Non‐polar lipids accumulate during storage of transfusion products and do not contribute to the onset of transfusion‐related acute lung injury

Abstract

We conclude that non-polar lipids accumulate in RBC and plasma transfusion products and that accumulation is temperature dependent. Accumulation of non-polar lipids does not appear to explain the onset of TRALI (Dutch Trial Register - NTR4455).

Supernatants and lipids from stored red blood cells activate pulmonary microvascular endothelium through the BLT2 receptor and protein kinase C activation

“…33,70,81,82 Aside from becoming febrile with a mild increase in the respiratory rate, the subjects were not as ill as the LPS-treated rats. 33,70,81,82 Moreover, LPS does not induce proinflammatory changes in human PMNs and HMVECs at concentrations of less than 20 ng/mL in vitro, which is orders of magnitude higher than the in vivo dosing. 5,33,73,83 These data support prior clinical reports that identified stored RBC transfusion as an independent risk factor for postinjury ALI or ARDS, MOF, infections, and mortality.…”

“…81,82 However, the dose of endotoxin (2 ng/kg; 40-50 pg/mL) used in these experiments was much less than the IV doses (1 mg) for the treatment of neurosyphilis, which was completed in most cases without significant mortality. 33,70,81,82 Aside from becoming febrile with a mild increase in the respiratory rate, the subjects were not as ill as the LPS-treated rats. 33,70,81,82 Moreover, LPS does not induce proinflammatory changes in human PMNs and HMVECs at concentrations of less than 20 ng/mL in vitro, which is orders of magnitude higher than the in vivo dosing.…”

“…Longer storage was required for lipid accumulation in AS‐3–stored LR‐RBCs. Finally, the two‐event model of ALI employed has been questioned because humans who received endotoxin did not manifest injury when transfused with older, stored blood RBCs . However, the dose of endotoxin (2 ng/kg; 40‐50 pg/mL) used in these experiments was much less than the IV doses (≥1 mg) for the treatment of neurosyphilis, which was completed in most cases without significant mortality .…”

“…Finally, the two‐event model of ALI employed has been questioned because humans who received endotoxin did not manifest injury when transfused with older, stored blood RBCs . However, the dose of endotoxin (2 ng/kg; 40‐50 pg/mL) used in these experiments was much less than the IV doses (≥1 mg) for the treatment of neurosyphilis, which was completed in most cases without significant mortality . Aside from becoming febrile with a mild increase in the respiratory rate, the subjects were not as ill as the LPS‐treated rats .…”

A comparison of different methods of red blood cell leukoreduction and additive solutions on the accumulation of neutrophil‐priming activity during storage

“…The two‐event model of TRALI has been recently criticized because of the inability of volunteers injected with 2 ng/kg Escherichia coli lipopolysaccharide (LPS) to manifest TRALI when transfused with autologous RBC units stored for 35 days . Injection of E. coli LPS induced fevers of more than 38°C, pulses or more than 90 beats/min, and mild tachypnea (>20 breaths/min) without evidence of pulmonary endothelial activation or PMN sequestration in the lung, a prerequisite for the two‐event model of TRALI . In contrast, animals used for the two‐event model of TRALI demonstrated fevers with rigors, copious diarrhea, and when euthanized pulmonary sequestration of PMNs .…”