1
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Yu S, Deng G, Li Q, Liao Z, Yu L, Zhao X. Impact on cytokine accumulation in 35-day preserved whole blood due to resin adsorption. Transfus Apher Sci 2024; 63:103942. [PMID: 38815499 DOI: 10.1016/j.transci.2024.103942] [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: 12/22/2023] [Revised: 04/17/2024] [Accepted: 05/02/2024] [Indexed: 06/01/2024]
Abstract
Blood transfusion in critically ill individuals such as sepsis was associated with higher morbidity and mortality. During storage, various bioactive substances accumulated, may exacerbate the initial immunosuppressive reaction in severely ill patients. The objective of this study is to explore how resin adsorption impacts the accumulation of cytokines and the presence of extracellular microvesicles (EVs) in whole blood. Through comparative analysis and screening, amberchrom CG 300 C was chosen to assess the adsorption efficiency and evaluate the quality of whole blood after adsorption. Subsequently, the supernatants from both the unadsorpted (UA) and adsorpted (A) groups were co-cultured with peripheral blood mononuclear cells (PBMCs) to assess their effects on cellular growth and cytokine concentrations. The findings of our study revealed that resin adsorption effectively eradicated most bioactive components in conserved blood, including IL-8, TGF-β, sCD40L, sFasL, without affecting the quality of the blood. Furthermore, scanning electron microscopy (SEM) revealed a reduction in extracellular microvesicles following adsorption. Compared to UA, A 's supernatant markedly enhanced PBMC growth (p < 0.01). Additionally, the A's supernatant markedly diminished the emission of pro-inflammatory cytokines, like IL-6. The research revealed that adsorbing resin effectively reduced bioactive substances from preserved whole blood, and did not impact red blood cell quality, proving to be a reliable method for extracting bioactive substances from storage blood. The results could pave the way for creating innovative blood bags and hold clinical significance in lowering the frequency of TRIM among patients who have undergone transfusions.
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Affiliation(s)
- Shifang Yu
- Department of Transfusion Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, PR China
| | - Gang Deng
- The Ningbo Central Blood Station, Ningbo, Zhejiang, PR China
| | - Qiang Li
- Department of Laboratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, PR China
| | - Zhaoping Liao
- Department of Transfusion Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, PR China
| | - Lu Yu
- The Ningbo Central Blood Station, Ningbo, Zhejiang, PR China
| | - Xiaoying Zhao
- Department of Transfusion Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, PR China.
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2
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Yang J, Yang Y, Gao L, Jiang X, Sun J, Wang Z, Xie R. Adverse effects of microparticles on transfusion of stored red blood cell concentrates. Hematol Transfus Cell Ther 2024:S2531-1379(24)00038-5. [PMID: 38519412 DOI: 10.1016/j.htct.2024.01.007] [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: 08/17/2023] [Revised: 01/03/2024] [Accepted: 01/25/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Systemic and pulmonary coagulopathy and inflammation are important characteristics of transfusion-related acute lung injury (TRALI). Whether microparticles that accumulate in transfused red blood cell concentrates (RBCs) have proinflammatory and procoagulant potential and contribute to adverse reactions of RBC transfusions is unclear. AIM To investigate the ability of microparticles in stored RBCs to promote thrombin generation and induce human pulmonary microvascular endothelial cell (HMVEC) activation and damage. METHODS The number and size of microparticles were determined by flow cytometric and nanoparticle tracking analyses, respectively. Thrombin generation and the intrinsic coagulation pathway were assayed by a calibrated automated thrombogram and by measuring activated partial thromboplastin time (aPTT), respectively. The expression of ICAM-1 and the release of cytokines by endothelial cells were detected by flow cytometric analyses. HMVEC damage was assessed by incubating lipopolysaccharide-activated endothelial cells with MP-primed polymorphonuclear neutrophils (PMNs). RESULTS The size of the microparticles in the RBC supernatant was approximately 100-300 nm. Microparticles promoted thrombin generation in a dose-dependent manner and the aPTT was shortened. Depleting microparticles from the supernatant of RBCs stored for 35 days by either filtration or centrifugation significantly decreased the promotion of thrombin generation. The expression of ICAM-1 on HMVECs was increased significantly by incubation with isolated microparticles. Furthermore, microparticles induced the release of interleukin-6 (IL-6) and interleukin-8 (IL-8) from HMVECs. Microparticles induced lipopolysaccharide-activated HMVEC damage by priming PMNs, but this effect was prevented by inhibiting the PMNs respiratory burst with apocynin. CONCLUSION Microparticles in stored RBCs promote thrombin generation, HMVEC activation and damage which may be involved in TRALI development.
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Affiliation(s)
- Jie Yang
- Shanghai Institute of Blood Transfusion, Shanghai Blood Center, Shanghai, China
| | - Yiming Yang
- Shanghai Institute of Blood Transfusion, Shanghai Blood Center, Shanghai, China
| | - Li Gao
- Shanghai Institute of Blood Transfusion, Shanghai Blood Center, Shanghai, China
| | - Xueyu Jiang
- Shanghai Institute of Blood Transfusion, Shanghai Blood Center, Shanghai, China
| | - Juan Sun
- Shanghai Institute of Blood Transfusion, Shanghai Blood Center, Shanghai, China
| | - Zhicheng Wang
- Department of Transfusion Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Rufeng Xie
- Department of Transfusion Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
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3
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Liu Y, Wang R, Song C, Ding S, Zuo Y, Yi K, Li N, Wang B, Geng Q. Crosstalk between neutrophil extracellular traps and immune regulation: insights into pathobiology and therapeutic implications of transfusion-related acute lung injury. Front Immunol 2023; 14:1324021. [PMID: 38162674 PMCID: PMC10755469 DOI: 10.3389/fimmu.2023.1324021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-associated death, occurring during or within 6 hours after transfusion. Reports indicate that TRALI can be categorized as having or lacking acute respiratory distress syndrome (ARDS) risk factors. There are two types of TRALI in terms of its pathogenesis: antibody-mediated and non-antibody-mediated. The key initiation steps involve the priming and activation of neutrophils, with neutrophil extracellular traps (NETs) being established as effector molecules formed by activated neutrophils in response to various stimuli. These NETs contribute to the production and release of reactive oxygen species (ROS) and participate in the destruction of pulmonary vascular endothelial cells. The significant role of NETs in TRALI is well recognized, offering a potential pathway for TRALI treatment. Moreover, platelets, macrophages, endothelial cells, and complements have been identified as promoters of NET formation. Concurrently, studies have demonstrated that the storage of platelets and concentrated red blood cells (RBC) can induce TRALI through bioactive lipids. In this article, recent clinical and pre-clinical studies on the pathophysiology and pathogenesis of TRALI are reviewed to further illuminate the mechanism through which NETs induce TRALI. This review aims to propose new therapeutic strategies for TRALI, with the hope of effectively improving its poor prognosis.
