C.F.) - all in Melbourne, VIC, Australia; Irish Critical Care Clinical Trials Network, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin (A.N.); the Département de Médecine Intensive Réanimation, Brest University Hospital, Brest, France (C.A.); the Department of Anesthesiology (K.-M.K.) and the Division of Intensive Care, Department of Anesthesiology (V.P.), Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki; and the Medical Research Institute of New Zealand and the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.)
| | - Bridget Ady
- From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (D.J.C., Z.K.M., A.N., B.A., C.A., M.B., R.B., D.G., K.-M.K., L.M., C.F.), the Department of Intensive Care, Alfred Hospital (D.J.C., A.N., D.G.), the Department of Haematology, Monash Health (Z.K.M.), the Department of Intensive Care, Austin Hospital (R.B.), the University of Melbourne (R.B., C.F.), Research and Development, Australian Red Cross Blood Service (D.O.I.), and the Department of Intensive Care, Western Health (C.F.) - all in Melbourne, VIC, Australia; Irish Critical Care Clinical Trials Network, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin (A.N.); the Département de Médecine Intensive Réanimation, Brest University Hospital, Brest, France (C.A.); the Department of Anesthesiology (K.-M.K.) and the Division of Intensive Care, Department of Anesthesiology (V.P.), Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki; and the Medical Research Institute of New Zealand and the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.)
| | - Cécile Aubron
- From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (D.J.C., Z.K.M., A.N., B.A., C.A., M.B., R.B., D.G., K.-M.K., L.M., C.F.), the Department of Intensive Care, Alfred Hospital (D.J.C., A.N., D.G.), the Department of Haematology, Monash Health (Z.K.M.), the Department of Intensive Care, Austin Hospital (R.B.), the University of Melbourne (R.B., C.F.), Research and Development, Australian Red Cross Blood Service (D.O.I.), and the Department of Intensive Care, Western Health (C.F.) - all in Melbourne, VIC, Australia; Irish Critical Care Clinical Trials Network, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin (A.N.); the Département de Médecine Intensive Réanimation, Brest University Hospital, Brest, France (C.A.); the Department of Anesthesiology (K.-M.K.) and the Division of Intensive Care, Department of Anesthesiology (V.P.), Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki; and the Medical Research Institute of New Zealand and the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.)
| | - Michael Bailey
- From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (D.J.C., Z.K.M., A.N., B.A., C.A., M.B., R.B., D.G., K.-M.K., L.M., C.F.), the Department of Intensive Care, Alfred Hospital (D.J.C., A.N., D.G.), the Department of Haematology, Monash Health (Z.K.M.), the Department of Intensive Care, Austin Hospital (R.B.), the University of Melbourne (R.B., C.F.), Research and Development, Australian Red Cross Blood Service (D.O.I.), and the Department of Intensive Care, Western Health (C.F.) - all in Melbourne, VIC, Australia; Irish Critical Care Clinical Trials Network, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin (A.N.); the Département de Médecine Intensive Réanimation, Brest University Hospital, Brest, France (C.A.); the Department of Anesthesiology (K.-M.K.) and the Division of Intensive Care, Department of Anesthesiology (V.P.), Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki; and the Medical Research Institute of New Zealand and the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.)
| | - Rinaldo Bellomo
- From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (D.J.C., Z.K.M., A.N., B.A., C.A., M.B., R.B., D.G., K.-M.K., L.M., C.F.), the Department of Intensive Care, Alfred Hospital (D.J.C., A.N., D.G.), the Department of Haematology, Monash Health (Z.K.M.), the Department of Intensive Care, Austin Hospital (R.B.), the University of Melbourne (R.B., C.F.), Research and Development, Australian Red Cross Blood Service (D.O.I.), and the Department of Intensive Care, Western Health (C.F.) - all in Melbourne, VIC, Australia; Irish Critical Care Clinical Trials Network, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin (A.N.); the Département de Médecine Intensive Réanimation, Brest University Hospital, Brest, France (C.A.); the Department of Anesthesiology (K.-M.K.) and the Division of Intensive Care, Department of Anesthesiology (V.P.), Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki; and the Medical Research Institute of New Zealand and the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.)
