Clinical Impact of Bioactive Substances in Blood Components: Implications for Leukocyte Filtration

Background: The new German regulations for hemotherapy require the use of autologous blood as buffy coat-poor packed red cells (PRC) and fresh frozen plasma (FFP) or as leukocytedepleted whole blood (ldWB). There are no data, however, documenting reduced allogeneic transfusion rates and/or a better outcome with PRC/FFP or ldWB. We investigated whether storage as processed blood results in a different rate of homologous transfusion in patients undergoing surgery for hip arthroplasty. Patients and Methods: After informed consent 94 patients (48 men, 46 women, age 36–78 years) scheduled for hip arthroplasty and predepositing autologous blood were allocated at random to either of three groups: group WB (predeposit stored as unprocessed whole blood, surgery in the 5th week after the first donation), group ldWB (leukocyte-depleted whole blood, surgery in week 6) and group PRC/FFP (packed red cells and fresh frozen plasma, surgery in week 7). Three units were requested, deferral hemoglobin concentration was 11 g/dl. Results: Hemoglobin concentration prior to donation was measured as 13.8 ± 1.0, 14.2 plusmn; 1.1, 14.0 plusmn; 1.1 g/dl in groups WB, ldWB and PRC/FFP, respectively (mean plusmn; standard deviation); hemoglobin concentration prior to surgery as 13.0 plusmn; 1.3*, 13.5 plusmn; 1.4, 13.8 plusmn; 1.1* g/dl (*p < 0,05). Blood loss amounted to 2,270 (970–3,760), 1,850 (930–3,680) and 1,680 (480–3,390) ml (median, range) (n.s.). Two patients in group WB, 2 in group ldWB, and 1 in group PRC/FFP required allogeneic transfusion (n.s.). Conclusions: The type of storage of autologous predeposit does not seem to influence the allogeneic transfusion rate in hip arthroplasty. The patients in groups ldWB and PRC/FFP were allowed more time for erythropoiesis, but red cells were lost due to processing of the blood. The data do not support the concept to leukocyte-deplete autologous blood or to produce components.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Type of Storage of Autologous Blood Does Not Influence Homologous Transfusion Requirements in Hip Arthroplasty

Lorentz¹,

Klever²,

Dempfle³

et al. 2001

“…We recently suggested that development of post-operative infectious complications in patients undergoing surgery for rectal cancer may be related to storage time of transfused, non-filtered SAGM blood [25]. These side-effects may in part be due to the well-known immunomodulating effect of transfused blood compounds [1,2], which potentially also may be related to the storage of blood products [9,10,26].…”

Section: Discussionmentioning

confidence: 99%

“…Granulocyte-and platelet-derived bioactive substances are accumulated extracellularly in both CPDA-1 and SAGM blood during storage [7,8]. Some of these substances may be related to storage time-dependent side-effects following transfusion of various blood components [9]. We have previously shown that supernatants from non-filtered CPDA-1 blood and SAGM blood may reduce stimulated tumour necrosis factoralpha (TNF-α) and interleukin-2 (IL-2) release in vitro in a storage time-dependent manner [10].…”

Section: Introductionmentioning

confidence: 99%

Prestorage Leucofiltration of Red Blood Cell Suspensions Modulates Storage Time-Dependent Suppression of in vitro Cytokine Release

Mynster¹,

Nielsen²

2000

Self Cite

Background: Leucocyte- and platelet-derived bioactive substances accumulated in blood preparations during procession and storage may play a role in side-effects, including immunosuppression, observed after transfusion. Leucodepletion by filtration may significantly reduce the amount of storage time-dependent accumulated substances. Therefore we studied the effect of pre-storage leucofiltration of red blood cell suspensions on stimulation of tumour necrosis factor-alpha (TNF-α) and interleukin-2 (IL-2) release in vitro. Materials and Methods: Nine units of CPDA-1 blood (whole blood suspended in citrate phosphate dextrose adenine-1), 9 units of pre-storage leucofiltered CPDA-1 blood, 9 units of SAGM blood (buffy coat-depleted red blood cells suspended in saline adenine glucose mannitol) and 9 units of pre-storage leucofiltered SAGM blood were stored for 35 days. Supernatants were collected from all units after storage for 1, 21 and 35 days. Assays of whole blood obtained from healthy volunteers with addition of supernatants from stored blood components were stimulated with lipopolysaccharide (LPS) or phytohemagglutinin A (PHA) and incubated for 24 h or 72 h. Control assays without addition of supernatants from stored blood components were run simultaneously. After incubation TNF-α and IL-2 concentrations were determined by ELISA methods in assay supernatants. Results: The stimulated TNF-α and IL-2 releases were significantly decreased by supernatants from CPDA-1 blood and SAGM blood in a storage time-dependent manner compared with release in control assays. Pre-storage leucofiltration of CPDA-1 blood improved TNF-α release significantly while leucofiltration of SAGM blood increased the release to concentrations higher than that observed in control assays. However, pre-storage leucofiltration had no effect on storage time-dependent decreased IL-2 release. Con-clusion: Pre-storage leucofiltration may improve certain in vitro immune responses impaired by supernatants from stored blood while others appear to be unaffected.

“…Substances such as MPO, plasminogen activator inhibitor-1 (PAI-1), histamine as well as vascular endothelial growth factor (VEGF) are involved in the regulation of tumor growth and dissemination. Recent data demonstrate blood transfusion-associated side effects as being related to storage time of blood components [15,19,20] Leukocyte content of whole blood averages about 2 × 10 9 per 500 ml. The critical immunogenic leukocyte load is defined as the concentration of leukocytes necessary to cause sensitization in a previously nonsensitized individual.…”

Section: Schlüsselwörtermentioning

confidence: 99%

Immunomodulation after Blood Transfusion – Impact on Incidence of Postoperative Infection

Hobisch-Hagen¹

2002

Objective: Overview of complications and side effects related to perioperative transfusion of allogeneic blood components. Data Sources: Present literature based on electronical search (PubMed). Results: Transfusion of blood components is one of the most common therapeutic methods used in medicine. However, transfusion of allogeneic blood components may be associated with certain postoperative complications. Recent data indicate that some of these adverse effects are related to the cellular content of the blood product and also to storage time as well as methods used for preparations. Storage of blood components may lead to accumulation of bioactive substances in a time-dependent manner. Conclusion: Evidence has emerged that allogeneic blood transfusions are an independent variable predicting postoperative infection. Based on present literature, the patients may benefit by implementing selective and objective transfusion regimes avoiding an overuse of blood components.