Effect of leukoreduction on inflammation in critically ill dogs receiving red blood cell transfusions: A randomized blinded controlled clinical trial

Abstract

Background: Prestorage leukoreduction of red blood cell (RBC) bags prevents accumulation of pro-inflammatory mediators and experimentally attenuates posttransfusion inflammation in healthy dogs. However, the effect of leukoreduction on post-transfusion inflammation in critically ill dogs is unclear.Hypothesis: Dogs transfused with leukoreduced (LR) RBC will have lower concentrations of leukocytes, interleukin (IL)-6, IL-8, monocyte chemoattractant protein-1 (MCP-1), and C-reactive protein (CRP) within 24 hours of post-transfusion compared to dogs transfused with nonleukoreduced (NLR) RBC.Animals: Sixty-one RBC-transfused dogs (LR = 34, NLR = 27).Methods: Randomized, blinded, controlled preliminary clinical trial. Blood bag processing was randomized to create identically appearing LR and NLR bags. Group allocation occurred with transfusion of the oldest compatible RBC bag. Blood samples were collected pretransfusion and at 8 and 24 hours post-transfusion for leukocyte count, IL-6, IL-8, MCP-1, and CRP. Data were analyzed on an intention-to-treat basis using linear mixed effects models. Significance was set at P < .05.Results: No significant differences were found between groups in concentrations of leukocytes (P = .93), IL-6 (P = .99), IL-8 (P = .75), MCP-1 (P = .69), or CRP (P = .18) over time. Eleven LR dogs (32%) and 4 NLR dogs (15%) were euthanized in the hospital (P = .14). No natural deaths occurred.Conclusions and Clinical Importance: No differences in inflammation biomarker concentrations were detected over time between dogs transfused with LR or NLR RBC, but heterogeneity likely hampered the ability to detect a difference with this sample size. The novel randomization and enrollment protocol was successfully implemented across 2 participating institutions and will be easily scaled up for a future multicenter clinical trial.

The content of leukocytes in the blood of recipient rabbits after allogeneic transfusion of packed red blood cells

“…At the same time, an experiment revealed no differences in concentrations of leukocytes in blood of dogs after receiving erythrocyte transfusion both with and without leukocytes. The authors assumed that absence of detected differences in changes in the numbers of leukocytes between the groups of animals was due to the sampling size and its heterogeneity (Claus et al, 2022). In the studies by Frey (2002), which dealt with preterm babies, the general amount of leukocytes and neutrophils 48 h after blood transfusion also did not change considerably.…”

Clinical Use of Canine Thawed Refrigerated Plasma: A Historical Case Series

“…The SOP was updated such that from February 2020 onwards, the expiry date was extended to 28 days based on new data demonstrating acceptable coagulation factor activity or concentration (of FV, VII, VIII, IX, X, vWF:Ag, and fibrinogen) for at least 28 days [ 10 ]. Between July 2017 and December 2018, 50% of the blood entering the blood bank was leukoreduced (LR) prior to centrifugation as part of a prospective clinical trial that focused on the effects of leukoreduction on the packed red blood cell component [ 12 ]. At all other times, all of the plasma was non-LR.…”

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“…M.A. Claus et al (2022) note that red blood cells are involved in blood clotting and fibrinolysis due to an agent similar to factor PI in platelets, as well as erythrokinase, which activates and converts profibrinolysin to fibrinolysin. The large surface area of red blood cells (4000 m 2 ), rapid turnover of non-deposited red blood cells (45 seconds), and their pronounced sorption capacity contribute to their detoxification function.…”