Additive effects of blood donor smoking and gamma irradiation on outcome measures of red blood cell transfusion

Abstract

BACKGROUND Recent publications have reported conflicting results regarding the role of blood donor tobacco use on hemoglobin (Hb) levels in patients after red blood cell (RBC) transfusion. We examined associations and interactions between donor, component, and recipient factors to better understand the impact of donor smoking on transfusion outcomes. STUDY DESIGN AND METHODS We linked blood donor and component manufacturing data, including self‐reported cigarette smoking, with a cohort of patients transfused RBCs between 2013 and 2016. Using multivariable regression, we examined Hb increments and subsequent transfusion requirements after single‐unit RBC transfusion episodes, adjusting for donor, component, and recipient factors. RESULTS We linked data on 4038 transfusion recipients who received one or more single‐unit RBC transfusions (n = 5086 units) to donor demographic and component manufacturing characteristics. Among RBC units from smokers (n = 326), Hb increments were reduced after transfusion of gamma‐irradiated units (0.76 g/dL; p = 0.033) but not unirradiated units (1.04 g/dL; p = 0.54) compared to those from nonsmokers (1.01 g/dL; n = 4760). In parallel with changes in Hb levels, donor smoking was associated with the receipt of additional RBC transfusions for irradiated (odds ratio [OR], 2.49; p = 0.01) but not unirradiated RBC units (OR, 1.10; p = 0.52). CONCLUSION Donor smoking was associated with reduced Hb increments and the need for additional transfusions in recipients of gamma‐irradiated RBC units. Additional research is needed to better understand interactions between donor, component, and recipient factors on efficacy measures of RBC transfusion.

Fatty acid desaturase activity in mature red blood cells and implications for blood storage quality

“…As a corollary to our model, dietary interventions that alter fatty acyl‐membrane lipid composition 55 (e.g., with HUFA‐rich fish oil diets) would influence not only RBC lipid homeostasis, but also energy metabolism and other critical metabolic pathways that impact FADS activation to balance NADH/NAD+ ratios. In addition, because differences in donor RBCs storage are known to occur, further work to understand how FADS activity and lipid oxidations are mechanistically associated in refrigerator‐stored RBCs as a function of donor demographics and their impact on RBC storage quality, such as donor sex, age, ethnicity, 9,56,57 processing strategies, 31 or donor habits (e.g., nicotine, 58,59 alcohol, 60 caffeine, 61 or taurine consumption) 62 . These hypotheses could be amenable to direct testing in tractable murine models of blood storage and transfusion.…”

Evidence for structural protein damage and membrane lipid remodeling in red blood cells from COVID-19 patients

“…Similarly, the present study was not sufficiently powered to determine the impact of COVID-19 on RBCs as a function of other biological variables, including subject sex, age, ethnicity, blood type, and habits (e.g., smoking); these are all associated with the RBC's capacity to cope with oxidant stress and modulate energy metabolism. 20,[48][49][50][51][52] 51. D'Alessandro A, Fu X, Reisz JA, et al Stored RBC metabolism as a function of caffeine levels.…”

Blood donor exposome and impact of common drugs on red blood cell metabolism

“…or blood processing. Previous studies focused on the metabolic impact of specific exposures, such as donor habits (e.g., smoking, 24,25 consumption of alcohol, 50 coffee 51 or taurine 52 ), or blood processing (e.g., plasticizers, storage additives, leukofiltration). As such, here we mostly focused on an as of yet unexplored aspect of RBC storage biology: the presence and potential impact of drugs on stored RBC metabolism.…”

“…22,23 It is a logical consequence of the studies described above that the antioxidant capacity of a mature RBC is affected by other factors beyond donor biology that could counteract or aggravate oxidant stress. One such factor is represented by donor habits, such as smoking, which in smaller cohorts has been shown to increase markers of oxidant stress in the stored unit (e.g., carboxyhemoglobin or altered glutathione homeostasis 24 ) and ultimately result in lower hemoglobin increments in recipients of units from smoking donors 25 . However, it is unclear whether and to what extent other factors derived from environmental exposures -referred to as the "exposome" 26 would impact the metabolic age of the stored RBC and, as a result, transfusion efficacy in the recipient.…”