The 24-hour posttransfusion survival and lifespan of autologous baboon red cells treated with inositol hexaphosphate-polyethylene glycol or inositol hexaphosphate-adenosine triphosphate-polyethylene glycol to decrease oxygen affinity

Massive Transfusion in the Intensive Care Unit

The transfusion of blood components is a frequent oc currence in intensive care units. Transfusion therapy demands not only a greater ability to meet the needs of acutely ill patients with an enlarging variety of blood components, but also an increasing awareness of previ ously recognized and newly discovered hazards of blood transfusion. Use of the more commonly adminis tered blood components is reviewed, and problems per tinent to the large-volume massively or multiply trans fused patient are discussed.

The survival and function of baboon red blood cells, platelets, and plasma proteins: a review of the experience from 1972 to 2002 at the Naval Blood Research Laboratory, Boston, Massachusetts

The studies reported in this monograph were performed between 1972 and 2002 when it was possible to study healthy male and female baboons. A colony of baboons was maintained for 30 years without any adverse events observed in these baboons in the numerous studies that were performed. These protocols were reviewed and approved by the institutional animal care and use committees (IACUC) at the sites where the studies were performed and by the veterinarian services of the U.S. Navy's Bureau of Medicine and Surgery, the Office of Naval Research, and the Department of Defense. The physiology of red blood cells (RBCs), platelets (PLTs), and plasma proteins in the baboon was investigated together with the viability and function of preserved RBCs, PLTs, and plasma proteins. These studies in the baboon could not have been performed in normal volunteers and patients. The data obtained have provided critical information to explain the clinical observations reported in normal volunteers and patients after transfusion of fresh and preserved blood products. These studies were supported by the U.S. Navy's Bureau of Medicine and Surgery and the Office of Naval Research. In addition, the support of the late Congressman J. Joseph Moakley from Massachusetts is acknowledged because without his support many of these studies could not have been performed. The authors acknowledge the contributions of the numerous research collaborators identified in the 52 peer-reviewed publications that cite other funding agencies that supported the research that is reported, the editorial assistance of Ms Cynthia Ann Valeri, and the assistance of Ms Deborah Tattersall who prepared the figures and tables reported in this publication.

Volume of RBCs, 24- and 48-hour posttransfusion survivals, and the lifespan of (51)Cr and biotin-X-N-hydroxysuccinimide (NHS)-labeled autologous baboon RBCs: effect of the anticoagulant and blood pH on (51)Cr and biotin-X-NHS elution in vivo

BACKGROUND

The RBC injury that occurs during collection of the first few milliliters of blood into the pH 5.0 ACD (NIH, Formula A) is referred to as the lesion of collection. The RBC injury was evaluated by labeling the ACD RBCs with (51)Cr and measuring the 24-hour posttransfusion survival. The effect of the acidification of ACD blood on the in vivo elution of (51)Cr from the RBC has not been reported.

STUDY DESIGN AND METHODS

Baboon blood was collected in heparin and in ACD and CP2D at different ratios of blood to anticoagulant. ACD blood with a pH of 5.7 to 6.9 was labeled with (51)Cr. Heparinized blood with a pH of 7.4 was labeled with biotin-X-N-hydroxysuccinimide (NHS). ACD blood with a pH of 5.9 was labeled with both (51)Cr and biotin-X-NHS. The RBC volumes, 24- and 48-hour posttransfusion survivals, and lifespans (T50) were measured.

RESULTS

The RBC volume of ACD blood with a pH ranging from 5.7 to 6.9 was not affected by (51)Cr labeling. (51)Cr-labeled ACD blood with a pH of 6.9 had an RBC volume that was significantly greater than that seen in heparinized blood with a pH of 7.4 labeled with biotin-X-NHS. In vivo elution of (51)Cr from the RBCs prepared from the ACD blood with a pH of 5.7 to 6.9 and in vivo elution of biotin-X-NHS from RBCs prepared from ACD blood with a pH of 5.9 were associated with reductions in 24- and 48-hour posttransfusion survivals and T50.

CONCLUSIONS

The anticoagulant and the pH of the medium in which the RBCs were labeled with (51)Cr or biotin-X-NHS affected in vivo elution of the label from the RBCs and may reduce posttransfusion survival values.

