Perfusion vs. oxygen delivery in transfusion with “fresh” and “old” red blood cells: The experimental evidence

Abstract

We review the experimental evidence showing systemic and microvascular effects of blood transfusions instituted to support the organism in extreme hemodilution and hemorrhagic shock, focusing on the use of fresh vs. stored blood as a variable. The question: "What does a blood transfusion remedy?" was analyzed in experimental models addressing systemic and microvascular effects showing that oxygen delivery is not the only function that must be addressed. In extreme hemodilution and hemorrhagic shock blood transfusions simultaneously restore blood viscosity and oxygen carrying capacity, the former being critically needed for reestablishing a functional mechanical environment of the microcirculation, necessary for obtaining adequate capillary blood perfusion. Increased oxygen affinity due to 2,3 DPG depletion is shown to have either no effect or a positive oxygenation effect, when the transfused red blood cells (RBCs) do not cause additional flow impairment due to structural malfunctions including increased rigidity and release of hemoglobin. It is concluded that fresh RBCs are shown to be superior to stored RBCs in transfusion, however increased oxygen affinity may be a positive factor in hemorrhagic shock resuscitation. Although experimental studies seldom reproduce emergency and clinical conditions, nonetheless they serve to explore fundamental physiological mechanisms in the microcirculation that cannot be directly studied in humans.

Habitual exercise plus dietary supplementation with milk fat globule membrane improves muscle function deficits via neuromuscular development in senescence-accelerated mice

“…Concurrently, the decreased erythrocytes and hemoglobin levels reduce the oxygen-carrying capacity of the blood (Tsai et al 2010); this may be consistent with the lower oxygen consumption in SAMP1 in the present study. MFGM intake combined with exercise increased hemoglobin and hematocrit levels and tended to increase the RBC count in the SAMP1 mice; this may have resulted in increased oxygen consumption.…”

“…SAMP1 had lower concentrations of circulating erythrocytes, and lower hemoglobin and hematocrit levels than did ICR mice, in parallel with previous findings that with advancing age these levels decline (Boggs and Patrene 1986 ; Coppola et al 2000 ). Concurrently, the decreased erythrocytes and hemoglobin levels reduce the oxygen-carrying capacity of the blood (Tsai et al 2010 ); this may be consistent with the lower oxygen consumption in SAMP1 in the present study. MFGM intake combined with exercise increased hemoglobin and hematocrit levels and tended to increase the RBC count in the SAMP1 mice; this may have resulted in increased oxygen consumption.…”

Habitual exercise plus dietary supplementation with milk fat globule membrane improves muscle function deficits via neuromuscular development in senescence-accelerated mice

“…Concurrently, the decreased erythrocytes and hemoglobin levels reduce the oxygen-carrying capacity of the blood (Tsai et al 2010); this may be consistent with the lower oxygen consumption in SAMP1 in the present study. MFGM intake combined with exercise increased hemoglobin and hematocrit levels and tended to increase the RBC count in the SAMP1 mice; this may have resulted in increased oxygen consumption.…”

“…SAMP1 had lower concentrations of circulating erythrocytes, and lower hemoglobin and hematocrit levels than did ICR mice, in parallel with previous findings that with advancing age these levels decline (Boggs and Patrene 1986 ; Coppola et al 2000 ). Concurrently, the decreased erythrocytes and hemoglobin levels reduce the oxygen-carrying capacity of the blood (Tsai et al 2010 ); this may be consistent with the lower oxygen consumption in SAMP1 in the present study. MFGM intake combined with exercise increased hemoglobin and hematocrit levels and tended to increase the RBC count in the SAMP1 mice; this may have resulted in increased oxygen consumption.…”

Plasma expander and blood storage effects on capillary perfusion in transfusion after hemorrhage

“…The same trend in the effects of plasma expanders were observed for both fresh blood and blood stored for 2 weeks. However, fresh blood yielded a consistently higher FCD upon transfusion by comparison to stored blood, an effect consistent with previous findings on the effects of storage on RBC properties 27 . Similar results were found in the study of Gonzalez and coworkers 28 who subjected rats to a 10% blood loss that were subsequently treated with fresh blood and 1‐ and 2‐week‐old stored blood.…”