| | - Dashiell Gantner
- From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (D.J.C., Z.K.M., A.N., B.A., C.A., M.B., R.B., D.G., K.-M.K., L.M., C.F.), the Department of Intensive Care, Alfred Hospital (D.J.C., A.N., D.G.), the Department of Haematology, Monash Health (Z.K.M.), the Department of Intensive Care, Austin Hospital (R.B.), the University of Melbourne (R.B., C.F.), Research and Development, Australian Red Cross Blood Service (D.O.I.), and the Department of Intensive Care, Western Health (C.F.) - all in Melbourne, VIC, Australia; Irish Critical Care Clinical Trials Network, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin (A.N.); the Département de Médecine Intensive Réanimation, Brest University Hospital, Brest, France (C.A.); the Department of Anesthesiology (K.-M.K.) and the Division of Intensive Care, Department of Anesthesiology (V.P.), Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki; and the Medical Research Institute of New Zealand and the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.)
| | - David O Irving
- From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (D.J.C., Z.K.M., A.N., B.A., C.A., M.B., R.B., D.G., K.-M.K., L.M., C.F.), the Department of Intensive Care, Alfred Hospital (D.J.C., A.N., D.G.), the Department of Haematology, Monash Health (Z.K.M.), the Department of Intensive Care, Austin Hospital (R.B.), the University of Melbourne (R.B., C.F.), Research and Development, Australian Red Cross Blood Service (D.O.I.), and the Department of Intensive Care, Western Health (C.F.) - all in Melbourne, VIC, Australia; Irish Critical Care Clinical Trials Network, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin (A.N.); the Département de Médecine Intensive Réanimation, Brest University Hospital, Brest, France (C.A.); the Department of Anesthesiology (K.-M.K.) and the Division of Intensive Care, Department of Anesthesiology (V.P.), Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki; and the Medical Research Institute of New Zealand and the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.)
| | - Kirsi-Maija Kaukonen
- From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (D.J.C., Z.K.M., A.N., B.A., C.A., M.B., R.B., D.G., K.-M.K., L.M., C.F.), the Department of Intensive Care, Alfred Hospital (D.J.C., A.N., D.G.), the Department of Haematology, Monash Health (Z.K.M.), the Department of Intensive Care, Austin Hospital (R.B.), the University of Melbourne (R.B., C.F.), Research and Development, Australian Red Cross Blood Service (D.O.I.), and the Department of Intensive Care, Western Health (C.F.) - all in Melbourne, VIC, Australia; Irish Critical Care Clinical Trials Network, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin (A.N.); the Département de Médecine Intensive Réanimation, Brest University Hospital, Brest, France (C.A.); the Department of Anesthesiology (K.-M.K.) and the Division of Intensive Care, Department of Anesthesiology (V.P.), Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki; and the Medical Research Institute of New Zealand and the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.)
| | - Colin McArthur
- From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (D.J.C., Z.K.M., A.N., B.A., C.A., M.B., R.B., D.G., K.-M.K., L.M., C.F.), the Department of Intensive Care, Alfred Hospital (D.J.C., A.N., D.G.), the Department of Haematology, Monash Health (Z.K.M.), the Department of Intensive Care, Austin Hospital (R.B.), the University of Melbourne (R.B., C.F.), Research and Development, Australian Red Cross Blood Service (D.O.I.), and the Department of Intensive Care, Western Health (C.F.) - all in Melbourne, VIC, Australia; Irish Critical Care Clinical Trials Network, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin (A.N.); the Département de Médecine Intensive Réanimation, Brest University Hospital, Brest, France (C.A.); the Department of Anesthesiology (K.-M.K.) and the Division of Intensive Care, Department of Anesthesiology (V.P.), Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki; and the Medical Research Institute of New Zealand and the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.)
| | - Lynne Murray
- From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (D.J.C., Z.K.M., A.N., B.A., C.A., M.B., R.B., D.G., K.-M.K., L.M., C.F.), the Department of Intensive Care, Alfred Hospital (D.J.C., A.N., D.G.), the Department of Haematology, Monash Health (Z.K.M.), the Department of Intensive Care, Austin Hospital (R.B.), the University of Melbourne (R.B., C.F.), Research and Development, Australian Red Cross Blood Service (D.O.I.), and the Department of Intensive Care, Western Health (C.F.) - all in Melbourne, VIC, Australia; Irish Critical Care Clinical Trials Network, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin (A.N.); the Département de Médecine Intensive Réanimation, Brest University Hospital, Brest, France (C.A.); the Department of Anesthesiology (K.-M.K.) and the Division of Intensive Care, Department of Anesthesiology (V.P.), Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki; and the Medical Research Institute of New Zealand and the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.)
