1
|
Pei S, Wang Y, Zhang Z, Mei C, Yin W, Fu X, Yan D, Zhu Y, Lin T, Zhou Y, Li N. Continuous blood exchange in rats as a novel approach for experimental investigation. Sci Rep 2024; 14:12194. [PMID: 38806542 PMCID: PMC11133302 DOI: 10.1038/s41598-024-63049-0] [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: 10/30/2023] [Accepted: 05/24/2024] [Indexed: 05/30/2024] Open
Abstract
Blood exchange therapy, specifically Whole blood exchange (WBE), is increasingly being utilized in clinical settings to effectively treat a range of diseases. Consequently, there is an urgent requirement to establish convenient and clinically applicable animal models that can facilitate the exploration of blood exchange therapy mechanisms. Our study conducted continuous WBE in rats through femoral and tail vein catheterization using dual-directional syringe pumps. To demonstrate the applicability of continuous WBE, drug-induced hemolytic anemia (DIHA) was induced through phenylhydrazine hydrochloride (PHZ) injection. Notability, the rats of DIHA + WBE group all survived and recovered within the subsequent period. After the implementation of continuous WBE therapy day (Day 1), the DIHA + WBE group exhibited a statistically significant increase in red blood cells (RBC) (P = 0.0343) and hemoglobin (HGB) levels (P = 0.0090) compared to DIHA group. The rats in the DIHA + WBE group exhibited a faster recovery rate compared to the DIHA group, indicating the successful establishment of a continuous blood exchange protocol. This experimental approach demonstrates not just promising efficacy in the treatment of DIHA and offers a valuable tool for investigating the underlying mechanisms of blood exchange. Furthermore, it has a great potential to the advancement of biomedical research such as drug delivery exploration.
Collapse
Affiliation(s)
- Siya Pei
- Department of Blood Transfusion, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Yanjie Wang
- Department of Blood Transfusion, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Zhimin Zhang
- Department of Blood Transfusion, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Cheng Mei
- Department of Blood Transfusion, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Wenyu Yin
- Department of Blood Transfusion, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Xiangjie Fu
- Department of Blood Transfusion, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Danyang Yan
- Department of Blood Transfusion, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Yuanyuan Zhu
- Department of Blood Transfusion, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Tianli Lin
- Department of Blood Transfusion, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Yiran Zhou
- Department of Blood Transfusion, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Ning Li
- Department of Blood Transfusion, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China.
- Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China.
- National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan Province, China.
| |
Collapse
|
2
|
Isiksacan Z, D’Alessandro A, Wolf SM, McKenna DH, Tessier SN, Kucukal E, Gokaltun AA, William N, Sandlin RD, Bischof J, Mohandas N, Busch MP, Elbuken C, Gurkan UA, Toner M, Acker JP, Yarmush ML, Usta OB. Assessment of stored red blood cells through lab-on-a-chip technologies for precision transfusion medicine. Proc Natl Acad Sci U S A 2023; 120:e2115616120. [PMID: 37494421 PMCID: PMC10410732 DOI: 10.1073/pnas.2115616120] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Transfusion of red blood cells (RBCs) is one of the most valuable and widespread treatments in modern medicine. Lifesaving RBC transfusions are facilitated by the cold storage of RBC units in blood banks worldwide. Currently, RBC storage and subsequent transfusion practices are performed using simplistic workflows. More specifically, most blood banks follow the "first-in-first-out" principle to avoid wastage, whereas most healthcare providers prefer the "last-in-first-out" approach simply favoring chronologically younger RBCs. Neither approach addresses recent advances through -omics showing that stored RBC quality is highly variable depending on donor-, time-, and processing-specific factors. Thus, it is time to rethink our workflows in transfusion medicine taking advantage of novel technologies to perform RBC quality assessment. We imagine a future where lab-on-a-chip technologies utilize novel predictive markers of RBC quality identified by -omics and machine learning to usher in a new era of safer and precise transfusion medicine.
Collapse
Affiliation(s)
- Ziya Isiksacan
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
| | - Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, CO80045
| | - Susan M. Wolf
- Law School, Medical School, Consortium on Law and Values in Health, Environment & the Life Sciences, University of Minnesota, Minneapolis, MN55455
| | - David H. McKenna
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN55455
| | - Shannon N. Tessier
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
| | | | - A. Aslihan Gokaltun
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
- Department of Chemical Engineering, Hacettepe University, Ankara06532, Turkey
| | - Nishaka William
- Laboratory Medicine and Pathology, University of Alberta, Edmonton, ABT6G 2R8, Canada
| | - Rebecca D. Sandlin
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
| | - John Bischof
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN55455
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN55455
| | | | - Michael P. Busch
- Vitalant Research Institute, San Francisco, CA94105
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA94105
| | - Caglar Elbuken
- Institute of Materials Science and Nanotechnology, National Nanotechnology Research Center, Bilkent University, Ankara06800, Turkey
- Faculty of Biochemistry and Molecular Medicine, Faculty of Medicine, University of Oulu, 90014Oulu, Finland
- Valtion Teknillinen Tutkimuskeskus Technical Research Centre of Finland Ltd., 90570Oulu, Finland
| | - Umut A. Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH44106
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH44106
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH44106
| | - Mehmet Toner
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
| | - Jason P. Acker
- Laboratory Medicine and Pathology, University of Alberta, Edmonton, ABT6G 2R8, Canada
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, ABT6G 2R8, Canada
| | - Martin L. Yarmush
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ08854
| | - O. Berk Usta
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
- Shriners Children’s, Boston, MA02114
| |
Collapse
|
3
|
Berndt M, Buttenberg M, Graw JA. Large Animal Models for Simulating Physiology of Transfusion of Red Cell Concentrates-A Scoping Review of The Literature. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1735. [PMID: 36556937 PMCID: PMC9787038 DOI: 10.3390/medicina58121735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022]
Abstract
Background and Objectives: Transfusion of red cell concentrates is a key component of medical therapy. To investigate the complex transfusion-associated biochemical and physiological processes as well as potential risks for human recipients, animal models are of particular importance. This scoping review summarizes existing large animal transfusion models for their ability to model the physiology associated with the storage of erythrocyte concentrates. Materials and Methods: The electronic databases PubMed, EMBASE, and Web of Science were systematically searched for original studies providing information on the intravenous application of erythrocyte concentrates in porcine, ovine, and canine animal models. Results: A total of 36 studies were included in the analysis. The majority of porcine studies evaluated hemorrhagic shock conditions. Pig models showed high physiological similarities with regard to red cell physiology during early storage. Ovine and canine studies were found to model typical aspects of human red cell storage at 42 days. Only four studies provided data on 24 h in vivo survival of red cells. Conclusions: While ovine and canine models can mimic typical human erythrocyte storage for up to 42 days, porcine models stand out for reliably simulating double-hit pathologies such as hemorrhagic shock. Large animal models remain an important area of translational research since they have an impact on testing new pharmacological or biophysical interventions to attenuate storage-related adverse effects and allow, in a controlled environment, to study background and interventions in dynamic and severe disease conditions.
