Influence of Erythrocyte Concentrate Storage Time on Postsurgical Morbidity in Cardiac Surgery Patients

Leal-Noval, Santiago R.; Jara-López, Irene; García-Garmendia, José Luis; Marín‐Niebla, Ana; Herruzo-Avilés, Ángel; Camacho-Laraña, Pedro; Loscertales, Jesús

doi:10.1097/00000542-200304000-00005

Cited by 185 publications

(172 citation statements)

References 30 publications

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“…The emphasis over the last several decades has been on lesions that develop over the storage period. Observational studies in trauma, critical illness, and cardiac surgery, linking the administration of older blood to increased mortality (3)(4)(5), support the concern that transfusion of older blood may be detrimental. Evidence also exists that transfusion is detrimental in some settings regardless of RBC storage duration.…”

Section: H) P Values Represent Comparison Between Values In Rbcs Assmentioning

confidence: 98%

“…However, numerous changes occur in RBCs during storage (collectively referred to as the ''storage lesion'') that may alter their biological function, including delivery of oxygen to cells (2). Retrospective cohort studies have found a correlation between RBC storage duration and morbidity and mortality rates after transfusion (3)(4)(5), suggesting progressive storage lesions may be responsible for adverse outcomes. Despite these observational data, no large controlled clinical trials have been conducted to evaluate the relationship between the age of stored RBCs and clinical outcomes.…”

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confidence: 99%

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Evolution of adverse changes in stored RBCs

Bennett‐Guerrero¹,

Veldman²,

Doctor

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

551

556

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Recent studies have underscored questions about the balance of risk and benefit of RBC transfusion. A better understanding of the nature and timing of molecular and functional changes in stored RBCs may provide strategies to improve the balance of benefit and risk of RBC transfusion. We analyzed changes occurring during RBC storage focusing on RBC deformability, RBC-dependent vasoregulatory function, and S-nitrosohemoglobin (SNO-Hb), through which hemoglobin (Hb) O2 desaturation is coupled to regional increases in blood flow in vivo (hypoxic vasodilation). Five hundred ml of blood from each of 15 healthy volunteers was processed into leukofiltered, additive solution 3-exposed RBCs and stored at 1-6°C according to AABB standards. Blood was subjected to 26 assays at 0, 3, 8, 24 and 96 h, and at 1, 2, 3, 4, and 6 weeks. RBC SNO-Hb decreased rapidly (1.2 ؋ 10 ؊4 at 3 h vs. 6.5 ؋ 10 ؊4 (fresh) mol S-nitrosothiol (SNO)/mol Hb tetramer (P ‫؍‬ 0.032, mercuric-displaced photolysis-chemiluminescence assay), and remained low over the 42-day period. The decline was corroborated by using the carbon monoxide-saturated copper-cysteine assay [3.0 ؋ 10 ؊5 at 3 h vs. 9.0 ؋ 10 ؊5 (fresh) mol SNO/mol Hb]. In parallel, vasodilation by stored RBCs was significantly depressed. RBC deformability assayed at a physiological shear stress decreased gradually over the 42-day period (P < 0.001). Time courses vary for several storage-induced defects that might account for recent observations linking blood transfusion with adverse outcomes. Of clinical concern is that SNO levels, and their physiological correlate, RBC-dependent vasodilation, become depressed soon after collection, suggesting that even ''fresh'' blood may have developed adverse biological characteristics.adenosine triphosphate ͉ hemoglobin ͉ nitric oxide ͉ S-nitrosothiols ͉ transfusion

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Section: H) P Values Represent Comparison Between Values In Rbcs Assmentioning

confidence: 98%

mentioning

confidence: 99%

Evolution of adverse changes in stored RBCs

Bennett‐Guerrero¹,

Veldman²,

Doctor

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

551

556

View full text Add to dashboard Cite

show abstract

“…Concern has also been expressed about the quality of stored blood and observations of negative outcomes in transfused patients. Retrospective studies found higher mortality and morbidity rates after transfusion that correlated with the duration of RBC storage [12][13][14][15]. This suggested that changes in RBC function during storage may be responsible for adverse outcomes [12].…”

Section: Introductionmentioning

confidence: 99%

September 2007 Update on EORTC Guidelines and Anemia Management with Erythropoiesis-Stimulating Agents

2008

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“…Immunomodulation with down-regulation of cellular immune function increases the risk of nosocomial infections [3,4] . Furthermore, transfusion of older blood raises the incidence of serious complications and increases time to ventilation [5][6][7] . Transfusion related acute lung injury, an uncommon but probably underestimated complication, is one of the leading causes of transfusion-related mor-bidity and mortality [8,9] .…”

Section: Introductionmentioning

confidence: 99%

Perfusionist strategies for blood conservation in pediatric cardiac surgery

Durandy¹

2010

WJC

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There is increasing concern about the safety of homologous blood transfusion during cardiac surgery, and a restrictive transfusion practice is associated with improved outcome. Transfusion-free pediatric cardiac surgery is unrealistic for the vast majority of procedures in neonates or small infants; however, considerable progress has been made by using techniques that decrease the need for homologous blood products or even allow bloodless surgery in older infants and children. These techniques involve a decrease in prime volume by downsizing the bypass circuit with the help of vacuumassisted venous drainage, microplegia, autologous blood predonation with or without infusion of recombinant (erythropoietin), cell salvaging, ultrafiltration and retrograde autologous priming. The three major techniques which are simple, safe, efficient, and cost-effective are: a prime volume as small as possible, cardioplegia with negligible hydric balance and circuit residual blood salvaged without any alteration. Furthermore, these three techniques can be used for all the patients, including emergencies and small babies. In every pediatric surgical unit, a strategy to decrease or avoid blood bank transfusion must be implemented. A strategy to minimize transfusion requirement requires a combined effort involving the entire surgical team with pre-, peri-, and postoperative planning and management.

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Influence of Erythrocyte Concentrate Storage Time on Postsurgical Morbidity in Cardiac Surgery Patients

Abstract: Prolonged storage of erythrocytes does not increase morbidity in cardiac surgery. However, storage for longer than 28 days could be a risk factor for the acquisition of nosocomial pneumonia.

Cited by 185 publications

References 30 publications

Evolution of adverse changes in stored RBCs

Evolution of adverse changes in stored RBCs

September 2007 Update on EORTC Guidelines and Anemia Management with Erythropoiesis-Stimulating Agents

Perfusionist strategies for blood conservation in pediatric cardiac surgery

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