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Affiliation(s)
- Yi Liu
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Rong Wang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Congkuan Song
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Song Ding
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yifan Zuo
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ke Yi
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ning Li
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bo Wang
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing Geng
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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4
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Yu Y, Lian Z. Update on transfusion-related acute lung injury: an overview of its pathogenesis and management. Front Immunol 2023; 14:1175387. [PMID: 37251400 PMCID: PMC10213666 DOI: 10.3389/fimmu.2023.1175387] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Transfusion-related acute lung injury (TRALI) is a severe adverse event and a leading cause of transfusion-associated death. Its poor associated prognosis is due, in large part, to the current dearth of effective therapeutic strategies. Hence, an urgent need exists for effective management strategies for the prevention and treatment of associated lung edema. Recently, various preclinical and clinical studies have advanced the current knowledge regarding TRALI pathogenesis. In fact, the application of this knowledge to patient management has successfully decreased TRALI-associated morbidity. This article reviews the most relevant data and recent progress related to TRALI pathogenesis. Based on the existing two-hit theory, a novel three-step pathogenesis model composed of a priming step, pulmonary reaction, and effector phase is postulated to explain the process of TRALI. TRALI pathogenesis stage-specific management strategies based on clinical studies and preclinical models are summarized with an explication of their models of prevention and experimental drugs. The primary aim of this review is to provide useful insights regarding the underlying pathogenesis of TRALI to inform the development of preventive or therapeutic alternatives.
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Affiliation(s)
| | - Zhengqiu Lian
- Department of Blood Transfusion, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
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5
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Tung JP, Chiaretti S, Dean MM, Sultana AJ, Reade MC, Fung YL. Transfusion-related acute lung injury (TRALI): Potential pathways of development, strategies for prevention and treatment, and future research directions. Blood Rev 2022; 53:100926. [DOI: 10.1016/j.blre.2021.100926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/01/2021] [Accepted: 12/30/2021] [Indexed: 02/08/2023]
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6
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Arslan D, Yildizdas D, Horoz OO, Aslan N, Leblebisatan G. Transfusion-Associated Acute Lung Injury following Donor Granulocyte Transfusion in Two Pediatric Patients. J Pediatr Intensive Care 2019; 8:251-254. [PMID: 31673463 DOI: 10.1055/s-0039-1694991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/06/2019] [Indexed: 10/26/2022] Open
Abstract
Transfusion-associated acute lung injury (TRALI) is one of the complications seen due to transfusion. Hypoxemia and bilateral pulmonary infiltration in posteroanterior chest roentgenogram is seen in all cases during transfusion or within the first 6 hours; fever, hypotension, and pink frothy bleeding from endotracheal tube may also be seen. It can be seen following the administration of any blood product. The management strategies for TRALI include withholding the transfusion, positive pressure breathing support, and diuretics. There are few reported cases of TRALI occurring following donor granulocyte transfusion (DGT). In this article, we discuss two cases of TRALI following DGT transfusion.
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Affiliation(s)
- Didar Arslan
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Dincer Yildizdas
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ozden Ozgur Horoz
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Nagehan Aslan
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Goksel Leblebisatan
- Department of Pediatric Hematology, Çukurova University Faculty of Medicine, Adana, Turkey
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7
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Kuldanek SA, Kelher M, Silliman CC. Risk factors, management and prevention of transfusion-related acute lung injury: a comprehensive update. Expert Rev Hematol 2019; 12:773-785. [PMID: 31282773 PMCID: PMC6715498 DOI: 10.1080/17474086.2019.1640599] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 07/03/2019] [Indexed: 12/13/2022]
Abstract
Introduction: Despite mitigation strategies that include the exclusion of females from plasma donation or the exclusion of females with a history of pregnancy or known anti-leukocyte antibody, transfusion-related acute lung injury (TRALI) remains a leading cause of transfusion-related morbidity and mortality. Areas covered: The definition of TRALI is discussed and re-aligned with the new Berlin Diagnostic Criteria for the acute respiratory distress syndrome (ARDS). The risk factors associated with TRALI are summarized as are the mitigation strategies to further reduce TRALI. The emerging basic research studies that may translate to clinical therapeutics for the prevention or treatment of TRALI are discussed. Expert opinion: At risk patients, including the genetic factors that may predispose patients to TRALI are summarized and discussed. The re-definition of TRALI employing the Berlin Criteria for ARDS will allow for increased recognition and improved research into pathophysiology and mitigation to reduce this fatal complication of hemotherapy.
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Affiliation(s)
- Susan A. Kuldanek
- The Division of Transfusion Medicine, School of Medicine University of Colorado Denver, Aurora, CO, USA
- Department of Pathology, School of Medicine University of Colorado Denver, Aurora, CO, USA
- Department of Pediatrics, School of Medicine University of Colorado Denver, Aurora, CO, USA
| | - Marguerite Kelher
- Department of Surgery, School of Medicine University of Colorado Denver, Aurora, CO, USA
| | - Christopher C. Silliman
- Department of Pediatrics, School of Medicine University of Colorado Denver, Aurora, CO, USA
- Department of Surgery, School of Medicine University of Colorado Denver, Aurora, CO, USA
- Vitalant Research Institute, Vitalant Mountain Division, Denver, CO, USA
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8
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Roubinian N. TACO and TRALI: biology, risk factors, and prevention strategies. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:585-594. [PMID: 30570487 PMCID: PMC6324877 DOI: 10.1182/asheducation-2018.1.585] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the leading causes of transfusion-related morbidity and mortality. These adverse events are characterized by acute pulmonary edema within 6 hours of a blood transfusion and have historically been difficult to study due to underrecognition and nonspecific diagnostic criteria. However, in the past decade, in vivo models and clinical studies utilizing active surveillance have advanced our understanding of their epidemiology and pathogenesis. With the adoption of mitigation strategies and patient blood management, the incidence of TRALI and TACO has decreased. Continued research to prevent and treat these severe cardiopulmonary events is focused on both the blood component and the transfusion recipient.