| | - Ville Pettilä
- From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (D.J.C., Z.K.M., A.N., B.A., C.A., M.B., R.B., D.G., K.-M.K., L.M., C.F.), the Department of Intensive Care, Alfred Hospital (D.J.C., A.N., D.G.), the Department of Haematology, Monash Health (Z.K.M.), the Department of Intensive Care, Austin Hospital (R.B.), the University of Melbourne (R.B., C.F.), Research and Development, Australian Red Cross Blood Service (D.O.I.), and the Department of Intensive Care, Western Health (C.F.) - all in Melbourne, VIC, Australia; Irish Critical Care Clinical Trials Network, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin (A.N.); the Département de Médecine Intensive Réanimation, Brest University Hospital, Brest, France (C.A.); the Department of Anesthesiology (K.-M.K.) and the Division of Intensive Care, Department of Anesthesiology (V.P.), Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki; and the Medical Research Institute of New Zealand and the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.)
| | - Craig French
- From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (D.J.C., Z.K.M., A.N., B.A., C.A., M.B., R.B., D.G., K.-M.K., L.M., C.F.), the Department of Intensive Care, Alfred Hospital (D.J.C., A.N., D.G.), the Department of Haematology, Monash Health (Z.K.M.), the Department of Intensive Care, Austin Hospital (R.B.), the University of Melbourne (R.B., C.F.), Research and Development, Australian Red Cross Blood Service (D.O.I.), and the Department of Intensive Care, Western Health (C.F.) - all in Melbourne, VIC, Australia; Irish Critical Care Clinical Trials Network, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin (A.N.); the Département de Médecine Intensive Réanimation, Brest University Hospital, Brest, France (C.A.); the Department of Anesthesiology (K.-M.K.) and the Division of Intensive Care, Department of Anesthesiology (V.P.), Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki; and the Medical Research Institute of New Zealand and the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.)
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Abstract
PURPOSE OF REVIEW Red blood cell transfusion is a common treatment for anaemia worldwide, but concerns continue to be raised about adverse effects of cellular blood components, which are biological products. One hypothesis for the adverse effects associated with blood transfusion is the harmful effects of storage on red cells that have been demonstrated in laboratory and animal studies. Over the past few years, a number of more significant randomized controlled trials comparing 'fresh' versus 'older' blood have been published in an attempt to address the clinical consequences of storage age, with two further large trials ongoing. RECENT FINDINGS These recent trials enrolled approximately 4000 participants across a variety of populations - cardiac surgical, critically ill, paediatric and acute hospitalized in-patients. All trials achieved statistically significant separation of red cell storage duration between both groups. The results of all these trials have found no clinical benefit to using fresher red cells when compared with older or standard-issue red cells. However, certain subgroups of patients either receiving red cells stored at more extreme ages of storage or those with additional risks for impaired microcirculations (critically ill elderly, severe sepsis and major haemorrhage) were either underrepresented or not included in these trials. SUMMARY At present, on the basis of recent trials, there is no indication for blood transfusion services to implement preferential utilization of fresher red cell units.
