Increased Rate of Infection Associated With Transfusion of Old Blood After Severe Injury

Offner, Patrick J.; Moore, Ernest E.; Biffl, Walter L.; Johnson, Jeffrey L.; Silliman, Christopher C.

doi:10.1001/archsurg.137.6.711

Cited by 305 publications

(278 citation statements)

References 41 publications

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“…Moreover, these studies do not explain the nonpulmonary complications observed in these patients, notably higher rates of multi-organ failure, infections, or thromboembolic complications. 10,11,13 The findings presented here offer a possible antibody-independent mechanism of transfusion-related pathology.…”

Section: Discussionmentioning

confidence: 66%

“…During the past decades, there has been substantial controversy over the question whether an increased storage time of blood products before transfusion is associated with higher patient morbidity and mortality. 3 Whereas some studies were negative, 4,5 various other studies found increased overall mortality rates, 6-9 a higher incidence of postoperative infections, 10 renal failure, 7 and a higher frequency of clotting disorders 11,12 in patients who received aged blood products compared with those who received fresh blood products and identified critically ill individuals, that is, patients after trauma or cardiac surgery, to be the most vulnerable patient population. 8,13 During aging, erythrocytes undergo a series of biochemical and physical changes known as the storage lesion.…”

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confidence: 99%

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Erythrocyte-Derived Microvesicles Amplify Systemic Inflammation by Thrombin-Dependent Activation of Complement

Zecher

Čumpelik

Schifferli

2014

ATVB

105

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Objective-Transfusion of aged blood has been associated with increased morbidity and mortality in critically ill patients.During storage, erythrocytes release increasing numbers of microvesicles (red blood cell-derived microvesicles [RBC-MV]). We hypothesized that RBC-MV mediate some of the deleterious effects of aged blood transfusions. Approach and Results-We established a murine transfusion model using RBC-MV purified from aged mouse erythrocytes. Injection of RBC-MV into healthy mice had no effect. However, they aggravated pulmonary leukocyte sequestration and peripheral blood leukopenia induced by lipopolysaccharides. Lipopolysaccharide-induced proinflammatory cytokines were significantly increased in plasma after RBC-MV injection. These effects were not seen in C5aR-deficient mice. In vitro, RBC-MV bound C3 fragments after incubation with plasma but failed to bind immunoglobulins, C1q, or mannose-binding lectin. Preventing thrombin generation inhibited complement activation in vitro and in vivo and reversed the proinflammatory effects of RBC-MV in lipopolysaccharide-primed mice. Finally, the RBC-MV-induced phenotype was recapitulated using phosphatidylserineexpressing liposomes, suggesting that surface expression of phosphatidylserine by RBC-MV was mechanistically involved. Conclusions-These

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Section: Discussionmentioning

confidence: 66%

mentioning

confidence: 99%

Erythrocyte-Derived Microvesicles Amplify Systemic Inflammation by Thrombin-Dependent Activation of Complement

Zecher

Čumpelik

Schifferli

2014

ATVB

105

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“…These alterations, together with other biological substances present in preserved red blood cell units, may reduce oxygen delivery and stimulate inflammatory pathways. Observational studies in trauma patients [51][52][53] support these physiologic data by suggesting adverse clinical outcomes from the use of older rather than fresher red blood cell units, and a large randomized trial investigating the effect of red blood cell unit storage time on clinical outcomes in critically ill patients is ongoing (ISRCTN44878718; details available at www.controlledtrials.com). In our study, we did not collect data on pretransfusion storage time of red blood cell units.…”

Section: Discussionmentioning

confidence: 96%

Early massive transfusion in trauma patients: Canadian single-centre retrospective cohort study

Mahambrey

Fowler

Pinto

et al. 2009

Can J Anesth/J Can Anesth

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Purpose To determine associations between red blood cell (RBC) transfusion and early and late clinical outcomes in massively transfused adult trauma patients. Methods A retrospective cohort study (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001) including 260 patients receiving C10 RBC units B24 hr after admission to a university-affiliated trauma centre. We extracted demographic and clinical data and used multivariable regression to determine independent effects of RBC transfusion on clinical outcomes. ]).Conclusions Hospital mortality is high among massively transfused trauma patients. Among early survivors, 48-hr RBC transfusion volume is associated with increased organ dysfunction, but not hospital mortality. Also, it is not associated with 48-hr mortality. Future research should continue to explore methods to improve hemostasis and minimize the need for RBC transfusion. RésuméObjectif De´terminer les associations qui existent entre la transfusion d'e´rythrocytes et les devenirs cliniques R. A. Fowler and N. K. J. Adhikari contributed equally to this study.

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“…In 2002, Offner and his colleagues reported on a second trauma cohort of 61 patients again identified on the basis of having received 6-20 units of red blood cells in the first 12 h after admission [45]. In this second cohort, patients who received older red blood cells had an increased number of major infections that led to increased length of ICU stay.…”

Section: Data From Clinical Studiesmentioning

confidence: 99%

Current issues relating to the transfusion of stored red blood cells

Zimrin¹,

2009

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The development of blood storage systems allowed donation and transfusion to be separated in time and space. This separation has permitted the regionalization of donor services with subsequent economies of scale and improvements in the quality and availability of blood products. However, the availability of storage raises the question of how long blood products can and should be stored and how long they are safe and effective. The efficacy of red blood cells was originally measured as the increment in haematocrit and safety began with typing and the effort to reduce the risk of bacterial contamination. Appreciation of a growing list of storage lesions of red blood cells has developed with our increasing understanding of red blood cell physiology and our experience with red blood cell transfusion. However, other than frank haemolysis, rare episodes of bacterial contamination and overgrowth, the reduction of oxygen-carrying capacity associated with the failure of some transfused cells to circulate, and the toxicity of lysophospholipids released from membrane breakdown, storage-induced lesions have not had obvious correlations with safety or efficacy. The safety of red blood cell storage has also been approached in retrospective epidemiologic studies of transfused patients, but the results are frequently biased by the fact that sicker patients are transfused more often and blood banks do not issue blood products in a random order. Several large prospective studies of the safety of stored red blood cells are planned.

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Increased Rate of Infection Associated With Transfusion of Old Blood After Severe Injury

Abstract: Blood components undergo changes during storage that may affect the recipient, including the release of bioactive agents, with significant immune consequences. We hypothesized that transfusion of old blood increases infection risk in severely injured patients.

Cited by 305 publications

References 41 publications

Erythrocyte-Derived Microvesicles Amplify Systemic Inflammation by Thrombin-Dependent Activation of Complement

Erythrocyte-Derived Microvesicles Amplify Systemic Inflammation by Thrombin-Dependent Activation of Complement

Early massive transfusion in trauma patients: Canadian single-centre retrospective cohort study

Current issues relating to the transfusion of stored red blood cells

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