BackgroundThe endothelial glycocalyx layer (EGL) is a key regulator of vascular permeability, cell adhesion, and inflammation. The EGL is primarily composed of syndecan-1, hyaluronic acid (HA), heparan sulfate (HS) and chondroitin sulfate (CS). While many studies have observed increased shedding of syndecan-1 during hemorrhagic shock, little is known about the shedding of other EGL components, and their effects on altered permeability and coagulation. We characterized shedding of all four primary components of the EGL, as well as the plasma’s effect on permeability and thrombin generation in a cohort of trauma patients.MethodsPlasma samples were collected from 5 healthy consented volunteers and 22 severely injured trauma patients upon admission to the emergency department. ELISA assays were performed to quantify shed HA, HS, CS and syndecan-1 in plasma. A colloid osmometer and Electric Cell-substrate Impedance Sensing (ECIS) system were used to measure plasma colloid osmotic pressure (COP) and cell permeability, respectively. Thrombin generation was measured using a calibrated automated thrombogram (CAT). Initial vital signs, routine laboratory values, and injury severity scores (ISS) were recorded. Non-parametric statistical tests were used to compare differences between groups.ResultsWe observed increased shedding of all four proteins in trauma patient plasma compared to healthy controls: 31.7 vs. 21.2 U/L of CS, 175.8 vs. 121.9 ng/ml of HS, 946.7 vs. 618.6 ng/ml of HA and 245.8 vs. 31.6 ng/ml of syndecan-1 (all p < 0.05). Patients with low plasma COP (≤16 mmHg) had significantly increased syndecan-1 and HA compared to those with normal COP, which corresponded to increased cell permeability via ECIS. CS and HS did not vary between COP groups. Lastly, patients with low COP displayed reduced peak thrombin generation of less than 250 nM on average (p < 0.05).ConclusionsGlycocalyx components were shed more in trauma patients compared to healthy controls in this cohort. However, only syndecan-1 and HA shedding were significantly higher in patients with reduced plasma COP. Thrombin generation was impaired in patients with low plasma COP. These data suggest that low plasma COP correlates well to glycocalyx degradation and thrombin loss following trauma, which consequently affect permeability and coagulation.

This study furnishes evidence that both confirms and refutes a long-standing maxim that a one-unit transfusion of red blood cells should yield a posttransfusion hemoglobin increment of 1 g/dL.

ID-NAT and serology are complementary in detecting HBV infection in first-time donors, but HBV-DNA is superior to HBsAg detection in repeat donors.

Deaths were rarely observed, but newborns and other vulnerable populations are at risk for severe complications.

Introduction Blood transfusion is one of the most common medical procedures during hospitalization in the United States. To understand the benefits of transfusion while mitigating potential risks, a multicenter database containing detailed information on transfusion incidence and recipient outcomes would facilitate research. Methods The Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) program has developed a comprehensive transfusion recipient database utilizing data from hospital electronic health records at 12 participating hospitals in four geographic regions. Transfused inpatient and outpatient data from January 1, 2013 until December 31, 2014 included patient age, sex, ethnicity, primary diagnosis, type of blood product provided, issue location, pre- and post-transfusion hemoglobin, and hospital outcomes. Transfusion incidence per encounter was calculated by blood product and various patient characteristics. Results During the two-year study period, 80,362 (12.5%) inpatient encounters involved transfusion. Among inpatients, the most commonly transfused blood products were red cells (10.9% of encounters), followed by platelets (3.2%), and plasma (2.9%). Among transfused patients, the median number of red-cell units was one, pre-transfusion hemoglobin was 7.6 g/dL, and hemoglobin increment/unit was 1.4 g/dL. Encounter mortality increased with patient age, number of units transfused, and the use of platelet or plasma products. The most common reported transfusion reaction was febrile non-hemolytic. Conclusion The REDS-III recipient database contains comprehensive data regarding transfusion use and patient outcomes. This report describes an evaluation of the first two years of a planned four-year linked blood donor-component-recipient database which represents a critical new resource for transfusion medicine researchers.