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Affiliation(s)
- Nareg Roubinian
- Blood Systems Research Institute, San Francisco, CA; Kaiser Permanente Northern California Medical Center and Division of Research, Oakland, CA; and Department of Laboratory Medicine, University of California, San Francisco, CA
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9
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Wirtz MR, Jurgens J, Zuurbier CJ, Roelofs JJTH, Spinella PC, Muszynski JA, Carel Goslings J, Juffermans NP. Washing or filtering of blood products does not improve outcome in a rat model of trauma and multiple transfusion. Transfusion 2018; 59:134-145. [PMID: 30461025 PMCID: PMC7379301 DOI: 10.1111/trf.15039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/04/2018] [Accepted: 09/16/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Transfusion is associated with organ failure and nosocomial infection in trauma patients, which may be mediated by soluble bioactive substances in blood products, including extracellular vesicles (EVs). We hypothesize that removing EVs, by washing or filtering of blood products, reduces organ failure and improves host immune response. MATERIALS AND METHODS Blood products were prepared from syngeneic rat blood. EVs were removed from RBCs and platelets by washing. Plasma was filtered through a 0.22‐μm filter. Rats were traumatized by crush injury to the intestines and liver, and a femur was fractured. Rats were hemorrhaged until a mean arterial pressure of 40 mm Hg and randomized to receive resuscitation with standard or washed/filtered blood products, in a 1:1:1 ratio. Sham controls were not resuscitated. Ex vivo whole blood stimulation tests were performed and histopathology was done. RESULTS Washing of blood products improved quality metrics compared to standard products. Also, EV levels reduced by 12% to 77%. The coagulation status, as assessed by thromboelastometry, was deranged in both groups and normalized during transfusion, without significant differences. Use of washed/filtered products did not reduce organ failure, as assessed by histopathologic score and biochemical measurements. Immune response ex vivo was decreased following transfusion compared to sham but did not differ between transfusion groups. CONCLUSION Filtering or washing of blood products improved biochemical properties and reduced EV counts, while maintaining coagulation abilities. However, in this trauma and transfusion model, the use of optimized blood components did not attenuate organ injury or immune suppression.
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Affiliation(s)
- Mathijs R Wirtz
- Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Trauma Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Jordy Jurgens
- Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Coert J Zuurbier
- Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Joris J T H Roelofs
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Philip C Spinella
- Department of Pediatrics, Division of Critical Care, Washington University in St Louis, St Louis, Missouri
| | - Jennifer A Muszynski
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - J Carel Goslings
- Department of Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands
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10
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Loi MM, Kelher M, Dzieciatkowska M, Hansen KC, Banerjee A, West FB, Stanley C, Briel M, Silliman CC. A comparison of different methods of red blood cell leukoreduction and additive solutions on the accumulation of neutrophil-priming activity during storage. Transfusion 2018; 58:2003-2012. [PMID: 30171813 DOI: 10.1111/trf.14788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/21/2018] [Accepted: 03/15/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Three methods of leukoreduction (LR) are used worldwide: filtration, buffy coat removal (BCR), and a combination of the previous two methods. Additionally, there are a number of additive solutions (ASs) used to preserve red blood cell (RBC) function throughout storage. During RBC storage, proinflammatory activity accumulates; thus, we hypothesize that both the method of LR and the AS affect the accumulation of proinflammatory activity. STUDY DESIGN AND METHODS Ten units of whole blood were drawn from healthy donors, the RBC units were isolated, divided in half by weight, and leukoreduced by: 1) BCR, 2) filtration, or 3) BCR and filtration (combination-LR); stored in bags containing AS-3 per AABB criteria; and sampled weekly. The supernatants were isolated and frozen (-80°C). RBC units drawn from healthy donors into AS-1-, AS-3-, or AS-5-containing bags were also stored and sampled weekly, and the supernatants were isolated and frozen. The supernatants were assayed for neutrophil (PMN)-priming activity and underwent proteomic analyses. RESULTS Filtration and combination LR decreased priming activity accumulation versus buffy coat LR, although the accumulation of priming activity was not different during storage. Combination LR increased hemolysis versus filtration via proteomic analysis. Priming activity from AS-3 units was significant later in storage versus AS-1- or AS-5-stored units. CONCLUSIONS Although both filtration and combination LR decrease the accumulation of proinflammatory activity versus buffy coat LR, combination LR is not more advantageous over filtration, has increased costs, and may cause increased hemolysis. In addition, AS-3 decreases the early accumulation of PMN-priming activity during storage versus AS-1 or AS-5.
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Affiliation(s)
- Michele M Loi
- Department of Research Laboratory, University of Colorado Denver, Aurora, Colorado.,Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
| | - Marguerite Kelher
- Department of Research Laboratory, University of Colorado Denver, Aurora, Colorado.,Department of Surgery, University of Colorado Denver, Aurora, Colorado
| | - Monika Dzieciatkowska
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Aurora, Colorado
| | - Kirk C Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Aurora, Colorado
| | - Anirban Banerjee
- Department of Surgery, University of Colorado Denver, Aurora, Colorado
| | - F Bernadette West
- Connecticut, Mid-Atlantic, and Appalachian Regions, American Red Cross, Hartford, Connecticut
| | | | - Matthew Briel
- Manufacturing, Bonfils Blood Center, Denver, Colorado
| | - Christopher C Silliman
- Department of Research Laboratory, University of Colorado Denver, Aurora, Colorado.,Department of Pediatrics, University of Colorado Denver, Aurora, Colorado.,Department of Surgery, University of Colorado Denver, Aurora, Colorado
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11
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Garraud O, Sut C, Haddad A, Tariket S, Aloui C, Laradi S, Hamzeh-Cognasse H, Bourlet T, Zeni F, Aubron C, Ozier Y, Laperche S, Peyrard T, Buffet P, Guyotat D, Tavernier E, Cognasse F, Pozzetto B, Andreu G. Transfusion-associated hazards: A revisit of their presentation. Transfus Clin Biol 2018; 25:118-135. [PMID: 29625790 DOI: 10.1016/j.tracli.2018.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
As a therapy or a support to other therapies, despite being largely beneficial to patients in general, transfusion it is not devoid of some risks. In a moderate number of cases, patients may manifest adverse reactions, otherwise referred to as transfusion-associated hazards (TAHs). The latest French 2016 haemovigilance report indicates that 93% of TAHs are minor (grade 1), 5.5% are moderate (grade 2) and 1.6% are severe (grade 3), with only five deaths (grade 4) being attributed to transfusion with relative certainty (imputability of level [or grade] 1 to 3). Health-care providers need to be well aware of the benefits and potential risks (to best evaluate and discuss the benefit-risk ratio), how to prevent TAHs, the overall costs and the availability of alternative therapeutic options. In high-income countries, most blood establishments (BEs) and hospital blood banks (HBBs) have developed tools for reporting and analysing at least severe transfusion reactions. With nearly two decades of haemovigilance, transfusion reaction databases should be quite informative, though there are four main caveats that prevent it from being fully efficient: (ai) reporting is mainly declarative and is thus barely exhaustive even in countries where it is mandatory by law; (aii) it is often difficult to differentiate between the different complications related to transfusion, diseases, comorbidities and other types of therapies in patients suffering from debilitating conditions; (aiii) there is a lack of consistency in the definitions used to describe and report some transfusion reactions, their severity and their likelihood of being related to transfusion; and (aiv) it is difficult to assess the imputability of a particular BC given to a patient who has previously received many BCs over a relatively short period of time. When compiling all available information published so far, it appears that TAHs can be analysed using different approaches: (bi) their pathophysiological nature; (bii) their severity; (biii) the onset scheme; (biv) a quality assessment (preventable or non-preventable); (bv) their impact on ongoing therapy. Moreover, TAHs can be reported either in a non-integrative or in an integrative way; in the latter case, presentation may also differ when issued by a blood establishment or a treating ward. At some point, a recapitulative document would be useful to gain a better understanding of TAHs in order to decrease their occurrence and severity and allow decision makers to determine action plans: this is what this review attempts to make. This review attempts to merge the different aspects, with a focus on the hospital side, i.e., how the most frequent TAHs can be avoided or mitigated.
