Fresh Red Blood Transfusion as a Successful Erythrocyte Cholinesterase Supplement in Organophosphate Poisoning

Abstract

Despite improvements to standard treatments (atropine, oxime) and intensive care management, the mortality associated with organophosphate (OP) poisoning has not substantially decreased. In this study, we evaluated the role of packed red blood cells (RBCs) transfusion in acute OP poisoning. Patients diagnosed with OP poisoning were included in this prospective study, and then were transfused with packed RBCs stored less than 10 days or 10 to 35 days. Cholinesterase (ChE) level in blood, atropine usage and durations were recorded. We found both shorter-and longer-storage RBCs (200~400 ml) significantly increased AChE level in blood, improved ChE recovery, and reduced the usage and shortened the duration of atropine and followed clinical recovery. Shorter-storage RBCs had better effect than longer-storage (longer storage) ones. Due to erythrocyte cholinesterase supplement, packed RBCs might be used as an alternative approach in patients with OP poisoning, especially at the early stages.

Investigating the Effect of Fresh Frozen Plasma and Albumin on DNA Damage and Oxidative Stress Biomarkers in Poisoning Cases by Organophosphates

“…In severe poisoning, enzyme recovery usually takes about 4 weeks [24]. If the enzyme level remains low for lasts long, it could cause 'rebound' or intermediate syndrome', and might lead to paralysis of respiratory muscle, which increases the mortality rate [25]. In this study, the levels of ChE enzyme activity were assessed upon arrival and three consecutive later days in all three groups (control, al-bumin, and FFP).…”

Role of intravenous lipid emulsion therapy and packed red blood cell transfusion as adjuvant treatment in the management of a child with severe organophosphate poisoning (chlorpyrifos)

“…On top of lipid emulsion therapy, we also considered giving packed RBC transfusion because of its potential to restore AChE activity by delivering additional erythrocyte cholinesterase to scavenge circulating OPs and its potential to decrease total atropine requirement especially in our patient who developed toxicity 8 34 35. Two studies showed this effect where the recovery of the measurable AChE level was significantly faster by 10–20 hours and total atropine requirement was significantly lower by 20%–30% among those who received packed RBC transfusion (200–400 mL) 8 29. These studies also showed that transfusion of fresh RBCs which are stored for less than 10 days showed superiority compared with those in longer storage since AChE activity declines with time 29.…”

“…A single dose of 21 mL (1.5 mL/kg, 20%) lipid emulsion was given intravenously over 3 min and was followed by 79 mL (5.5 mL/kg) given at 50 mL/hour (full maintenance rate). Transfusion with packed RBC was also requested as a source of additional erythrocyte cholinesterase, which could be the potential target substrate for circulating OPs 6 8. Six hours after the intravenous lipid emulsion therapy ended, she was transfused with a single dose of 140 mL packed RBC (10 mL/kg/dose) given over 4 hours.…”