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Francis RO, Hod EA. The questions surrounding stored blood do not get old. Transfusion 2017; 57:1328-1331. [PMID: 28594139 DOI: 10.1111/trf.14129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Richard O Francis
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
| | - Eldad A Hod
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
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Sanz CC, Pereira A. Age of blood and survival after massive transfusion. Transfus Clin Biol 2017; 24:449-453. [PMID: 28529005 DOI: 10.1016/j.tracli.2017.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/06/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Massive transfusion is the clinical scenario where the presumed adverse effects of stored blood are expected to be more evident because the whole patient's blood volume is replaced by stored blood. OBJECTIVE To analyse the association between age of transfused red blood cells (RBC) and survival in massively transfused patients. METHODS In this retrospective study, clinical and transfusion data of all consecutive patients massively transfused between 2008 and 2014 in a large, tertiary-care hospital were electronically extracted from the Transfusion Service database and the patients' electronic medical records. Prognostic factors for in-hospital mortality were investigated by multivariate logistic regression. RESULTS A total of 689 consecutive patients were analysed (median age: 61 years; 65% males) and 272 died in-hospital. Projected mortality at 2, 30, and 90 days was 21%, 35% and 45%, respectively. The odds ratio (OR) for in-hospital mortality among patients who survived after the 2nd day increased with patient age (OR: 1.037, 95% CI: 1.021-1.054; per year P<0.001), with the number of RBC unit transfused in the first 48hours (OR: 1.060; 95% CI: 1.038-1.020 per unit; P<0.001), and the percentage of such RBC stored for more than 28 days (1.010, 95% CI: 1.005-1.018 per percent point; P=0.01). CONCLUSION Mortality after massive transfusion was associated with a higher proportion of old RBCs transfused in the first 48hours. Other factors associated with poor prognosis were older patient's age and larger volumes of transfused RBCs.
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Affiliation(s)
- C C Sanz
- Transfusion Service, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain.
| | - A Pereira
- Transfusion Service, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
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Baek JH, Yalamanoglu A, Gao Y, Guenster R, Spahn DR, Schaer DJ, Buehler PW. Iron accelerates hemoglobin oxidation increasing mortality in vascular diseased guinea pigs following transfusion of stored blood. JCI Insight 2017; 2:93577. [PMID: 28469086 DOI: 10.1172/jci.insight.93577] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/04/2017] [Indexed: 12/20/2022] Open
Abstract
Non-transferrin-bound iron (NTBI) and free hemoglobin (Hb) accumulate in circulation following stored RBC transfusions. This study investigated transfusion, vascular disease, and mortality in guinea pigs after stored RBC transfusion alone and following cotransfusion with apo-transferrin (apo-Tf) and haptoglobin (Hp). The effects of RBC exchange transfusion dose (1, 3, and 9 units), storage period (14 days), and mortality were evaluated in guinea pigs with a vascular disease phenotype. Seven-day mortality and the interaction between iron and Hb as cocontributors to adverse outcome were studied. Concentrations of iron and free Hb were greatest after transfusion with 9 units of stored RBCs compared with fresh RBCs or stored RBCs at 1- and 3-unit volumes. Nine units of stored RBCs led to mortality in vascular diseased animals, but not normal animals. One and 3 units of stored RBCs did not cause a mortality effect, suggesting the concomitant relevance of NTBI and Hb on outcome. Cotransfusion with apo-Tf or Hp restored survival to 100% following 9-unit RBC transfusions in vascular diseased animals. Our data suggest that increases in plasma NTBI and Hb contribute to vascular disease-associated mortality through iron-enhanced Hb oxidation and enhanced tissue injury.
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Affiliation(s)
| | | | - Yamei Gao
- Division of Viral Products, Center of Biologics Evaluation and Research (CBER), FDA, Silver Spring, Maryland, USA
| | - Ricardo Guenster
- Institute of Anesthesiology, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anesthesiology, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Dominik J Schaer
- Division of Internal Medicine, University of Zurich, Zurich, Switzerland
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50
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Comparison of the Pharmacokinetic Properties of Hemoglobin-Based Oxygen Carriers. J Funct Biomater 2017; 8:jfb8010011. [PMID: 28335469 PMCID: PMC5371884 DOI: 10.3390/jfb8010011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 12/23/2022] Open
Abstract
Hemoglobin (Hb) is an ideal material for use in the development of an oxygen carrier in view of its innate biological properties. However, the vascular retention of free Hb is too short to permit a full therapeutic effect because Hb is rapidly cleared from the kidney via glomerular filtration or from the liver via the haptogloblin-CD 163 pathway when free Hb is administered in the blood circulation. Attempts have been made to develop alternate acellular and cellular types of Hb based oxygen carriers (HBOCs), in which Hb is processed via various routes in order to regulate its pharmacokinetic properties. These HBOCs have been demonstrated to have superior pharmacokinetic properties including a longer half-life than the Hb molecule in preclinical and clinical trials. The present review summarizes and compares the pharmacokinetic properties of acellular and cellular type HBOCs that have been developed through different approaches, such as polymerization, PEGylation, cross-linking, and encapsulation.
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