Flow-Cytometric Determination of Survival Time and 24-Hour Recovery of Transfused Red Blood Cells

Zeiler, T.; Müller, Jan Tobias; Kretschmer, V.

doi:10.1159/000069340

Cited by 17 publications

(19 citation statements)

References 18 publications

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“…1,3 Moreover, although RBC survival studies for FDA licensure are typically performed in healthy volunteers, the 24-hour posttransfusion RBC survival is often lower in critically ill patients. 3,4 Finally, most RBC clearance occurs within the first hour after transfusion. 3 One human RBC unit contains 220 to 250 mg of iron; 5 therefore, rapid RBC clearance of up to 25% of even a single unit, acutely delivers a massive load of hemoglobin iron to the monocyte/macrophage system.…”

mentioning

confidence: 99%

Transfusion of red blood cells after prolonged storage produces harmful effects that are mediated by iron and inflammation

Hod

Zhang²,

Sokol

et al. 2010

Blood

423

498

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Although red blood cell (RBC) transfusions can be lifesaving, they are not without risk. In critically ill patients, RBC transfusions are associated with increased morbidity and mortality, which may increase with prolonged RBC storage before transfusion. The mechanisms responsible remain unknown. We hypothesized that acute clearance of a subset of damaged, stored RBCs delivers large amounts of iron to the monocyte/macrophage system, inducing inflammation. To test this in a well-controlled setting, we used a murine RBC storage and transfusion model to show that the transfusion of stored RBCs, or washed stored RBCs, increases plasma nontransferrin bound iron (NTBI), produces acute tissue iron deposition, and initiates inflammation. In contrast, the transfusion of fresh RBCs, or the infusion of stored RBC-derived supernatant, ghosts, or stroma-free lysate, does not produce these effects. Furthermore, the insult induced by transfusion of stored RBC synergizes with subclinical endotoxinemia producing clinically overt signs and symptoms. The increased plasma NTBI also enhances bacterial growth in vitro. Taken together, these results suggest that, in a mouse model, the cellular component of leukoreduced, stored RBC units contributes to the harmful effects of RBC transfusion that occur after prolonged storage. Nonetheless, these findings must be confirmed by prospective human studies.

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mentioning

confidence: 99%

Transfusion of red blood cells after prolonged storage produces harmful effects that are mediated by iron and inflammation

Hod

Zhang²,

Sokol

et al. 2010

Blood

423

498

View full text Add to dashboard Cite

show abstract

“…We based our power calculation on previously published reports in which from 22% to 26.5% RBC clearance was detected 24 hours after infusion . We measured clearance during the 5 hours of LPS‐induced endotoxemia and, thus, expected less clearance.…”

Section: Methodsmentioning

confidence: 99%

“…However, the relative contribution, if any, remains unclear . Increased posttransfusion RBC clearance caused by prolonged storage has been speculated to be detrimental; indeed, several studies have reported shortened RBC survival with increased RBC storage time . This observation, and the observation that mainly critically ill patients are prone to develop adverse events of transfusion, led us to hypothesize that RBC transfusion storage time and the recipient's inflammatory status influence posttransfusion RBC clearance.…”

mentioning

confidence: 99%

Clearance of stored red blood cells is not increased compared with fresh red blood cells in a human endotoxemia model

Peters¹,

Beuger

Mock

et al. 2016

Transfusion

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Background Clearance of transfused red blood cells (RBCs) is thought to be related to both storage time of the transfusion product and to inflammatory status of the recipient. We investigated these effects in a randomized “two hit” healthy volunteer transfusion model, comparing autologous RBCs stored for 35 days with RBCs stored for 2 days. Study Design and Methods Healthy male volunteers donated one unit of autologous RBCs either 2 (2D) or 35 days (35D) before the study day. The experiment was started by infusion of 2 ng/kg LPS (“first hit”). Two hours later the stored RBCs (“second hit”) were reinfused followed by RBCs labeled with biotin. Clearance of biotin labeled RBCs (BioRBCs) was measured during the 5 h post-transfusion endotoxemia period, along with measurement of PS-exposure, lactadherin binding and CD47 expression. Results In the 2D stored RBCs group, 1.5±3.4% of infused BioRBCs were cleared from the circulation 5 h post-transfusion versus 4.8±4.0% in the 35D stored group (p=0.1). There were no differences in PS-exposure, lactadherin binding, and CD47 expression between fresh and stored RBCs or between pre- and post-transfusion. Conclusion Our study shows a low clearance of RBCs even during endotoxemia. Furthermore, short-term clearance of BioRBCs during endotoxemia was not related to storage duration. Consistent with these observations, PS-exposure, lactadherin binding and CD47 expression did not differ between 2D and 35D stored cells before or after transfusion. We conclude that in the presence of endotoxemia, clearance of 35D stored autologous RBCs is not increased compared to 2D fresh RBCs.

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“…Repeat transfusions may lead to significant morbidity and mortality [11]. Transfused RBCs, which have a shorter life span than endogenous RBCs [12], undergo erythrophagocytosis with release of iron that eventually overloads macrophages. When this excess iron reenters the plasma, it overwhelms the iron-carrying capacity of transferrin and circulates as NTBI.…”

Section: Secondary Iron Overloadmentioning

confidence: 99%

Iron overload and toxicity: implications for anesthesiologists

Shander

Berth

Betta

et al. 2012

Journal of Clinical Anesthesia

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Flow-Cytometric Determination of Survival Time and 24-Hour Recovery of Transfused Red Blood Cells

Cited by 17 publications

References 18 publications

Transfusion of red blood cells after prolonged storage produces harmful effects that are mediated by iron and inflammation

Transfusion of red blood cells after prolonged storage produces harmful effects that are mediated by iron and inflammation

Clearance of stored red blood cells is not increased compared with fresh red blood cells in a human endotoxemia model

Iron overload and toxicity: implications for anesthesiologists

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