Collapse
Affiliation(s)
- Melanie Berndt
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Maximilian Buttenberg
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Jan A. Graw
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany
- Department of Anesthesiology and Intensive Care Medicine, Ulm University, 89081 Ulm, Germany
| |
Collapse
|
4
|
Graw JA, Bünger V, Materne LA, Krannich A, Balzer F, Francis RCE, Pruß A, Spies CD, Kuebler WM, Weber-Carstens S, Menk M, Hunsicker O. Age of Red Cells for Transfusion and Outcomes in Patients with ARDS. J Clin Med 2022; 11:jcm11010245. [PMID: 35011986 PMCID: PMC8745782 DOI: 10.3390/jcm11010245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 12/12/2022] Open
Abstract
Packed red blood cells (PRBCs), stored for prolonged intervals, might contribute to adverse clinical outcomes in critically ill patients. In this study, short-term outcome after transfusion of PRBCs of two storage duration periods was analyzed in patients with Acute Respiratory Distress Syndrome (ARDS). Patients who received transfusions of PRBCs were identified from a cohort of 1044 ARDS patients. Patients were grouped according to the mean storage age of all transfused units. Patients transfused with PRBCs of a mean storage age ≤ 28 days were compared to patients transfused with PRBCs of a mean storage age > 28 days. The primary endpoint was 28-day mortality. Secondary endpoints included failure-free days composites. Two hundred and eighty-three patients were eligible for analysis. Patients in the short-term storage group had similar baseline characteristics and received a similar amount of PRBC units compared with patients in the long-term storage group (five units (IQR, 3-10) vs. four units (2-8), p = 0.14). The mean storage age in the short-term storage group was 20 (±5.4) days compared with 32 (±3.1) days in the long-term storage group (mean difference 12 days (95%-CI, 11-13)). There was no difference in 28-day mortality between the short-term storage group compared with the long-term storage group (hazard ratio, 1.36 (95%-CI, 0.84-2.21), p = 0.21). While there were no differences in ventilator-free, sedation-free, and vasopressor-free days composites, patients in the long-term storage group compared with patients in the short-term storage group had a 75% lower chance for successful weaning from renal replacement therapy (RRT) within 28 days after ARDS onset (subdistribution hazard ratio, 0.24 (95%-CI, 0.1-0.55), p < 0.001). Further analysis indicated that even a single PRBC unit stored for more than 28 days decreased the chance for successful weaning from RRT. Prolonged storage of PRBCs was not associated with a higher mortality in adults with ARDS. However, transfusion of long-term stored PRBCs was associated with prolonged dependence of RRT in critically ill patients with an ARDS.
Collapse
Affiliation(s)
- Jan A. Graw
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (V.B.); (L.A.M.); (R.C.E.F.); (C.D.S.); (S.W.-C.); (M.M.); (O.H.)
- ARDS/ECMO Centrum Charité, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Berlin Institute of Health (BIH), Charitéplatz 1, 10117 Berlin, Germany
- Correspondence:
| | - Victoria Bünger
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (V.B.); (L.A.M.); (R.C.E.F.); (C.D.S.); (S.W.-C.); (M.M.); (O.H.)
| | - Lorenz A. Materne
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (V.B.); (L.A.M.); (R.C.E.F.); (C.D.S.); (S.W.-C.); (M.M.); (O.H.)
| | - Alexander Krannich
- Experimental and Clinical Research Center (ECRC), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Felix Balzer
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, 10115 Berlin, Germany;
| | - Roland C. E. Francis
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (V.B.); (L.A.M.); (R.C.E.F.); (C.D.S.); (S.W.-C.); (M.M.); (O.H.)
- ARDS/ECMO Centrum Charité, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Axel Pruß
- Institute of Transfusion Medicine, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Claudia D. Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (V.B.); (L.A.M.); (R.C.E.F.); (C.D.S.); (S.W.-C.); (M.M.); (O.H.)
- ARDS/ECMO Centrum Charité, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Wolfgang M. Kuebler
- Institute of Physiology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (V.B.); (L.A.M.); (R.C.E.F.); (C.D.S.); (S.W.-C.); (M.M.); (O.H.)
- ARDS/ECMO Centrum Charité, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Mario Menk
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (V.B.); (L.A.M.); (R.C.E.F.); (C.D.S.); (S.W.-C.); (M.M.); (O.H.)
- ARDS/ECMO Centrum Charité, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Oliver Hunsicker
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (V.B.); (L.A.M.); (R.C.E.F.); (C.D.S.); (S.W.-C.); (M.M.); (O.H.)
- ARDS/ECMO Centrum Charité, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| |
Collapse
|
5
|
Coll AC, Ross MK, Williams ML, Wills RW, Mackin AJ, Thomason JM. Effect of washing units of canine red blood cells on storage lesions. J Vet Intern Med 2021; 36:66-77. [PMID: 34939231 PMCID: PMC8783348 DOI: 10.1111/jvim.16340] [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: 03/04/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background In humans, washing stored blood products before transfusion reduces storage lesions and incidence of transfusion reactions, but the effectiveness of washing canine blood is unknown. Objectives The objective was to determine if manually washing units of stored blood would reduce storage lesions without adversely affecting erythrocytes. We hypothesized that washing stored units would reduce concentrations of storage lesions and cause minimal erythrocyte damage. Animals Eight healthy research dogs. Methods Repeated measure cohort study. Units of whole blood were stored for 28 days and washed 3 times with 0.9% NaCl. Blood samples were collected before and after storage, after each wash, and after being held at a simulated transfusion temperature. Variables measured included CBC variables, blood gas analysis, erythrocyte morphology, mean corpuscular fragility (MCF), and eicosanoid concentrations. A Friedman's test was used to evaluate changes in variables (P < .05 was considered significant). Results After the first wash, compared to values after storage, there was a significant decrease in potassium (4.3 mmol/L [4.0‐4.7] to 1.2 mmol/L [1‐1.6]; P < .0001, median [range]), lactate (1.45 mmol/L [1.07‐1.79] to 0.69 mmol/L [0.39‐0.93]; P = .002), and partial pressure carbon dioxide (102 mm Hg [80.2‐119.2] to 33.7 mm Hg [24.5‐44.5]; P < .0001), and increase in MCV (69.3 fL [65.7‐72.3] to 74 fL [69.6‐79.5]; P = .0003), and MCF (0.444 fL [0.279‐0.527] to 0.491 fL [0.43‐0.616]; P = .0006). Conclusions and Clinical Importance A single wash of stored whole blood significantly reduces most extracellular storage lesions, and additional washing might cause hemolysis.