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Affiliation(s)
- O Garraud
- EA3064, University of Lyon/Saint-Etienne, Saint-Etienne, France; Institut National de la Transfusion Sanguine, 75017 Paris, France.
| | - C Sut
- EA3064, University of Lyon/Saint-Etienne, Saint-Etienne, France
| | - A Haddad
- EA3064, University of Lyon/Saint-Etienne, Saint-Etienne, France; Sacré-Cœur University Hospital, Beirut, Lebanon
| | - S Tariket
- EA3064, University of Lyon/Saint-Etienne, Saint-Etienne, France
| | - C Aloui
- EA3064, University of Lyon/Saint-Etienne, Saint-Etienne, France
| | - S Laradi
- EA3064, University of Lyon/Saint-Etienne, Saint-Etienne, France; Sacré-Cœur University Hospital, Beirut, Lebanon
| | | | - T Bourlet
- EA3064, University of Lyon/Saint-Etienne, Saint-Etienne, France; Department of Microbiology, University Hospital, 42023 Saint-Etienne, France
| | - F Zeni
- EA3064, University of Lyon/Saint-Etienne, Saint-Etienne, France; Department of Critical Care, University Hospital, 29200 Saint-Etienne, France
| | - C Aubron
- Université de Bretagne Occidentale, 29200 Brest, France; Department of Critical Care, University Hospital, 75005 Brest, France
| | - Y Ozier
- Université de Bretagne Occidentale, 29200 Brest, France; Department of Critical Care, University Hospital, 75005 Brest, France
| | - S Laperche
- Institut National de la Transfusion Sanguine, 75017 Paris, France
| | - T Peyrard
- Institut National de la Transfusion Sanguine, 75017 Paris, France; Inserm S_1134, 75015 Paris, France
| | - P Buffet
- Institut National de la Transfusion Sanguine, 75017 Paris, France; Inserm S_1134, 75015 Paris, France; University Paris-Descartes, Paris, France
| | - D Guyotat
- UMR_5229, University of Lyon, 69675 Lyon, France; Institut du Cancer Lucien Neuwirth, 42023 Saint-Etienne, France
| | - E Tavernier
- UMR_5229, University of Lyon, 69675 Lyon, France; Institut du Cancer Lucien Neuwirth, 42023 Saint-Etienne, France
| | - F Cognasse
- EA3064, University of Lyon/Saint-Etienne, Saint-Etienne, France; Sacré-Cœur University Hospital, Beirut, Lebanon
| | - B Pozzetto
- EA3064, University of Lyon/Saint-Etienne, Saint-Etienne, France; Department of Microbiology, University Hospital, 42023 Saint-Etienne, France
| | - G Andreu
- Institut National de la Transfusion Sanguine, 75017 Paris, France
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12
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Affiliation(s)
- Y. L. Fung
- School of Health & Sports Sciences; University of Sunshine Coast; Sunshine Coast QLD Australia
| | - J.P. Tung
- Research and Development; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
- Critical Care Research Group; University of Queensland and The Prince Charles Hospital; Brisbane QLD Australia
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13
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Weisberg SP, Shaz BH, Tumer G, Silliman CC, Kelher MR, Cohn CS. PAS-C platelets contain less plasma protein, lower anti-A and anti-B titers, and decreased HLA antibody specificities compared to plasma platelets. Transfusion 2018; 58:891-895. [DOI: 10.1111/trf.14523] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/24/2017] [Accepted: 11/24/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Stuart P. Weisberg
- Department of Pathology and Cell Biology; Columbia University; New York New York
| | - Beth H. Shaz
- Department of Pathology and Cell Biology; Columbia University; New York New York
| | - Gizem Tumer
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis Minnesota
| | - Chris C. Silliman
- Department of Surgery; Denver Health Medical Center; Denver Colorado
| | | | - Claudia S. Cohn
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis Minnesota
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14
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Microparticles in red cell concentrates prime polymorphonuclear neutrophils and cause acute lung injury in a two-event mouse model. Int Immunopharmacol 2018; 55:98-104. [DOI: 10.1016/j.intimp.2017.11.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 12/31/2022]
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15
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Silliman CC, Kelher MR, Khan SY, West FB, McLaughlin NJD, Elzi DJ, England K, Bjornsen J, Kuldanek SA, Banerjee A. Supernatants and lipids from stored red blood cells activate pulmonary microvascular endothelium through the BLT2 receptor and protein kinase C activation. Transfusion 2017; 57:2690-2700. [PMID: 28880373 DOI: 10.1111/trf.14271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although transfusion is a lifesaving intervention, it may be associated with significant morbidity in injured patients. We hypothesize that stored red blood cells (RBCs) induce proinflammatory activation of human pulmonary microvascular endothelial cells (HMVECs) resulting in neutrophil (PMN) adhesion and predisposition to acute lung injury (ALI). STUDY DESIGN AND METHODS Ten units of RBCs were collected; 50% (by weight) were leukoreduced (LR-RBCs) and the remainder was unmodified and stored in additive solution-5 (AS-5). An additional 10 units of RBCs were collected, leukoreduced, and stored in AS-3. HMVECs were incubated with [10%-40%]FINAL of the supernatants on Day (D)1 to D42 of storage, lipid extracts, and purified lipids. Endothelial surface expression of intercellular adhesion molecule-1 (ICAM-1), interleukin (IL)-8 release, and PMN adhesion to HMVECs were measured. HMVEC signaling via the BLT2 receptor was evaluated. Supernatants and lipids were also employed as the first event in a two-event model of ALI. RESULTS The supernatants [10%-40%]FINAL from D21 LR-RBCs and D42 RBCs and LR-RBCs and the lipids from D42 stored in AS-5 induced increased ICAM-1 surface expression on endothelium, IL-8 release, and PMN adhesion. In addition, the supernatants [20%-40%]FINAL from D21 and D42 RBCs in AS-5 also increased endothelial surface expression of ICAM-1. D42 supernatants and lipids also caused coprecipitation of β-arrestin-1 with BLT2, protein kinase C (PKC)βI , and PKCδ and served as the first event in a two-event rodent model of ALI. CONCLUSION Lipids that accumulate during RBC storage activate endothelium and predispose to ALI, which may explain some of the adverse events associated with the transfusion of critically injured patients.
