Hemolysis and red blood cell mechanical fragility in shed blood after total knee arthroplasty

Ley, John; Yazer, Mark H.; Waters, Jonathan H.

doi:10.1111/j.1537-2995.2011.03217.x

Cited by 13 publications

(15 citation statements)

References 23 publications

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“…Mechanical shear stress associated with washing has been shown previously to cause a sublethal injury to RBCs and increased in vivo hemolysis after transfusion with subsequent release of CFH and iron. 30,31 Although exposure to saline during the wash may contribute to increased cell fragility, the washed cells are immediately resuspended in standard preservative solution. We postulate that the "older" more fragile cells are lost during the washing process and the cells that remain are more susceptible to lysis than before washing, especially after 42 days of storage.…”

Section: Discussionmentioning

confidence: 99%

Washing older blood units before transfusion reduces plasma iron and improves outcomes in experimental canine pneumonia

Cortés‐Puch

Wang

Sun

et al. 2014

Blood

107

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• Washing older blood before transfusion reduces plasma iron, improving outcomes from established infection in canines.• In contrast, washing fresh blood before transfusion increases in vivo plasma CFH release, worsening outcomes.In a randomized controlled blinded trial, 2-year-old purpose-bred beagles (n 5 24), with Staphylococcus aureus pneumonia, were exchanged-transfused with either 7-or 42-dayold washed or unwashed canine universal donor blood (80 mL/kg in 4 divided doses). Washing red cells (RBC) before transfusion had a significantly different effect on canine survival, multiple organ injury, plasma iron, and cell-free hemoglobin (CFH) levels depending on the age of stored blood (all, P < .05 for interactions). Washing older units of blood improved survival rates, shock score, lung injury, cardiac performance and liver function, and reduced levels of non-transferrin bound iron and plasma labile iron. In contrast, washing fresh blood worsened all these same clinical parameters and increased CFH levels. Our data indicate that transfusion of fresh blood, which results in less hemolysis, CFH, and iron release, is less toxic than transfusion of older blood in critically ill infected subjects. However, washing older blood prevented elevations in plasma circulating iron and improved survival and multiple organ injury in animals with an established pulmonary infection. Our data suggest that fresh blood should not be washed routinely because, in a setting of established infection, washed RBC are prone to release CFH and result in worsened clinical outcomes. (Blood. 2014;123(9):1403-1411 IntroductionTransfusion of older stored canine universal donor blood in a canine model of experimental Staphylococcus aureus pneumonia results in markedly increased lung injury and mortality rates.1 Transfusion with older blood is also associated with increased levels of cell-free hemoglobin (CFH), transferrin bound iron (TBI), non-TBI (NTBI) and plasma labile iron (PLI). NTBI represents iron excess bound to proteins that do not normally handle circulating iron, and PLI is the toxic iron moiety in plasma. Whereas increased nitric oxide scavenging by CFH causing vasoconstriction and vascular injury and increased available iron promoting bacterial growth represent 2 candidate mechanisms of injury, multiple other biological changes have been documented with increasing blood storage interval.2,3 Some of these changes involve the release into the plasma of biologically active proteins, microvesicles, potassium, acid, and plasticizer, all of which can be reduced by means of standard red cell (RBC) washing procedures. [4][5][6][7][8][9][10] The clinical effect(s) of washing on the RBC storage lesion has not been studied.RBC washing has long been performed to reduce potassium levels in stored blood transfused to neonates, debris from RBCs recovered during surgery, cryoprotectant glycerol from cryopreserved RBCs, and plasma proteins from blood intended for patients who have been sensitized to those proteins.11-13 Automated cell washers cap...

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Section: Discussionmentioning

confidence: 99%

Washing older blood units before transfusion reduces plasma iron and improves outcomes in experimental canine pneumonia

Cortés‐Puch

Wang

Sun

et al. 2014

Blood

107

View full text Add to dashboard Cite

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“…Washing is efficient at reducing the free hemoglobin content. Rates of clearance have been reported to be between 53% and 99%, with the concentration of free hemoglobin in the washed product ranging from 1.0 to 30.4 mg/mL 52–56 …”

Section: Washingmentioning

confidence: 99%

Washing and filtering of cell‐salvaged blood – does it make autotransfusion safer?

König

Waters

2012

Transfus Alt Transfus Med

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SUMMARY Autologous transfusion was first performed in the late 1800s, but it was not until the 1970s that devices were developed that enabled widespread adoption of the practice. Unwashed salvaged blood contains thrombogenic products, cell breakdown products and plasma proteins, and gross chemical, cellular and physical contaminants. Washing and filtering of salvaged blood is routinely performed to remove or reduce these elements. In this paper we review the clinical data supporting the need for washing and filtering of salvaged blood.

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“…In a recent study exploring the fragility of cell salvaged blood, washed and unwashed post total knee arthroplasty, it was demonstrated that there was more haemolysis and damage in the washed group compared with the unwashed group as shown by a higher free Hb and higher mechanical fragility index. Washed blood, similar to methods we have used in our institution had a total free Hb dose of 0·55 g but this was not statistically different ( P = 0·615) when compared with unwashed ones (Ley et al , ).…”

Section: Discussionmentioning

confidence: 76%

“…Free Hb is a scavenger of nitric oxide (NO) irreversibly binding to and reducing levels. NO is a regulator of smooth muscle tone and platelet activation and acts as a vasodilator in the microcirculation (Rother et al, 2005;Ley et al, 2012). Reduced NO levels result in vasoconstriction, systolic and diastolic blood pressure (BP) increases, reduced tissue oxygenation, smooth muscle dystomies, gastrointestinal (GI) contractions, endotheliac dysfunction and platelet aggregation with increased thrombotic events (Rother et al, 2005;Sloan et al, 2009;Kelleher et al, 2011;Vermeulen Windsant et al, 2012).…”

mentioning

confidence: 99%

Assessment of intra‐operative cell salvage haemolysis in the obstetric and orthopaedic clinical setting, in comparison with allogeneic blood

Sullivan

Faulds

2014

Transfusion Medicine

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ICS involving skimming collection techniques (orthopaedics) had significantly more haemolysis than pooled collections (obstetrics) (P < 0·001). Further analysis of orthopaedic data highlighted a difference between the three machines used with the Haemonetics OrthoPat (Haemonetics Ltd., Watford, UK) significantly higher with a free Hb of 29·8 g L(-1) compared with the other two machines 6·7 g L(-1) (P < 0·001). On comparison of ICS blood to allogeneic blood, free Hb levels obtained from ICS were significantly higher (P < 0·001).

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Hemolysis and red blood cell mechanical fragility in shed blood after total knee arthroplasty

Abstract: The washing device returned more Hb to the patients relative to the amount of free Hb.

Cited by 13 publications

References 23 publications

Washing older blood units before transfusion reduces plasma iron and improves outcomes in experimental canine pneumonia

Washing older blood units before transfusion reduces plasma iron and improves outcomes in experimental canine pneumonia

Washing and filtering of cell‐salvaged blood – does it make autotransfusion safer?

Assessment of intra‐operative cell salvage haemolysis in the obstetric and orthopaedic clinical setting, in comparison with allogeneic blood

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