Collapse
Affiliation(s)
- Ashley C Coll
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Matthew K Ross
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Matthew L Williams
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Robert W Wills
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Andrew J Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - John M Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| |
Collapse
|
6
|
Callan MB, Thawley VJ, Marryott KA, Shabro A, Fernando S, Kahn S, Hudson KE, Hod EA. Hemolytic anemia blunts the cytokine response to transfusion of older red blood cells in mice and dogs. Transfusion 2021; 61:3309-3319. [PMID: 34633666 DOI: 10.1111/trf.16690] [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: 06/08/2021] [Revised: 08/25/2021] [Accepted: 09/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Transfusion of red blood cells (RBCs) stored for longer durations induces hemolysis and inflammatory cytokine production in murine and canine models. Despite immune system activation by stored RBCs, human randomized trials suggest that fresher RBC transfusions do not improve clinical outcomes. We hypothesized that underlying recipient hemolysis may affect cytokine responses to older RBC transfusions. STUDY DESIGN AND METHODS C57BL/6 mouse cohorts were infused with anti-TER119 antibody to induce hemolysis, rabbit anti-platelet antiserum to induce immune thrombocytopenia (ITP), or appropriate control antibodies. Two days later, mice were transfused with fresh or stored RBCs. Furthermore, in a prospective, randomized, blinded trial, 38 client-owned dogs with primary autoimmune hemolytic anemia (AIHA) and two dogs with ITP, requiring RBC transfusion, were enrolled and randomized to receive fresh (≤7 days) or old (≥21 days) stored RBC transfusions. Monocyte chemoattractant protein (MCP)-1 levels were assessed at defined times after transfusion. RESULTS Prior immune-mediated hemolysis blunted the MCP-1 response to stored RBC transfusion in mice (361 ± 111 pg/ml vs. 6836 ± 1528 pg/ml in mice with immune hemolysis vs. ITP, respectively; mean ± SD; p < .0001). Although hemolysis markers increased after transfusion of older RBCs, the cytokine response was also muted in dogs with AIHA. No differences in morbidity or mortality were evident comparing dogs randomized to fresh or old RBCs. CONCLUSION These data suggest that underlying hemolysis blunts inflammatory responses to old RBC transfusions. The canine data support randomized trial results suggesting a lack of clinical benefit with fresh RBC transfusions in subjects with underlying, baseline hemolysis.
Collapse
Affiliation(s)
- Mary Beth Callan
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Vincent J Thawley
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Kimberly A Marryott
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Aidin Shabro
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center - New York Presbyterian Hospital, New York, New York, USA
| | - Sebastian Fernando
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center - New York Presbyterian Hospital, New York, New York, USA
| | - Stacie Kahn
- Department of Pediatrics, Columbia University Irving Medical Center - New York Presbyterian Hospital, New York, New York, USA
| | - Krystalyn E Hudson
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center - New York Presbyterian Hospital, New York, New York, USA
| | - Eldad A Hod
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center - New York Presbyterian Hospital, New York, New York, USA
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Kanias T, Busch MP. Diversity in a blood bag: application of omics technologies to inform precision Transfusion Medicine. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:258-262. [PMID: 31184580 PMCID: PMC6683866 DOI: 10.2450/2019.0056-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/10/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Tamir Kanias
- Vitalant Research Institute, Denver, CO, United States of America
| | - Michael P. Busch
- Vitalant Research Institute, San Francisco, CA, United States of America
- Department of Laboratory Medicine, University of California, San Francisco, CA, United States of America
| |
Collapse
|
9
|
Sharma S. Role of redox iron towards an increase in mortality among patients: a systemic review and meta-analysis. Blood Res 2019; 54:87-101. [PMID: 31309086 PMCID: PMC6614104 DOI: 10.5045/br.2019.54.2.87] [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: 09/23/2018] [Revised: 11/06/2018] [Accepted: 11/06/2018] [Indexed: 11/25/2022] Open
Abstract
An increase in biochemical concentrations of non-transferrin bound iron (NTBI) within the patients with an increase in serum iron concentration was evaluated with the following objectives: (a) Iron overloading diseases/conditions with free radicle form of ‘iron containing’ reactive oxygen species (ROS) and its imbalance mediated mortality, and (b) Intervention with iron containing drugs in context to increased redox iron concentration and treatment induced mortality. Literature search was done within Pubmed and cochrane review articles. The Redox iron levels are increased during dys-erythropoiesis and among transfusion recipient population and are responsive to iron-chelation therapy. Near expiry ‘stored blood units’ show a significant rise in the ROS level. Iron mediated ROS damage may be estimated by the serum antioxidant level, and show reduction in toxicity with high antioxidant, low pro-oxidant levels. Iron drug therapy causes a significant increase in NTBI and labile iron levels. Hospitalized patients on iron therapy however show a lower mortality rate. Serum ferritin is a mortality indicator among the high-dose iron therapy and transfusion dependent population. The cumulative difference of pre-chelation to post chelation ROS iron level was 0.97 (0.62; 1.32; N=261) among the transfusion dependent subjects and 2.89 (1.81–3.98; N=130) in the post iron therapy ‘iron ROS’ group. In conclusion, iron mediated mortality may not be mediated by redox iron among multi-transfused and iron overloaded patients.