Survival and function of baboon RBCs released from clotted blood and washed before autologous transfusion

BACKGROUND

One alternative to an allogeneic transfusion is the salvaging of the patient's own shed blood. In this study, baboon blood was allowed to clot and the RBCs that were released from the clotted blood lysed with and without urokinase were washed before autologous transfusion.

STUDY DESIGN AND METHODS

Forty-four studies were done in 13 baboons (Papio cynocephalus or Papio anubis) over a 3-year period. In 24 studies, a 50-mL volume of blood was collected without an anticoagulant and stored at 22 degrees C for as long as 72 hours before washing and autologous transfusion. In 20 other studies, a 50-mL volume of blood was collected without an anticoagulant and allowed to clot for 30 to 60 minutes. Urokinase, ranging from 2,500 to 10,000 units per mL, was added, and the blood was stored at 22 degrees C for 24 hours before washing and autologous transfusion.

RESULTS

RBCs that were stored at 22 degrees C without urokinase for 24 hours exhibited an in vitro recovery value of 45 percent, a (51)Cr 24-hour posttransfusion survival of 86 percent, and an index of therapeutic effectiveness of 39 percent. The (51)Cr T(50) value was normal at 14 days, and RBC oxygen-transport function was slightly reduced. RBCs that were stored at 22 degrees C for 24 hours with 10,000 units per mL of urokinase exhibited an in vitro recovery value of 89 percent, a (51)Cr 24-hour posttransfusion survival value of 86 percent, and an index of therapeutic effectiveness of 76 percent. The (51)Cr T(50) value was normal at 14 days, and the RBC oxygen-transport function was only slightly reduced.

CONCLUSION

Autologous baboon RBCs isolated from clotted blood treated or not treated with urokinase and washed before transfusion have excellent survival and normal or only slightly reduced oxygen-transport function.

The effect of disinfection on viability and function of baboon red blood cells

Methods that have been optimized for disinfection of red blood cells before transfusion must be evaluated for their effect on red blood cell viability and function in vitro and in vivo. This study evaluates (1) in vitro effects of Panavirocide treatment and benzoporphyrin (BPD) photosensitization on baboon and human red blood cell parameters and (2) in vivo effects of five disinfectant treatments on 24 h posttransfusion survival and cell lifetimes for baboon red blood cells. The in vitro studies showed that both disinfection methods resulted in a significant reduction in red blood cell potassium, suggesting that intracellular potassium is a sensitive measure of red cell injury during disinfection. The in vivo studies demonstrated significant reductions in the 24 h posttransfusion survival of baboon red blood cells and reductions in cell lifespan treated with a Panavirocide solution, BPD photosensitization and 15 mM nonactivated sodium chlorite. No effects were seen with 250 ppm formaldehyde, aluminum phthalocyanine photosensitization or activated sodium chlorite. These in vivo data showing effects of disinfection treatments support the use of baboons in studying disinfection procedures of autologous red blood cells before attempting studies in humans.

Membrane processes associated with the osmotic-pulse incorporation of inositol hexaphosphate

In previous studies (Biochem. Biophys. Res. Commun. 144, 779-786 (1987); Prog. Clin. Biol. Res. 292, 65-75 (1989)), we showed that inositol hexaphosphate (IHP), when added to erythrocyte membrane ghosts in the range 0.6-2.5 mM, caused a large disruption of skeletal protein-protein interactions as monitored by electron paramagnetic resonance techniques. IHP incorporated into intact cells by an osmotic-pulse method (J. Cell. Physiol. 129, 221-229 (1986)) leads to cells with markedly decreased oxygen affinity. Exposure of the red cells to higher levels of IHP during the osmotic pulse leads to less lysis and more normal cellular indices after healing of the transiently-disrupted membrane (J. Lab. Clin. Med. 113, 58-66 (1989)). In order to determine what effect higher levels of IHP had on skeletal proteins and bilayer lipids of membrane ghosts, spin labeling studies were performed. The main findings were: (a) There was a concentration-dependent alteration in skeletal protein interactions. At concentrations greater than 25 mM IHP, the effectiveness of IHP to disrupt skeletal protein interactions was diminished. (b) No apparent alteration of the motion or order of phospholipids or the lipid water interface of intact cells into which IHP was incorporated occurred, suggesting that higher levels of IHP do not alter the physical state of the lipid bilayer.