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Affiliation(s)
- Christopher C Silliman
- Research Laboratory, Bonfils Blood Center, Denver, Colorado.,Department of Surgery, School of Medicine, University of Colorado at Denver, Aurora, Colorado.,Department of Pediatrics, School of Medicine, University of Colorado at Denver, Aurora, Colorado
| | - Marguerite R Kelher
- Research Laboratory, Bonfils Blood Center, Denver, Colorado.,Department of Surgery, School of Medicine, University of Colorado at Denver, Aurora, Colorado
| | - Samina Y Khan
- Research Laboratory, Bonfils Blood Center, Denver, Colorado.,Department of Pediatrics, School of Medicine, University of Colorado at Denver, Aurora, Colorado
| | | | - Nathan J D McLaughlin
- Research Laboratory, Bonfils Blood Center, Denver, Colorado.,Department of Pediatrics, School of Medicine, University of Colorado at Denver, Aurora, Colorado
| | - David J Elzi
- Research Laboratory, Bonfils Blood Center, Denver, Colorado.,Department of Surgery, School of Medicine, University of Colorado at Denver, Aurora, Colorado
| | - Kelly England
- Research Laboratory, Bonfils Blood Center, Denver, Colorado.,Department of Surgery, School of Medicine, University of Colorado at Denver, Aurora, Colorado
| | - Jason Bjornsen
- Research Laboratory, Bonfils Blood Center, Denver, Colorado
| | - Susan A Kuldanek
- Research Laboratory, Bonfils Blood Center, Denver, Colorado.,Department of Pediatrics, School of Medicine, University of Colorado at Denver, Aurora, Colorado
| | - Anirban Banerjee
- Department of Surgery, School of Medicine, University of Colorado at Denver, Aurora, Colorado
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16
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The accumulation of lipids and proteins during red blood cell storage: the roles of leucoreduction and experimental filtration. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 15:131-136. [PMID: 28263170 DOI: 10.2450/2017.0314-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/20/2016] [Indexed: 02/06/2023]
Abstract
Pre-storage leucoreduction has been universally adopted in most developed countries in Asia, Europe and the Americas. It decreases febrile transfusion reactions, alloimmunisation to HLA antigens, cytomegalovirus exposure, the accumulation of a number of pro-inflammatory mediators in the supernatant, including the accumulation of platelet-and leucocyte-derived proteins and metabolites during routine storage. This review will highlight the lipids and proteins, biological response modifiers (BRMs) that accumulate, their clinical effects in transfused hosts, and methods of mitigation.
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17
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Juffermans NP, Vlaar AP. Transfusion and Acute Respiratory Distress Syndrome: Pathogenesis and Potential Mechanisms. Respir Med 2017. [DOI: 10.1007/978-3-319-41912-1_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Delaney M, Wendel S, Bercovitz RS, Cid J, Cohn C, Dunbar NM, Apelseth TO, Popovsky M, Stanworth SJ, Tinmouth A, Van De Watering L, Waters JH, Yazer M, Ziman A. Transfusion reactions: prevention, diagnosis, and treatment. Lancet 2016; 388:2825-2836. [PMID: 27083327 DOI: 10.1016/s0140-6736(15)01313-6] [Citation(s) in RCA: 244] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Blood transfusion is one of the most common procedures in patients in hospital so it is imperative that clinicians are knowledgeable about appropriate blood product administration, as well as the signs, symptoms, and management of transfusion reactions. In this Review, we, an international panel, provide a synopsis of the pathophysiology, treatment, and management of each diagnostic category of transfusion reaction using evidence-based recommendations whenever available.
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Affiliation(s)
- Meghan Delaney
- Bloodworks NW, Seattle, WA, USA; University of Washington, Department of Laboratory Medicine, Seattle, WA, USA.