Collapse
Affiliation(s)
- Sankalp Sharma
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences Raipur, Chhattisgarh, India
| |
Collapse
|
10
|
Vostal JG, Buehler PW, Gelderman MP, Alayash AI, Doctor A, Zimring JC, Glynn SA, Hess JR, Klein H, Acker JP, Spinella PC, D'Alessandro A, Palsson B, Raife TJ, Busch MP, McMahon TJ, Intaglietta M, Swartz HM, Dubick MA, Cardin S, Patel RP, Natanson C, Weisel JW, Muszynski JA, Norris PJ, Ness PM. Proceedings of the Food and Drug Administration's public workshop on new red blood cell product regulatory science 2016. Transfusion 2017; 58:255-266. [PMID: 29243830 DOI: 10.1111/trf.14435] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 01/28/2023]
Abstract
The US Food and Drug Administration (FDA) held a workshop on red blood cell (RBC) product regulatory science on October 6 and 7, 2016, at the Natcher Conference Center on the National Institutes of Health (NIH) Campus in Bethesda, Maryland. The workshop was supported by the National Heart, Lung, and Blood Institute, NIH; the Department of Defense; the Office of the Assistant Secretary for Health, Department of Health and Human Services; and the Center for Biologics Evaluation and Research, FDA. The workshop reviewed the status and scientific basis of the current regulatory framework and the available scientific tools to expand it to evaluate innovative and future RBC transfusion products. A full record of the proceedings is available on the FDA website (http://www.fda.gov/BiologicsBloodVaccines/NewsEvents/WorkshopsMeetingsConferences/ucm507890.htm). The contents of the summary are the authors' opinions and do not represent agency policy.
Collapse
Affiliation(s)
- Jaroslav G Vostal
- Division of Blood Components and Devices, OBRR, CBER, Food and Drug Administration, Silver Spring, Maryland
| | - Paul W Buehler
- Division of Blood Components and Devices, OBRR, CBER, Food and Drug Administration, Silver Spring, Maryland
| | - Monique P Gelderman
- Division of Blood Components and Devices, OBRR, CBER, Food and Drug Administration, Silver Spring, Maryland
| | - Abdu I Alayash
- Division of Blood Components and Devices, OBRR, CBER, Food and Drug Administration, Silver Spring, Maryland
| | - Alan Doctor
- Department of Pediatric Critical Care, St Louis Children's Hospital, St Louis, Missouri
| | | | - Simone A Glynn
- Division of Blood Diseases and Resources, NHLBI, NIH, Bethesda, Maryland
| | - John R Hess
- Department of Laboratory Medicine and Hematology, University of Washington, School of Medicine, Seattle, Washington
| | - Harvey Klein
- Department of Transfusion Medicine, National Institutes of Health, Clinical Center, Bethesda, Maryland
| | - Jason P Acker
- Department of Research & Development, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Philip C Spinella
- Department of Pediatric Critical Care, Washington University School of Medicine, St Louis, Missouri
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado-Anschutz Medical Campus, Denver, Colorado
| | - Bernhard Palsson
- Center for Systems Biology, University of Iceland, Reykjavik, Iceland
| | - Thomas J Raife
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Timothy J McMahon
- Department of Medicine, Pulmonary, Allergy, & Critical Care Medicine, Duke University Medical Center, and the Durham VA Medical Center, Durham, North Carolina
| | - Marcos Intaglietta
- Department of Bioengineering, University of California at San Diego, San Diego, California
| | - Harold M Swartz
- Department of Radiology, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire
| | | | - Sylvain Cardin
- Naval Medical Research Unit-San Antonio, San Antonio, Texas
| | - Rakesh P Patel
- Center for Free Radical Biology and Translational and Molecular Sciences Certificate Program, University of Alabama, Birmingham, Alabama
| | | | - John W Weisel
- Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer A Muszynski
- Division of Critical Care Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Philip J Norris
- Blood Systems Research Institute, Blood Systems, Inc., San Francisco, California
| | - Paul M Ness
- Division of Transfusion Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
11
|
Kalhan TG, Bateman DA, Bowker RM, Hod EA, Kashyap S. Effect of red blood cell storage time on markers of hemolysis and inflammation in transfused very low birth weight infants. Pediatr Res 2017; 82:964-969. [PMID: 28738026 PMCID: PMC5685900 DOI: 10.1038/pr.2017.177] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/18/2017] [Indexed: 12/19/2022]
Abstract
BackgroundProlonged storage of transfused red blood cells (RBCs) is associated with hemolysis in healthy adults and inflammation in animal models. We aimed to determine whether storage duration affects markers of hemolysis (e.g., serum bilirubin, iron, and non-transferrin-bound iron (NTBI)) and inflammation (e.g., interleukin (IL)-8 and monocyte chemoattractant protein (MCP)-1) in transfused very low birth weight (VLBW) infants.MethodsBlood samples from 23 independent transfusion events were collected by heel stick before and 2-6 h after transfusion.ResultsSerum iron, total bilirubin, NTBI, and MCP-1 levels were significantly increased after transfusion of RBCs (P<0.05 for each comparison). The storage age of transfused RBCs positively correlated with increases in NTBI following transfusion (P<0.001; R2=0.44). No associations between storage duration and changes in the other analytes were observed.ConclusionTransfusion of RBCs into VLBW infants is associated with increased markers of hemolysis and the inflammatory chemokine MCP-1. RBC-storage duration only correlated with increases in NTBI levels following transfusion. NTBI was only observed in healthy adults following 35 days of storage; however, this study suggests that VLBW infants are potentially more susceptible to produce this pathological form of iron, with increased levels observed after transfusion of only 20-day-old RBCs.
