Equilibration of Hemoglobin Concentration after Transfusion in Medical Inpatients Not Actively Bleeding

Wiesen, Andrew R.; Hospenthal, Duane R.; Byrd, John C.; Glass, Kevin L.; Howard, Robin S.; Diehl, Louis F.

doi:10.7326/0003-4819-121-4-199408150-00009

Cited by 86 publications

(83 citation statements)

References 6 publications

(8 reference statements)

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“…31,32 An incidental finding from this study is the extent of variability in hemoglobin levels measured soon after transfusion ( Figure 1B-C), with 6 of 14 volunteers exhibiting either a decrease or no increase in hemoglobin at 4 hours after transfusion of fresh autologous RBCs. Although this finding supports classic textbook teaching 33 that it requires up to 24 hours for hemoglobin levels to equilibrate, more recent studies suggest that hemoglobin levels quickly equilibrate after transfusion in adult 34 and neonatal 35 patients. Therefore, our findings suggest that hemoglobin measurements may not be ideal for assessing the effectiveness of RBC transfusions until 24 hours after transfusion, although this assertion is limited by an absence of measurements between 4 and 24 hours after transfusion.…”

mentioning

confidence: 64%

Transfusion of human volunteers with older, stored red blood cells produces extravascular hemolysis and circulating non–transferrin-bound iron

Hod¹,

Brittenham

Billote

et al. 2011

Blood

256

286

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Transfusions of RBCs stored for longer durations are associated with adverse effects in hospitalized patients. We prospectively studied 14 healthy human volunteers who donated standard leukoreduced, double RBC units. One unit was autologously transfused "fresh" (3-7 days of storage), and the other "older" unit was transfused after 40 to 42 days of storage. Of the routine laboratory parameters measured at defined times surrounding transfusion, significant differences between fresh and older transfusions were only observed in iron parameters and markers of extravascular hemolysis. IntroductionThe safety of transfusing RBCs after longer durations of refrigerated storage was recently identified as "the most critical issue facing transfusion medicine." 1 page 667 Concern was heightened when a large observational study of cardiac surgery patients found an increased risk of postoperative complications and reduced survival in those who received RBCs stored for more than 14 days. 2 Although still controversial, adverse clinical consequences have since been reported in most, [3][4][5] although not all, 6,7 epidemiologic studies of transfusions of RBCs stored for longer durations, but still within Food and Drug Administration (FDA) guidelines. The association between the duration of RBC storage and increased rates of serious infections, sepsis, and mortality is particularly strong in trauma patients. [7][8][9][10][11] Definitive determination of the potential risks associated with transfusion of RBCs stored for longer durations has been elusive, in part because the mechanisms responsible have not yet been identified.More than 14 million RBC units are transfused in the United States each year, with a mean storage interval of 18 days before transfusion. 12 During storage, RBCs undergo cumulative biochemical and biomechanical changes (the "storage lesion") that reduce their survival in vivo after transfusion. 13,14 In mouse models, 15 transfusion of RBCs stored for longer durations was followed by brisk extravascular clearance of a subpopulation of these cells, which were damaged during storage and removed by macrophages in the spleen and liver of recipient mice. The iron liberated by phagocytic digestion of these RBCs rapidly entered the systemic circulation in amounts that exceeded the transport capacity of plasma transferrin, the physiologic iron-binding protein; in this way, circulating non-transferrin-bound iron appeared and promoted the proliferation of pathogenic bacteria both in vitro 15 and in vivo. 16 We hypothesized that the infectious complications observed in human patients after transfusion of RBCs stored for longer durations were, at least in part, the result of the production of circulating non-transferrin-bound iron. Therefore, we prospectively examined healthy human volunteers to determine (1) if transfusion of autologous RBCs stored for longer durations was followed by the appearance of circulating non-transferrin-bound iron in vivo, and (2) if this increased circulating non-transferrinbound iron was assoc...

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mentioning

confidence: 64%

Transfusion of human volunteers with older, stored red blood cells produces extravascular hemolysis and circulating non–transferrin-bound iron

Hod¹,

Brittenham

Billote

et al. 2011

Blood

256

286

View full text Add to dashboard Cite

show abstract

“…Huber et al (1964) 18 found the average increase in hemoglobin concentrations was 0.9 ±0.1 g/dL) in a study of 16 adult patients with mild splenomegaly. Wiesen et al (1994) 23 in their study concluded that transfusion with 1 unit of packed erythrocytes increases the hemoglobin level an average of 10 g/L (1.0 g/dL). Mungayi et al (2014) 31 in their study reported that the mean 24 in their study reported that the agreement between 15-minute and 24-hour values was excellent, as only 6 percent of patients exhibited a clinically significant difference (> 6 g/L) between the hemoglobin measurements.…”

Section: Methodsmentioning

confidence: 99%

“…It has been implied that blood volume is expanded immediately after transfusion and does not return to normal for 24 hours 22 . Wiesen et al (1994) 23 24 .…”

Section: Introductionmentioning

confidence: 99%

Equilibration and Increase of Hemoglobin Concentration after One Unit Whole Blood Transfusion among Patients Not Actively Bleeding

Hoque

Adnan

Karim³

et al. 2015

J Dhaka Med Coll

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“…The change takes effect within an hour. 5 The duration of this effect, even if the RBCs have been stored for their maximum of 35 days, is determined by the normal survival time of RBCs, that is, approximately 100 days. 6 On this basis, because each donation will contain a mixture of RBCs, young to old, 50% of the transfused RBCs will disappear by 50 days.…”

Section: Blood (Red Cell) Transfusionmentioning

confidence: 99%

A systematic review and economic evaluation of epoetin alfa, epoetin beta and darbepoetin alfa in anaemia associated with cancer, especially that attributable to cancer treatment

Wilson

Yao²,

Raftery³

et al. 2007

Health Technol Assess

147

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show abstract

Equilibration of Hemoglobin Concentration after Transfusion in Medical Inpatients Not Actively Bleeding

Cited by 86 publications

References 6 publications

Transfusion of human volunteers with older, stored red blood cells produces extravascular hemolysis and circulating non–transferrin-bound iron

Transfusion of human volunteers with older, stored red blood cells produces extravascular hemolysis and circulating non–transferrin-bound iron

Equilibration and Increase of Hemoglobin Concentration after One Unit Whole Blood Transfusion among Patients Not Actively Bleeding

A systematic review and economic evaluation of epoetin alfa, epoetin beta and darbepoetin alfa in anaemia associated with cancer, especially that attributable to cancer treatment

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