| | | | | | - Joan Cid
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clínic, UB, Barcelona, Spain
| | - Claudia Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Nancy M Dunbar
- Department of Pathology and Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Torunn O Apelseth
- Laboratory of Clinical Biochemistry and Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Simon J Stanworth
- NHS Blood and Transplant/Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK; Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alan Tinmouth
- Department of Medicine and Department of Laboratory Medicine & Pathology, University of Ottawa, Ottawa, ON, Canada; University of Ottawa Centre for Transfusion Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Jonathan H Waters
- Department of Anesthesiology & Bioengineering, University of Pittsburgh & McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA
| | - Mark Yazer
- Division of Transfusion Medicine, Department of Pathology, University of Pittsburgh, Institute for Transfusion Medicine, Pittsburgh, PA, USA
| | - Alyssa Ziman
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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19
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Affiliation(s)
- A. L. Peters
- Laboratory of Experimental Intensive Care and Anesthesiology/Department of Intensive Care; Academic Medical Centre; Amsterdam The Netherlands
| | - A. P. J. Vlaar
- Laboratory of Experimental Intensive Care and Anesthesiology/Department of Intensive Care; Academic Medical Centre; Amsterdam The Netherlands
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20
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Affiliation(s)
- A. D'Alessandro
- Department of Biochemistry and Molecular Genetics; University of Colorado Denver; Aurora CO USA
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21
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Peters AL, Vervaart MAT, van Bruggen R, de Korte D, Nieuwland R, Kulik W, Vlaar APJ. Non-polar lipids accumulate during storage of transfusion products and do not contribute to the onset of transfusion-related acute lung injury. Vox Sang 2016; 112:25-32. [DOI: 10.1111/vox.12453] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/27/2016] [Accepted: 09/02/2016] [Indexed: 12/23/2022]
Affiliation(s)
- A. L. Peters
- Laboratory of Experimental Intensive Care and Anesthesia; Academic Medical Center; Amsterdam The Netherlands
- Department of Intensive Care; Academic Medical Center; Amsterdam The Netherlands
| | - M. A. T. Vervaart
- Laboratory Genetic Metabolic Diseases; Academic Medical Center; Amsterdam The Netherlands
| | - R. van Bruggen
- Department of Blood Cell Research; Sanquin Research; Amsterdam The Netherlands
| | - D. de Korte
- Department of Blood Cell Research; Sanquin Research; Amsterdam The Netherlands
- Department Product and Process Development; Sanquin Blood Bank; Amsterdam The Netherlands
| | - R. Nieuwland
- Laboratory for Experimental Clinical Chemistry; Academic Medical Center; Amsterdam The Netherlands
| | - W. Kulik
- Laboratory Genetic Metabolic Diseases; Academic Medical Center; Amsterdam The Netherlands
| | - A. P. J. Vlaar
- Laboratory of Experimental Intensive Care and Anesthesia; Academic Medical Center; Amsterdam The Netherlands
- Department of Intensive Care; Academic Medical Center; Amsterdam The Netherlands
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22
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Kelher MR, Banerjee A, Gamboni F, Anderson C, Silliman CC. Antibodies to major histocompatibility complex class II antigens directly prime neutrophils and cause acute lung injury in a two-event in vivo rat model. Transfusion 2016; 56:3004-3011. [PMID: 27667662 DOI: 10.1111/trf.13817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/18/2016] [Accepted: 07/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is a significant cause of mortality, especially after transfusions containing antibodies to major histocompatibility complex (MHC) class II antigens. We hypothesize that a first event induces both 1) polymorphonuclear neutrophils (PMNs) to express MHC class II antigens, and 2) activation of the pulmonary endothelium, leading to PMN sequestration, so that the infusion of specific MHC class II antibodies to these antigens causes PMN-mediated acute lung injury (ALI). STUDY DESIGN AND METHODS Rats were treated with saline (NS), endotoxin (lipopolysaccharide [LPS]), or cytokines (interferon-γ [IFNγ], macrophage colony-stimulating factor [MCSF], tumor necrosis factor-α [TNFα]); the PMNs were isolated; and the surface expression of the MHC class II antigen OX6 and priming by OX6 antibodies were measured by flow cytometry or priming assays. RESULTS A two-event model of ALI was completed with NS, LPS, or IFNγ/MCSF/TNFα (first events) and the infusion of OX6 (second event). Compared with NS incubation, rats treated with either LPS or IFNγ/MCSF/TNFα exhibited OX6 PMN surface expression, OX6 antibodies primed the formyl-methionyl-leucyl phenylalanine (fMLF)-activated respiratory burst, and PMN sequestration was increased. OX6 antibody infusion into LPS-incubated or IFNγ/MCSF/TNFα-incubated rats elicited ALI, the OX6 antibody was present on the PMNs, and PMN depletion abrogated ALI. CONCLUSION Proinflammatory first events induce PMN MHC class II surface expression, activation of the pulmonary endothelium, and PMN sequestration such that the infusion of cognate antibodies precipitates TRALI.
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Affiliation(s)
- Marguerite R Kelher
- Research Laboratory, Bonfils Blood Center, Denver, Colorado.,Department of Surgery, University of Colorado Denver, Aurora, Colorado
| | - Anirban Banerjee
- Department of Surgery, University of Colorado Denver, Aurora, Colorado
| | - Fabia Gamboni
- Department of Surgery, University of Colorado Denver, Aurora, Colorado
| | - Cameron Anderson
- Department of Surgery, University of Colorado Denver, Aurora, Colorado
| | - Christopher C Silliman
- Research Laboratory, Bonfils Blood Center, Denver, Colorado.,Department of Surgery, University of Colorado Denver, Aurora, Colorado.,Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora, Colorado
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23
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Fu X, Felcyn JR, Odem-Davis K, Zimring JC. Bioactive lipids accumulate in stored red blood cells despite leukoreduction: a targeted metabolomics study. Transfusion 2016; 56:2560-2570. [DOI: 10.1111/trf.13748] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Xiaoyun Fu
- Bloodworks Northwest Research Institute
- School of Medicine, Department of Internal Medicine, Division of Hematology; University of Washington
| | | | | | - James C. Zimring
- Bloodworks Northwest Research Institute
- School of Medicine, Department of Internal Medicine, Division of Hematology; University of Washington
- Department of Laboratory Medicine; University of Washington School of Medicine; Seattle Washington
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24
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Schmidt AE, Refaai MA, Blumberg N. Past, present and forecast of transfusion medicine: What has changed and what is expected to change? Presse Med 2016; 45:e253-72. [PMID: 27474234 DOI: 10.1016/j.lpm.2016.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Blood transfusion is the second most used medical procedures in health care systems worldwide. Over the last few decades, significant changes have been evolved in transfusion medicine practices. These changes were mainly needed to increase safety, efficacy, and availability of blood products as well as reduce recipients' unnecessary exposure to allogeneic blood. Blood products collection, processing, and storage as well as transfusion practices throughout all patient populations were the main stream of these changes. Health care systems across the world have adopted some or most of these changes to reduce transfusion risks, to improve overall patients' outcome, and to reduce health care costs. In this article, we are going to present and discuss some of these recent modifications and their impact on patients' safety.
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Affiliation(s)
- Amy E Schmidt
- University of Rochester medical center, department of pathology and laboratory medicine, 14642 Rochester, NY, USA
| | - Majed A Refaai
- University of Rochester medical center, department of pathology and laboratory medicine, 14642 Rochester, NY, USA
| | - Neil Blumberg
- University of Rochester medical center, department of pathology and laboratory medicine, 14642 Rochester, NY, USA.