Collapse
Affiliation(s)
- Tamara G. Kalhan
- Division of Neonatology, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York 10461
| | - David A. Bateman
- Division of Neonatology, Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, New York 10032
| | - Rakhee M. Bowker
- Division of Neonatology, Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - Eldad A. Hod
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY 10032,Correspondence: Eldad A. Hod, M.D., Department of Pathology and Cell Biology, 630 West 168th St, Room P&S 14-434, Laboratory of Transfusion Biology, College of Physicians & Surgeons of Columbia University, New York, NY 10032; Phone: 212-342-5648;
| | - Sudha Kashyap
- Division of Neonatology, Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, New York 10032
| |
Collapse
|
12
|
Fischer D, Büssow J, Meybohm P, Weber CF, Zacharowski K, Urbschat A, Müller MM, Jennewein C. Microparticles from stored red blood cells enhance procoagulant and proinflammatory activity. Transfusion 2017; 57:2701-2711. [DOI: 10.1111/trf.14268] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Dania Fischer
- Department of Anesthesiology; Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt; Frankfurt am Main Germany
| | - Julian Büssow
- Department of Anesthesiology; Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt; Frankfurt am Main Germany
| | - Patrick Meybohm
- Department of Anesthesiology; Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt; Frankfurt am Main Germany
| | - Christian Friedrich Weber
- Department of Anesthesiology; Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt; Frankfurt am Main Germany
| | - Kai Zacharowski
- Department of Anesthesiology; Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt; Frankfurt am Main Germany
| | - Anja Urbschat
- Department of Urology and Pediatric Urology; University Hospital of Marburg, Philipps-University; Marburg Germany
| | - Markus Matthias Müller
- German Red Cross Blood Transfusion Service of Baden-Wuerttemberg-Hessen, Institute of Transfusion Medicine and Immunohematology, University Hospital of Frankfurt; Frankfurt am Main Germany
| | - Carla Jennewein
- Department of Anesthesiology; Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt; Frankfurt am Main Germany
| |
Collapse
|
13
|
Suffredini DA, Xu W, Sun J, Barea-Mendoza J, Solomon SB, Brashears SL, Perlegas A, Kim-Shapiro DB, Klein HG, Natanson C, Cortés-Puch I. Parenteral irons versus transfused red blood cells for treatment of anemia during canine experimental bacterial pneumonia. Transfusion 2017; 57:2338-2347. [PMID: 28656646 DOI: 10.1111/trf.14214] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND No studies have been performed comparing intravenous (IV) iron with transfused red blood cells (RBCs) for treating anemia during infection. In a previous report, transfused older RBCs increased free iron release and mortality in infected animals when compared to fresher cells. We hypothesized that treating anemia during infection with transfused fresh RBCs, with minimal free iron release, would prove superior to IV iron therapy. STUDY DESIGN AND METHODS Purpose-bred beagles (n = 42) with experimental Staphylococcus aureus pneumonia rendered anemic were randomized to be transfused RBCs stored for 7 days or one of two IV iron preparations (7 mg/kg), iron sucrose, a widely used preparation, or ferumoxytol, a newer formulation that blunts circulating iron levels. RESULTS Both irons increased the alveolar-arterial oxygen gradient at 24 to 48 hours (p = 0.02-0.001), worsened shock at 16 hours (p = 0.02-0.003, respectively), and reduced survival (transfusion 56%; iron sucrose 8%, p = 0.01; ferumoxytol 9%, p = 0.04). Compared to fresh RBC transfusion, plasma iron measured by non-transferrin-bound iron levels increased with iron sucrose at 7, 10, 13, 16, 24, and 48 hours (p = 0.04 to p < 0.0001) and ferumoxytol at 7, 24, and 48 hours (p = 0.04 to p = 0.004). No significant differences in cardiac filling pressures or performance, hemoglobin (Hb), or cell-free Hb were observed. CONCLUSIONS During canine experimental bacterial pneumonia, treatment of mild anemia with IV iron significantly increased free iron levels, shock, lung injury, and mortality compared to transfusion of fresh RBCs. This was true for iron preparations that do or do not blunt circulating free iron level elevations. These findings suggest that treatment of anemia with IV iron during infection should be undertaken with caution.
Collapse
Affiliation(s)
- Dante A Suffredini
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Wanying Xu
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Junfeng Sun
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Jesús Barea-Mendoza
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Steven B Solomon
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Samuel L Brashears
- Department of Physics and the Translational Science Center, Wake Forest University, Winston-Salem, North Carolina
| | - Andreas Perlegas
- Department of Physics and the Translational Science Center, Wake Forest University, Winston-Salem, North Carolina
| | - Daniel B Kim-Shapiro
- Department of Physics and the Translational Science Center, Wake Forest University, Winston-Salem, North Carolina
| | - Harvey G Klein
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Charles Natanson
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Irene Cortés-Puch
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
14
|
The red cell storage lesion(s): of dogs and men. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 15:107-111. [PMID: 28263166 DOI: 10.2450/2017.0306-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 11/15/2015] [Indexed: 12/31/2022]
Abstract
The advent of preservative solutions permitted refrigerated storage of red blood cells. However, the convenience of having red blood cell inventories was accompanied by a disadvantage. Red cells undergo numerous physical and metabolic changes during cold storage, the "storage lesion(s)". Whereas controlled clinical trials have not confirmed the clinical importance of such changes, ethical and operational issues have prevented careful study of the oldest stored red blood cells. Suggestions of toxicity from meta-analyses motivated us to develop pre-clinical canine models to compare the freshest vs the oldest red blood cells. Our model of canine pneumonia with red blood cell transfusion indicated that the oldest red blood cells increased mortality, that the severity of pneumonia is important, but that the dose of transfused red blood cells is not. Washing the oldest red blood cells reduces mortality by removing senescent cells and remnants, whereas washing fresher cells increases mortality by damaging the red blood cell membrane. An opposite effect was found in a model of haemorrhagic shock with reperfusion injury. Physiological studies indicate that release of iron from old cells is a primary mechanism of toxicity during infection, whereas scavenging of cell-free haemoglobin may be beneficial during reperfusion injury. Intravenous iron appears to have toxicity equivalent to old red blood cells in the pneumonia model, suggesting that intravenous iron and old red blood cells should be administered with caution to infected patients.
Collapse
|
15
|
The controversy over the age of blood: what do the clinical trials really teach us? BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 15:112-115. [PMID: 28263167 DOI: 10.2450/2017.0328-16] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/25/2016] [Indexed: 01/28/2023]
Abstract
Red blood cell transfusions have been used in clinical practice for decades and represent the most common therapeutic procedure performed in hospitalised patients. Depending on the storage solution and national regulatory requirements, red blood cells can be stored in the refrigerator up to 42 days before transfusion. We reviewed five of the most recent randomised clinical trials that examined clinical outcomes in specific patient populations. Although these studies provide some comfort regarding our current standard of care, they do not address whether the oldest blood is associated with harm in certain patient populations.
