Transfusion of older stored blood worsens outcomes in canines depending on the presence and severity of pneumonia

Media type: E-Article
Title: Transfusion of older stored blood worsens outcomes in canines depending on the presence and severity of pneumonia
Contributor: Wang, Dong; Cortés‐Puch, Irene; Sun, Junfeng; Solomon, Steven B.; Kanias, Tamir; Remy, Kenneth E.; Feng, Jing; Alimchandani, Meghna; Quezado, Martha; Helms, Christine; Perlegas, Andreas; Gladwin, Mark T.; Kim‐Shapiro, Daniel B.; Klein, Harvey G.; Natanson, Charles
imprint: Wiley, 2014
Published in: Transfusion
Language: English
DOI: 10.1111/trf.12607
ISSN: 1537-2995; 0041-1132
Keywords: Hematology ; Immunology ; Immunology and Allergy
Origination:
Footnote:
Description: <jats:sec><jats:title>Background</jats:title><jats:p>In experimental pneumonia we found that transfused older blood increased mortality and lung injury that was associated with increased in vivo hemolysis and elevated plasma cell‐free hemoglobin (<jats:styled-content style="fixed-case">CFH</jats:styled-content>), non–transferrin‐bound iron (<jats:styled-content style="fixed-case">NTBI</jats:styled-content>), and plasma labile iron (<jats:styled-content style="fixed-case">PLI</jats:styled-content>) levels. In this study, we additionally analyze identically treated animals that received lower or higher bacterial doses.</jats:p></jats:sec><jats:sec><jats:title>Study Design and Methods</jats:title><jats:p>Two‐year‐old purpose‐bred beagles (n = 48) challenged intrabronchially with <jats:italic><jats:styled-content style="fixed-case">S</jats:styled-content>taphylococcus aureus</jats:italic> (0 [n = 8], 1.0 × 10<jats:sup>9</jats:sup> [n = 8], 1.25 × 10<jats:sup>9</jats:sup> [n = 24], and ≥1.5 × 10<jats:sup>9</jats:sup> [n = 8] colony‐forming units/kg) were exchange transfused with either 7‐ or 42‐day‐old canine universal donor blood (80 <jats:styled-content style="fixed-case">mL</jats:styled-content>/kg in four divided doses).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The greater increases in <jats:styled-content style="fixed-case">CFH</jats:styled-content> with older blood over days after exchange proved relatively independent of bacterial dose. The lesser increases in <jats:styled-content style="fixed-case">CFH</jats:styled-content> observed with fresher blood were bacterial dose dependent potentially related to bacterial hemolysins. Without bacterial challenge, levels of <jats:styled-content style="fixed-case">CFH</jats:styled-content>, <jats:styled-content style="fixed-case">NTBI</jats:styled-content>, and <jats:styled-content style="fixed-case">PLI</jats:styled-content> were significantly higher with older versus fresher blood transfusion but there was no significant measurable injury. With higher‐dose bacterial challenge, the elevated <jats:styled-content style="fixed-case">NTBI</jats:styled-content> and <jats:styled-content style="fixed-case">PLI</jats:styled-content> levels declined more rapidly and to a greater extent after transfusion with older versus fresher blood, and older blood was associated with significantly worse shock, lung injury, and mortality.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The augmented in vivo hemolysis of transfused older red blood cells (<jats:styled-content style="fixed-case">RBCs</jats:styled-content>) appears to result in excess plasma <jats:styled-content style="fixed-case">CFH</jats:styled-content> and iron release, which requires the presence of established infection to worsen outcome. These data suggest that transfused older <jats:styled-content style="fixed-case">RBCs</jats:styled-content> increase the risks from infection in septic subjects.</jats:p></jats:sec>

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