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25
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Transfusion of 35-Day Stored RBCs in the Presence of Endotoxemia Does Not Result in Lung Injury in Humans*. Crit Care Med 2016; 44:e412-9. [DOI: 10.1097/ccm.0000000000001614] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Osman A, Hitzler WE, Provost P. Peculiarities of studying the effects of pathogen reduction technologies on platelets. Proteomics Clin Appl 2016; 10:805-15. [PMID: 27095411 DOI: 10.1002/prca.201500124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/27/2016] [Accepted: 04/14/2016] [Indexed: 12/31/2022]
Abstract
The transfusion of platelet concentrates (PCs) is mainly used for treatment of thrombocytopenic, trauma or surgery patients. The integrity and safety of these platelet preparations, however, is compromised by the presence of pathogens, such as viruses, bacteria and parasites. The transfer of allogeneic donor leukocytes contaminating PCs can also potentially cause adverse reactions in recipients. These considerations prompted the development and implementation of pathogen reduction technologies (PRT), which are based on chemically induced cross-linking and inactivation of nucleic acids. While the incumbent PRT may provide some protection against transfusion-transmitted infections, they are ineffective against infectious prions and may not inactivate other emerging pathogens. In addition, the safety of PRT concerning platelet viability and function has been questioned in several reports. Recent studies suggest that PRT, such as Intercept, may adversely affect the messenger RNA (mRNA) and microRNA content of platelets, as well as their functional integrity, which may compromise the clinical benefits of PRT. Here, we will discuss about the peculiarities of studying the effects of PRT on platelets, which will need to be taken into account in future studies aimed to characterize further, and polish, the rugged side of this otherwise useful and potentially important approach in transfusion medicine.
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Affiliation(s)
- Abdimajid Osman
- Department of Clinical Chemistry, Region Östergötland, Linköping, Sweden.,Department of Clinical and Experimental Medicine, University of Linköping, Linköping, Sweden
| | - Walter E Hitzler
- Transfusion Center, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Patrick Provost
- CHUQ Research Center/CHUL, Quebec, QC, Canada.,Faculty of Medicine, Université Laval, Quebec, QC, Canada
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27
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D'Alessandro A, Dzieciatkowska M, Hill RC, Hansen KC. Supernatant protein biomarkers of red blood cell storage hemolysis as determined through an absolute quantification proteomics technology. Transfusion 2016; 56:1329-39. [PMID: 26813021 DOI: 10.1111/trf.13483] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/09/2015] [Accepted: 12/09/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laboratory technologies have highlighted the progressive accumulation of the so-called "storage lesion," a wide series of alterations to stored red blood cells (RBCs) that may affect the safety and effectiveness of the transfusion therapy. New improvements in the field are awaited to ameliorate this lesion, such as the introduction of washing technologies in the cell processing pipeline. Laboratory studies that have tested such technologies so far rely on observational qualitative or semiquantitative techniques. STUDY DESIGN AND METHODS A state-of-the-art quantitative proteomics approach utilizing quantitative concatamers (QconCAT) was used to simultaneously monitor fluctuations in the abundance of 114 proteins in AS-3 RBC supernatants (n = 5; 11 time points, including before and after leukoreduction, at 3 hours, on Days 1 and 2, and weekly sampling from Day 7 through Day 42). RESULTS Leukoreduction-dependent depletion of plasma proteins was observed at the earliest time points. A subset of proteins showed very high linear correlation (r(2) > 0.9) not only with storage time, but also with absolute levels of hemoglobin α1 and β, a proxy for RBC hemolysis and vesiculation. Linear regression was performed to describe the temporal relationship between these proteins. Our findings suggest a role for supernatant glyceraldehyde-3-phosphate dehydrogenase; peroxiredoxin-1, -2, and -6; carbonic anhydrase-1 and -2; selenium binding protein-1; biliverdin reductase; aminolevulinate dehydratase; and catalase as potential biomarkers of RBC quality during storage. CONCLUSION A targeted proteomics technology revealed novel biomarkers of the RBC storage lesion and promises to become a key analytical readout for the development and testing of alternative cell processing strategies.
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Affiliation(s)
- Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Monika Dzieciatkowska
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Ryan C Hill
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Kirk C Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
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28
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Leucoreduction of blood components: an effective way to increase blood safety? BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 14:214-27. [PMID: 26710353 DOI: 10.2450/2015.0154-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/31/2015] [Indexed: 02/08/2023]
Abstract
Over the past 30 years, it has been demonstrated that removal of white blood cells from blood components is effective in preventing some adverse reactions such as febrile non-haemolytic transfusion reactions, immunisation against human leucocyte antigens and human platelet antigens, and transmission of cytomegalovirus. In this review we discuss indications for leucoreduction and classify them into three categories: evidence-based indications for which the clinical efficacy is proven, indications based on the analysis of observational clinical studies with very consistent results and indications for which the clinical efficacy is partial or unproven.
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29
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Current options for transfusion-related acute lung injury risk mitigation in platelet transfusions. Curr Opin Hematol 2015; 22:554-8. [DOI: 10.1097/moh.0000000000000187] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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30
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Popovsky MA. Transfusion-related acute lung injury: three decades of progress but miles to go before we sleep. Transfusion 2015; 55:930-4. [DOI: 10.1111/trf.13064] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 01/30/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Mark A. Popovsky
- Vice President and Chief Medical Officer; Haemonetics Corporation; Braintree MA
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31
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Peters AL, Van Stein D, Vlaar APJ. Antibody-mediated transfusion-related acute lung injury; from discovery to prevention. Br J Haematol 2015; 170:597-614. [PMID: 25921271 DOI: 10.1111/bjh.13459] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Transfusion-related acute lung injury (TRALI), a syndrome of respiratory distress caused by blood transfusion, is the leading cause of transfusion-related mortality. The majority of TRALI cases have been related to passive infusion of human leucocyte antigen (HLA) and human neutrophil antigen (HNA) antibodies in donor blood. In vitro, ex vivo and in vivo animal models have provided insight in TRALI pathogenesis. The various classes of antibodies implicated in TRALI appear to have different pathophysiological mechanisms for the induction of TRALI involving endothelial cells, neutrophils, monocytes and, as very recently has been discovered, lymphocytes. The HLA and HNA-antibodies are found mainly in blood from multiparous women as they have become sensitized during pregnancy. The incidence of TRALI has decreased rapidly following the introduction of a male-only strategy for plasma donation. This review focuses on pre-clinical and clinical studies investigating the pathophysiology of antibody-mediated TRALI.