Collapse
|
16
|
Karafin MS, Carpenter E, Pan A, Simpson P, Field JJ. Older red cell units are associated with an increased incidence of infection in chronically transfused adults with sickle cell disease. Transfus Apher Sci 2017; 56:345-351. [PMID: 28279592 DOI: 10.1016/j.transci.2017.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 11/18/2016] [Accepted: 01/31/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND In adults with sickle cell disease (SCD), the effects of the red cell storage lesion are not well defined. The objectives of this study were to: (1) describe the distribution of storage ages provided to adults with SCD, and (2) evaluate clinical outcomes associated with storage age. PATIENTS AND METHODS We performed a retrospective cohort study of adults with SCD managed with prophylactic simple transfusion regimens. Units were universally pre-storage leukocyte reduced and CEK-matched. Age of the unit was 42 days minus the difference between the expiration and transfusion dates. A mixed effects model, which accounts for a subject's contribution to repeated transfusion encounters, was used to investigate the association between storage age and the incidence of hospital encounters for infection and pain crises prior to the next red cell transfusion. RESULTS Over the study interval, twenty-eight steady-state adults with SCD received 627 units via simple transfusion over 281 outpatient encounters. Overall median unit storage age was 22 days (range: 2-42 days). Receipt of older units was associated with an increased incidence of emergency department or hospital admission for infection prior to the next transfusion (p=0.04). There was no association between unit storage age and admission for pain (p=0.4). DISCUSSION In a cohort of chronically transfused adults with SCD, we provide evidence that receipt of older units is associated with a higher rate of admission for infection. Prospective studies will need to validate these data and explore potential mechanisms by which these older units promote infection.
Collapse
Affiliation(s)
- Matthew S Karafin
- Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, WI, United States; Medical College of Wisconsin, Milwaukee, WI, United States.
| | | | - Amy Pan
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Pippa Simpson
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joshua J Field
- Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, WI, United States; Medical College of Wisconsin, Milwaukee, WI, United States
| |
Collapse
|
17
|
Rapido F, Brittenham GM, Bandyopadhyay S, La Carpia F, L'Acqua C, McMahon DJ, Rebbaa A, Wojczyk BS, Netterwald J, Wang H, Schwartz J, Eisenberger A, Soffing M, Yeh R, Divgi C, Ginzburg YZ, Shaz BH, Sheth S, Francis RO, Spitalnik SL, Hod EA. Prolonged red cell storage before transfusion increases extravascular hemolysis. J Clin Invest 2016; 127:375-382. [PMID: 27941245 DOI: 10.1172/jci90837] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/27/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Some countries have limited the maximum allowable storage duration for red cells to 5 weeks before transfusion. In the US, red blood cells can be stored for up to 6 weeks, but randomized trials have not assessed the effects of this final week of storage on clinical outcomes. METHODS Sixty healthy adult volunteers were randomized to a single standard, autologous, leukoreduced, packed red cell transfusion after 1, 2, 3, 4, 5, or 6 weeks of storage (n = 10 per group). 51-Chromium posttransfusion red cell recovery studies were performed and laboratory parameters measured before and at defined times after transfusion. RESULTS Extravascular hemolysis after transfusion progressively increased with increasing storage time (P < 0.001 for linear trend in the AUC of serum indirect bilirubin and iron levels). Longer storage duration was associated with decreasing posttransfusion red cell recovery (P = 0.002), decreasing elevations in hematocrit (P = 0.02), and increasing serum ferritin (P < 0.0001). After 6 weeks of refrigerated storage, transfusion was followed by increases in AUC for serum iron (P < 0.01), transferrin saturation (P < 0.001), and nontransferrin-bound iron (P < 0.001) as compared with transfusion after 1 to 5 weeks of storage. CONCLUSIONS After 6 weeks of refrigerated storage, transfusion of autologous red cells to healthy human volunteers increased extravascular hemolysis, saturated serum transferrin, and produced circulating nontransferrin-bound iron. These outcomes, associated with increased risks of harm, provide evidence that the maximal allowable red cell storage duration should be reduced to the minimum sustainable by the blood supply, with 35 days as an attainable goal.REGISTRATION. ClinicalTrials.gov NCT02087514. FUNDING NIH grant HL115557 and UL1 TR000040.
Collapse
|
18
|
Could Microparticles Be the Universal Quality Indicator for Platelet Viability and Function? JOURNAL OF BLOOD TRANSFUSION 2016; 2016:6140239. [PMID: 28053805 PMCID: PMC5178367 DOI: 10.1155/2016/6140239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/27/2016] [Accepted: 11/06/2016] [Indexed: 12/22/2022]
Abstract
High quality means good fitness for the intended use. Research activity regarding quality measures for platelet transfusions has focused on platelet storage and platelet storage lesion. Thus, platelet quality is judged from the manufacturer's point of view and regulated to ensure consistency and stability of the manufacturing process. Assuming that fresh product is always superior to aged product, maintaining in vitro characteristics should preserve high quality. However, despite the highest in vitro quality standards, platelets often fail in vivo. This suggests we may need different quality measures to predict platelet performance after transfusion. Adding to this complexity, platelets are used clinically for very different purposes: platelets need to circulate when given as prophylaxis to cancer patients and to stop bleeding when given to surgery or trauma patients. In addition, the emerging application of platelet-rich plasma injections exploits the immunological functions of platelets. Requirements for quality of platelets intended to prevent bleeding, stop bleeding, or promote wound healing are potentially very different. Can a single measurable characteristic describe platelet quality for all uses? Here we present microparticle measurement in platelet samples, and its potential to become the universal quality characteristic for platelet production, storage, viability, function, and compatibility.
Collapse
|
19
|
Peters AL, Kunanayagam RK, van Bruggen R, de Korte D, Juffermans NP, Vlaar APJ. Transfusion of 35-day stored red blood cells does not result in increase of plasma non-transferrin bound iron in human endotoxemia. Transfusion 2016; 57:53-59. [PMID: 27696454 DOI: 10.1111/trf.13849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Transfusion of a single unit of stored red blood cells (RBCs) has been hypothesized to induce supra-physiological levels of non-transferrin bound iron (NTBI), which may enhance inflammation and act as a nutrient for bacteria. We investigated the relation between RBC storage time and iron levels in a clinically relevant "two-hit" human transfusion model. STUDY DESIGN AND METHODS Eighteen healthy male volunteers (ages 18-35 years) were infused with 2 ng lipopolysaccharide (LPS)/kg to induce systemic inflammatory response syndrome. Two hours later, each participant received either 1 unit of 2-day stored (2D) autologous RBCs, 35-day stored (35D) autologous RBCs, or an equal volume of saline. Every 2 hours up to 8 hours after LPS infusion, hemoglobin, hemolysis parameters, and iron parameters, including NTBI, were measured. RESULTS Transfusion of both 2D and 35D RBCs caused increases in hemoglobin, plasma iron, and transferrin saturation; whereas levels remained stable in the saline group. Transfusion of 35D RBCs did not result in hemolysis nor did it lead to increased levels of NTBI compared with 2D RBCs or saline. LPS induced increases in ferritin, haptoglobin, bilirubin, and lactate dehydrogenase that were similar in all three groups. CONCLUSION We conclude that 35D autologous RBCs do not cause hemolysis or increased levels of NTBI during human endotoxemia.
