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Casimir M, Colard M, Dussiot M, Roussel C, Martinez A, Peyssonnaux C, Mayeux P, Benghiat S, Manceau S, Francois A, Marin N, Pène F, Buffet PA, Hermine O, Amireault P. Erythropoietin downregulates red blood cell clearance, increasing transfusion efficacy in severely anemic recipients. Am J Hematol 2023; 98:1923-1933. [PMID: 37792521 DOI: 10.1002/ajh.27117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Abstract
Red blood cells (RBC) transfusion is used to alleviate symptoms and prevent complications in anemic patients by restoring oxygen delivery to tissues. RBC transfusion efficacy, that can be measured by a rise in hemoglobin (Hb) concentration, is influenced by donor-, product-, and recipient-related characteristics. In some studies, severe pre-transfusion anemia is associated with a greater than expected Hb increment following transfusion but the biological mechanism underpinning this relationship remains poorly understood. We conducted a prospective study in critically ill patients and quantified Hb increment following one RBC transfusion. In a murine model, we investigated the possibility that, in conjunction with the host erythropoietic response, the persistence of transfused donor RBC is improved to maintain a highest RBC biomass. We confirmed a correlation between a greater Hb increment and a deeper pre-transfusion anemia in a cohort of 17 patients. In the mouse model, Hb increment and post-transfusion recovery were increased in anemic recipients. Post-transfusion RBC recovery was improved in hypoxic mice or those receiving an erythropoiesis-stimulating agent and decreased in those treated with erythropoietin (EPO)-neutralizing antibodies, suggesting that EPO signaling is necessary to observe this effect. Irradiated recipients also showed decreased post-transfusion RBC recovery. The EPO-induced post-transfusion RBC recovery improvement was abrogated in irradiated or in macrophage-depleted recipients, but maintained in splenectomized recipients, suggesting a mechanism requiring erythroid progenitors and macrophages, but which is not spleen-specific. Our study highlights a physiological role of EPO in downregulating post-transfusion RBC clearance, contributing to maintain a vital RBC biomass to rapidly cope with hypoxemia.
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Affiliation(s)
- Madeleine Casimir
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, INSERM, Institut Imagine, Université Paris Cité, Paris, France
- Département d'Hématologie, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
- Laboratory of Excellence GR-Ex, Paris, France
| | - Martin Colard
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, INSERM, Institut Imagine, Université Paris Cité, Paris, France
- Département d'Hématologie, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
- Laboratory of Excellence GR-Ex, Paris, France
| | - Michael Dussiot
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, INSERM, Institut Imagine, Université Paris Cité, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Camille Roussel
- Laboratory of Excellence GR-Ex, Paris, France
- Université Paris Cité et Université des Antilles, INSERM, BIGR, Paris, France
- Laboratoire d'Hématologie Générale, Hôpital Universitaire Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Anaïs Martinez
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, INSERM, Institut Imagine, Université Paris Cité, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Carole Peyssonnaux
- Laboratory of Excellence GR-Ex, Paris, France
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
| | - Patrick Mayeux
- Laboratory of Excellence GR-Ex, Paris, France
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
| | - Samantha Benghiat
- Département d'Hématologie, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Sandra Manceau
- Laboratory of Excellence GR-Ex, Paris, France
- Biotherapy Department, French National Sickle Cell Disease Referral Center, Clinical Investigation Center, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Anne Francois
- Établissement Français du Sang d'Ile de France, Site Hôpital Européen Georges Pompidou, Paris, France
| | - Nathalie Marin
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Centre-Université Paris Cité, Paris, France
| | - Frédéric Pène
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Centre-Université Paris Cité, Paris, France
| | - Pierre A Buffet
- Laboratory of Excellence GR-Ex, Paris, France
- Université Paris Cité et Université des Antilles, INSERM, BIGR, Paris, France
- Service Des Maladies Infectieuses et Tropicales, Hôpital Universitaire Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Olivier Hermine
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, INSERM, Institut Imagine, Université Paris Cité, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
- Département d'Hématologie, Hôpital Universitaire Necker Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Pascal Amireault
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, INSERM, Institut Imagine, Université Paris Cité, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
- Université Paris Cité et Université des Antilles, INSERM, BIGR, Paris, France
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Rapid clearance of storage-induced microerythrocytes alters transfusion recovery. Blood 2021; 137:2285-2298. [PMID: 33657208 DOI: 10.1182/blood.2020008563] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/16/2021] [Indexed: 12/19/2022] Open
Abstract
Permanent availability of red blood cells (RBCs) for transfusion depends on refrigerated storage, during which morphologically altered RBCs accumulate. Among these, a subpopulation of small RBCs, comprising type III echinocytes, spheroechinocytes, and spherocytes and defined as storage-induced microerythrocytes (SMEs), could be rapidly cleared from circulation posttransfusion. We quantified the proportion of SMEs in RBC concentrates from healthy human volunteers and assessed correlation with transfusion recovery, investigated the fate of SMEs upon perfusion through human spleen ex vivo, and explored where and how SMEs are cleared in a mouse model of blood storage and transfusion. In healthy human volunteers, high proportion of SMEs in long-stored RBC concentrates correlated with poor transfusion recovery. When perfused through human spleen, 15% and 61% of long-stored RBCs and SMEs were cleared in 70 minutes, respectively. High initial proportion of SMEs also correlated with high retention of RBCs by perfused human spleen. In the mouse model, SMEs accumulated during storage. Transfusion of long-stored RBCs resulted in reduced posttransfusion recovery, mostly due to SME clearance. After transfusion in mice, long-stored RBCs accumulated predominantly in spleen and were ingested mainly by splenic and hepatic macrophages. In macrophage-depleted mice, splenic accumulation and SME clearance were delayed, and transfusion recovery was improved. In healthy hosts, SMEs were cleared predominantly by macrophages in spleen and liver. When this well-demarcated subpopulation of altered RBCs was abundant in RBC concentrates, transfusion recovery was diminished. SME quantification has the potential to improve blood product quality assessment. This trial was registered at www.clinicaltrials.gov as #NCT02889133.
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