Effect of Hypoxic Blood Infusion on Pulmonary Physiology

Abstract

The ability to store red blood cells (RBCs) and other components for extended periods of time has expanded the availability and use of transfusion as a life-saving therapy. However, conventional RBC storage has a limited window of effective preservation and is accompanied by the progressive accumulation of a series of biochemical and morphological modifications, collectively referred to as “storage lesions.” These lesions have been associated with negative clinical outcomes (i.e., postoperative complications as well as reduced short-term and long-term survival) in patients transfused with conventionally stored blood with older and deteriorated transfused red cells. Hence, there is an increased unmet need for improved RBC storage. Hypoxic storage of blood entails the removal of large amounts of oxygen to low levels prior to refrigeration and maintenance of hypoxic levels through the entirety of storage. As opposed to conventionally stored blood, hypoxic storage can lead to a reduction of oxidative damage to slow storage lesion development and create a storage condition expected to result in enhanced efficacy of stored RBCs without an effect on oxygen exchange in the lung. Hypoxic blood transfusions appear to offer minimal safety concerns, even in patients with hypoxemia. This review describes the physiology of hypoxically stored blood, how it differs from conventionally stored blood, and its use in potential clinical application, such as massively transfused and critically ill patients with oxygenation/ventilation impairments.

Modulation of the allosteric and vasoregulatory arms of erythrocytic oxygen transport

“…One common lesion, oxidative damage, is caused by the buildup of oxidative species secondary to storage in the face of high levels of O 2 . Pittman et al (2022) discussed how RBCs stored in hypoxemic environments could mitigate this while having no effect on the efficacy of the RBC transfusion. The authors argue that these hypoxically stored RBCs endure exposure to fewer oxidative insults and thus less exposure to the downstream harmful lipid oxidation products following the oxidation of hemoglobin to methemoglobin.…”

Red Blood Cell Storage with Xenon: Safe or Disruption?

“…Antioxidants such as vitamins E, C, and beta-carotene [ 10 ] are being added to counteract the effects of storage lesions. In addition, anaerobic storage techniques are employed, including those involving the use of inert gases [ 11 , 12 , 13 , 14 ].…”

Atomic Force Microscopy and High-Resolution Spectrophotometry for Study of Anoxemia and Normoxemia in Model Experiment In Vitro

“…Recently, new technologies have been developed based on the use of inert gases to remove oxygen from solution for the storage of packed RBCs under hypoxic conditions. The anaerobic storage of RBCs provides a new opportunity to further investigate the mechanisms underlying metabolic storage lesions in order to improve the quality of stored RBCs for transfusion [ 43 , 44 , 45 ].…”