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Affiliation(s)
- Anna L Peters
- Laboratory of Experimental Intensive Care and Anaesthesia/Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands
| | - Danielle Van Stein
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Alexander P J Vlaar
- Laboratory of Experimental Intensive Care and Anaesthesia/Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands
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32
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Warkentin TE, Greinacher A, Bux J. The transfusion-related acute lung injury controversy: lessons from heparin-induced thrombocytopenia. Transfusion 2015; 55:1128-34. [PMID: 25647304 DOI: 10.1111/trf.12994] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/12/2014] [Indexed: 01/01/2023]
Affiliation(s)
- Theodore E Warkentin
- Department of Pathology and Molecular Medicine and the Department of Medicine, McMaster University, and Transfusion Medicine, Hamilton Regional Laboratory Medicine Program, Service of Clinical Hematology, Hamilton Health Sciences (General Site), Hamilton, Ontario, Canada
| | - Andreas Greinacher
- Institut Für Immunologie Und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
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33
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Pathogenesis of non-antibody mediated transfusion-related acute lung injury from bench to bedside. Blood Rev 2015; 29:51-61. [DOI: 10.1016/j.blre.2014.09.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/02/2014] [Indexed: 12/11/2022]
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34
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Middelburg RA, van der Bom JG. Transfusion-related acute lung injury not a two-hit, but a multicausal model. Transfusion 2014; 55:953-60. [PMID: 25494846 DOI: 10.1111/trf.12966] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/28/2014] [Accepted: 10/28/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The etiology of transfusion-related acute lung injury (TRALI) is often referred to as a "two-hit model," the first hit being patient predisposition and the second being a transfusion. This model lumps all patient-related risk factors together and thereby may hamper identification of individual, potentially preventable or modifiable risk factors. STUDY DESIGN AND METHODS Like any disease, TRALI is multicausal in nature. To be able to effectively scrutinize all contributing causes, we need to clearly describe this multicausality as completely as possible. Several models are already commonly used to describe the multicausality of other diseases, including threshold models and the sufficient cause model. RESULTS Here we describe the application of two different multicausal models to TRALI. These models can readily describe any potential scenario for the etiology of TRALI. First we will introduce the intuitively appealing threshold model, which shows some similarities with the Bux and Sachs threshold model for TRALI. Second we discuss the more abstract sufficient cause model. CONCLUSIONS Both models have their strengths and limitations. Both are, however, better equipped than the two-hit model to describe the multicausal nature of TRALI. Further identification of all involved risk factors and the complex interplay between them is facilitated by these models.
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Affiliation(s)
- Rutger A Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Jon J. van Rood Center for Clinical Transfusion Research, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Jon J. van Rood Center for Clinical Transfusion Research, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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35
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AuBuchon JP. TRALI: reducing its risk while trying to understand its causes. Transfusion 2014; 54:3021-5. [DOI: 10.1111/trf.12822] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- James P. AuBuchon
- Puget Sound Blood Center; Seattle WA
- Medicine and Laboratory Medicine; University of Washington; Seattle WA
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36
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Abstract
Abstract
Human neutrophil antigen-3a (HNA-3a) antibodies contained in donor plasma can result in severe, sometimes fatal transfusion-related acute lung injury (TRALI). Recent developments in TRALI secondary to antibodies to HNA-3a antigen span diagnosis, pathophysiology, treatment, and prevention resulting in improved understanding, potential treatments, and mitigation strategies. First, on the molecular level, characterization of HNA-3 antigen has allowed for genotyping methods that clarify population prevalence. Related work has led to generation of multiple antibody detection assays. These assays aid in determining potential populations at risk and potential mitigation strategies. Second, the development of TRALI requires a hit from the patient and from the product. Anti-HNA-3a is one of the product-derived factors and appears to result in TRALI by binding directly to pulmonary endothelium as well as to neutrophils expressing the corresponding antigen. Finally, potential mitigation strategies include red blood cell product filtration to remove anti-HNA-3a as well as other antibodies.
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Classic and alternative red blood cell storage strategies: seven years of "-omics" investigations. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 13:21-31. [PMID: 25369599 DOI: 10.2450/2014.0053-14] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/13/2014] [Indexed: 12/12/2022]
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D'Alessandro A, Kriebardis AG, Rinalducci S, Antonelou MH, Hansen KC, Papassideri IS, Zolla L. An update on red blood cell storage lesions, as gleaned through biochemistry and omics technologies. Transfusion 2014; 55:205-19. [DOI: 10.1111/trf.12804] [Citation(s) in RCA: 227] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/18/2014] [Accepted: 06/18/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics; University of Colorado Denver-Anschutz Medical Campus; Aurora Colorado
| | - Anastasios G. Kriebardis
- Department of Medical Laboratories, Faculty of Health and Caring Professions; Technological Educational Institute of Athens; Athens Greece
| | - Sara Rinalducci
- Department of Ecological and Biological Sciences; University of Tuscia; Viterbo Italy
| | - Marianna H. Antonelou
- Department of Cell Biology and Biophysics; Faculty of Biology; University of Athens; Athens Greece
| | - Kirk C. Hansen
- Department of Biochemistry and Molecular Genetics; University of Colorado Denver-Anschutz Medical Campus; Aurora Colorado
| | - Issidora S. Papassideri
- Department of Cell Biology and Biophysics; Faculty of Biology; University of Athens; Athens Greece
| | - Lello Zolla
- Department of Ecological and Biological Sciences; University of Tuscia; Viterbo Italy
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Babaev A, Pozzi F, Hare G, Zhang H. Storage of Red Blood Cells and Transfusion-Related Acute Lung Injury. ACTA ACUST UNITED AC 2014; 1. [PMID: 28066804 DOI: 10.15406/jaccoa.2014.01.00002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Transfusion-related acute lung injury (TRALI) is a major complication post-transfusion. A consensus definition of TRALI has been recently established to improve diagnosis but the pathogenesis of TRALI is yet to be understood. Although the antibody-mediated two-hit model of TRALI is the classical narrative, increasing evidence of the probable implications of prolonged storage of blood provides novel mechanisms towards storage lesion- the potentially injurious cellular and biochemical changes that occur in stored red blood cells. Red blood cell-derived lipids and micro vesicles may have been playing an important role in the development of TRALI. This article will provide a brief overview of the current understanding of TRALI and then discuss the implications and the potential mechanisms by which stored red blood cells may lead to TRALI.
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Affiliation(s)
- Arkady Babaev
- Department of Anesthesia and Department of Physiology, University of Toronto, Canada
| | - Federico Pozzi
- Department of Anesthesia and Department of Physiology, University of Toronto, Canada
| | - Gregory Hare
- Department of Anesthesia and Department of Physiology, University of Toronto, Canada
| | - Haibo Zhang
- Department of Anesthesia and Department of Physiology, University of Toronto, Canada
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