Collapse
Affiliation(s)
- Anna L Peters
- Laboratory of Experimental Intensive Care and Anesthesia, Academic Medical Center.,Department of Intensive Care, Academic Medical Center
| | - Renoja K Kunanayagam
- Laboratory of Experimental Intensive Care and Anesthesia, Academic Medical Center.,Department of Intensive Care, Academic Medical Center
| | | | - Dirk de Korte
- Department of Blood Cell Research, Sanquin Research.,Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, The Netherlands
| | - Nicole P Juffermans
- Laboratory of Experimental Intensive Care and Anesthesia, Academic Medical Center.,Department of Intensive Care, Academic Medical Center
| | - Alexander P J Vlaar
- Laboratory of Experimental Intensive Care and Anesthesia, Academic Medical Center.,Department of Intensive Care, Academic Medical Center
| |
Collapse
|
20
|
Graw JA, Mayeur C, Rosales I, Liu Y, Sabbisetti VS, Riley FE, Rechester O, Malhotra R, Warren HS, Colvin RB, Bonventre JV, Bloch DB, Zapol WM. Haptoglobin or Hemopexin Therapy Prevents Acute Adverse Effects of Resuscitation After Prolonged Storage of Red Cells. Circulation 2016; 134:945-60. [PMID: 27515135 DOI: 10.1161/circulationaha.115.019955] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 06/30/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Extracellular hemoglobin and cell-free heme are toxic breakdown products of hemolyzed erythrocytes. Mammals synthesize the scavenger proteins haptoglobin and hemopexin, which bind extracellular hemoglobin and heme, respectively. Transfusion of packed red blood cells is a lifesaving therapy for patients with hemorrhagic shock. Because erythrocytes undergo progressive deleterious morphological and biochemical changes during storage, transfusion of packed red blood cells that have been stored for prolonged intervals (SRBCs; stored for 35-40 days in humans or 14 days in mice) increases plasma levels of cell-free hemoglobin and heme. Therefore, in patients with hemorrhagic shock, perfusion-sensitive organs such as the kidneys are challenged not only by hypoperfusion but also by the high concentrations of plasma hemoglobin and heme that are associated with the transfusion of SRBCs. METHODS To test whether treatment with exogenous human haptoglobin or hemopexin can ameliorate adverse effects of resuscitation with SRBCs after 2 hours of hemorrhagic shock, mice that received SRBCs were given a coinfusion of haptoglobin, hemopexin, or albumin. RESULTS Treatment with haptoglobin or hemopexin but not albumin improved the survival rate and attenuated SRBC-induced inflammation. Treatment with haptoglobin retained free hemoglobin in the plasma and prevented SRBC-induced hemoglobinuria and kidney injury. In mice resuscitated with fresh packed red blood cells, treatment with haptoglobin, hemopexin, or albumin did not cause harmful effects. CONCLUSIONS In mice, the adverse effects of transfusion with SRBCs after hemorrhagic shock are ameliorated by treatment with either haptoglobin or hemopexin. Haptoglobin infusion prevents kidney injury associated with high plasma hemoglobin concentrations after resuscitation with SRBCs. Treatment with the naturally occurring human plasma proteins haptoglobin or hemopexin may have beneficial effects in conditions of severe hemolysis after prolonged hypotension.
Collapse
Affiliation(s)
- Jan A Graw
- From Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (J.A.G., C.M., D.B.B., W.M.Z.), Department of Pathology (I.R., R.B.C.), Department of Pediatrics (F.E.R., O.R., H.S.W.), Cardiovascular Research Center and Cardiology Division, Department of Medicine (R.M.), and Division of Rheumatology, Allergy and Immunology, Department of Medicine (D.B.B.), Massachusetts General Hospital, Harvard Medical School, Boston; and Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Y.L., V.S.S., H.S.W.)
| | - Claire Mayeur
- From Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (J.A.G., C.M., D.B.B., W.M.Z.), Department of Pathology (I.R., R.B.C.), Department of Pediatrics (F.E.R., O.R., H.S.W.), Cardiovascular Research Center and Cardiology Division, Department of Medicine (R.M.), and Division of Rheumatology, Allergy and Immunology, Department of Medicine (D.B.B.), Massachusetts General Hospital, Harvard Medical School, Boston; and Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Y.L., V.S.S., H.S.W.)
| | - Ivy Rosales
- From Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (J.A.G., C.M., D.B.B., W.M.Z.), Department of Pathology (I.R., R.B.C.), Department of Pediatrics (F.E.R., O.R., H.S.W.), Cardiovascular Research Center and Cardiology Division, Department of Medicine (R.M.), and Division of Rheumatology, Allergy and Immunology, Department of Medicine (D.B.B.), Massachusetts General Hospital, Harvard Medical School, Boston; and Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Y.L., V.S.S., H.S.W.)
| | - Yumin Liu
- From Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (J.A.G., C.M., D.B.B., W.M.Z.), Department of Pathology (I.R., R.B.C.), Department of Pediatrics (F.E.R., O.R., H.S.W.), Cardiovascular Research Center and Cardiology Division, Department of Medicine (R.M.), and Division of Rheumatology, Allergy and Immunology, Department of Medicine (D.B.B.), Massachusetts General Hospital, Harvard Medical School, Boston; and Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Y.L., V.S.S., H.S.W.)
| | - Venkata S Sabbisetti
- From Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (J.A.G., C.M., D.B.B., W.M.Z.), Department of Pathology (I.R., R.B.C.), Department of Pediatrics (F.E.R., O.R., H.S.W.), Cardiovascular Research Center and Cardiology Division, Department of Medicine (R.M.), and Division of Rheumatology, Allergy and Immunology, Department of Medicine (D.B.B.), Massachusetts General Hospital, Harvard Medical School, Boston; and Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Y.L., V.S.S., H.S.W.)
| | - Frank E Riley
- From Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (J.A.G., C.M., D.B.B., W.M.Z.), Department of Pathology (I.R., R.B.C.), Department of Pediatrics (F.E.R., O.R., H.S.W.), Cardiovascular Research Center and Cardiology Division, Department of Medicine (R.M.), and Division of Rheumatology, Allergy and Immunology, Department of Medicine (D.B.B.), Massachusetts General Hospital, Harvard Medical School, Boston; and Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Y.L., V.S.S., H.S.W.)
| | - Osher Rechester
- From Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (J.A.G., C.M., D.B.B., W.M.Z.), Department of Pathology (I.R., R.B.C.), Department of Pediatrics (F.E.R., O.R., H.S.W.), Cardiovascular Research Center and Cardiology Division, Department of Medicine (R.M.), and Division of Rheumatology, Allergy and Immunology, Department of Medicine (D.B.B.), Massachusetts General Hospital, Harvard Medical School, Boston; and Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Y.L., V.S.S., H.S.W.)
| | - Rajeev Malhotra
- From Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (J.A.G., C.M., D.B.B., W.M.Z.), Department of Pathology (I.R., R.B.C.), Department of Pediatrics (F.E.R., O.R., H.S.W.), Cardiovascular Research Center and Cardiology Division, Department of Medicine (R.M.), and Division of Rheumatology, Allergy and Immunology, Department of Medicine (D.B.B.), Massachusetts General Hospital, Harvard Medical School, Boston; and Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Y.L., V.S.S., H.S.W.)
| | - H Shaw Warren
- From Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (J.A.G., C.M., D.B.B., W.M.Z.), Department of Pathology (I.R., R.B.C.), Department of Pediatrics (F.E.R., O.R., H.S.W.), Cardiovascular Research Center and Cardiology Division, Department of Medicine (R.M.), and Division of Rheumatology, Allergy and Immunology, Department of Medicine (D.B.B.), Massachusetts General Hospital, Harvard Medical School, Boston; and Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Y.L., V.S.S., H.S.W.)
| | - Robert B Colvin
- From Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (J.A.G., C.M., D.B.B., W.M.Z.), Department of Pathology (I.R., R.B.C.), Department of Pediatrics (F.E.R., O.R., H.S.W.), Cardiovascular Research Center and Cardiology Division, Department of Medicine (R.M.), and Division of Rheumatology, Allergy and Immunology, Department of Medicine (D.B.B.), Massachusetts General Hospital, Harvard Medical School, Boston; and Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Y.L., V.S.S., H.S.W.)
| | - Joseph V Bonventre
- From Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (J.A.G., C.M., D.B.B., W.M.Z.), Department of Pathology (I.R., R.B.C.), Department of Pediatrics (F.E.R., O.R., H.S.W.), Cardiovascular Research Center and Cardiology Division, Department of Medicine (R.M.), and Division of Rheumatology, Allergy and Immunology, Department of Medicine (D.B.B.), Massachusetts General Hospital, Harvard Medical School, Boston; and Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Y.L., V.S.S., H.S.W.)
| | - Donald B Bloch
- From Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (J.A.G., C.M., D.B.B., W.M.Z.), Department of Pathology (I.R., R.B.C.), Department of Pediatrics (F.E.R., O.R., H.S.W.), Cardiovascular Research Center and Cardiology Division, Department of Medicine (R.M.), and Division of Rheumatology, Allergy and Immunology, Department of Medicine (D.B.B.), Massachusetts General Hospital, Harvard Medical School, Boston; and Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Y.L., V.S.S., H.S.W.)
| | - Warren M Zapol
- From Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (J.A.G., C.M., D.B.B., W.M.Z.), Department of Pathology (I.R., R.B.C.), Department of Pediatrics (F.E.R., O.R., H.S.W.), Cardiovascular Research Center and Cardiology Division, Department of Medicine (R.M.), and Division of Rheumatology, Allergy and Immunology, Department of Medicine (D.B.B.), Massachusetts General Hospital, Harvard Medical School, Boston; and Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Y.L., V.S.S., H.S.W.).
| |
Collapse
|
21
|
Glynn SA, Klein HG, Ness PM. The red blood cell storage lesion: the end of the beginning. Transfusion 2016; 56:1462-8. [PMID: 27080455 DOI: 10.1111/trf.13609] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/10/2016] [Accepted: 03/10/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Simone A Glynn
- Blood Epidemiology and Clinical Therapeutics Branch, Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute
| | - Harvey G Klein
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Paul M Ness
- Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| |
Collapse
|
22
|
Goel R, Johnson DJ, Scott AV, Tobian AA, Ness PM, Nagababu E, Frank SM. Red blood cells stored 35 days or more are associated with adverse outcomes in high-risk patients. Transfusion 2016; 56:1690-8. [DOI: 10.1111/trf.13559] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/24/2016] [Accepted: 02/05/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Ruchika Goel
- Departments of Pathology and Pediatric Hematology/Oncology; New York Presbyterian Hospital, Weill Cornell Medical College, and The New York Blood Center; New York New York
| | - Daniel J. Johnson
- Department of Anesthesiology/Critical Care Medicine; The Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Andrew V. Scott
- Department of Anesthesiology/Critical Care Medicine; The Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Aaron A.R. Tobian
- Department of Pathology (Transfusion Medicine); The Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Paul M. Ness
- Department of Pathology (Transfusion Medicine); The Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Enika Nagababu
- Department of Anesthesiology/Critical Care Medicine; The Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Steven M. Frank
- Department of Anesthesiology/Critical Care Medicine; The Johns Hopkins Medical Institutions; Baltimore Maryland
| |
Collapse
|
23
|
Gehrie EA, Tormey CA. The strengths and limitations of animal models in assessing the effects of red blood cell storage age on clinical outcomes. Transfusion 2015; 55:2537-40. [DOI: 10.1111/trf.13289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 01/04/2023]
Affiliation(s)
- Eric A. Gehrie
- Department of Laboratory Medicine; Yale University School of Medicine; New Haven CT
| | - Christopher A. Tormey
- Department of Laboratory Medicine; Yale University School of Medicine; New Haven CT
- Pathology & Laboratory Medicine Service; VA Connecticut Healthcare System; West Haven CT
| |
Collapse
|