Red Blood Cell Storage Duration and Trauma

“…Intravascular imaging microscopy and near-infrared tissue spectrometry in 93 anemic, although otherwise stable, severely injured trauma patients have suggested that significantly altered microvascular hemodynamics and tissue oxygen saturation may occur after transfusion of longer stored RBCs [26]. These findings are consistent with those from animal models of microvascular hemodynamics and the effects of transfusion of longer stored RBCs [119,120].…”

Habitual exercise plus dietary supplementation with milk fat globule membrane improves muscle function deficits via neuromuscular development in senescence-accelerated mice

“…Concurrently, the decreased erythrocytes and hemoglobin levels reduce the oxygen-carrying capacity of the blood (Tsai et al 2010); this may be consistent with the lower oxygen consumption in SAMP1 in the present study. MFGM intake combined with exercise increased hemoglobin and hematocrit levels and tended to increase the RBC count in the SAMP1 mice; this may have resulted in increased oxygen consumption.…”

“…SAMP1 had lower concentrations of circulating erythrocytes, and lower hemoglobin and hematocrit levels than did ICR mice, in parallel with previous findings that with advancing age these levels decline (Boggs and Patrene 1986 ; Coppola et al 2000 ). Concurrently, the decreased erythrocytes and hemoglobin levels reduce the oxygen-carrying capacity of the blood (Tsai et al 2010 ); this may be consistent with the lower oxygen consumption in SAMP1 in the present study. MFGM intake combined with exercise increased hemoglobin and hematocrit levels and tended to increase the RBC count in the SAMP1 mice; this may have resulted in increased oxygen consumption.…”

Plasma expander and blood storage effects on capillary perfusion in transfusion after hemorrhage

“…The same trend in the effects of plasma expanders were observed for both fresh blood and blood stored for 2 weeks. However, fresh blood yielded a consistently higher FCD upon transfusion by comparison to stored blood, an effect consistent with previous findings on the effects of storage on RBC properties 27 . Similar results were found in the study of Gonzalez and coworkers 28 who subjected rats to a 10% blood loss that were subsequently treated with fresh blood and 1‐ and 2‐week‐old stored blood.…”

Red Blood Cell Storage Duration and Trauma

“…Intravascular imaging microscopy and near-infrared tissue spectrometry in 93 anemic, although otherwise stable, severely injured trauma patients have suggested that significantly altered microvascular hemodynamics and tissue oxygen saturation may occur after transfusion of longer stored RBCs [26]. These findings are consistent with those from animal models of microvascular hemodynamics and the effects of transfusion of longer stored RBCs [119,120].…”

Habitual exercise plus dietary supplementation with milk fat globule membrane improves muscle function deficits via neuromuscular development in senescence-accelerated mice

“…Concurrently, the decreased erythrocytes and hemoglobin levels reduce the oxygen-carrying capacity of the blood (Tsai et al 2010); this may be consistent with the lower oxygen consumption in SAMP1 in the present study. MFGM intake combined with exercise increased hemoglobin and hematocrit levels and tended to increase the RBC count in the SAMP1 mice; this may have resulted in increased oxygen consumption.…”

“…SAMP1 had lower concentrations of circulating erythrocytes, and lower hemoglobin and hematocrit levels than did ICR mice, in parallel with previous findings that with advancing age these levels decline (Boggs and Patrene 1986 ; Coppola et al 2000 ). Concurrently, the decreased erythrocytes and hemoglobin levels reduce the oxygen-carrying capacity of the blood (Tsai et al 2010 ); this may be consistent with the lower oxygen consumption in SAMP1 in the present study. MFGM intake combined with exercise increased hemoglobin and hematocrit levels and tended to increase the RBC count in the SAMP1 mice; this may have resulted in increased oxygen consumption.…”

Plasma expander and blood storage effects on capillary perfusion in transfusion after hemorrhage

“…The same trend in the effects of plasma expanders were observed for both fresh blood and blood stored for 2 weeks. However, fresh blood yielded a consistently higher FCD upon transfusion by comparison to stored blood, an effect consistent with previous findings on the effects of storage on RBC properties 27 . Similar results were found in the study of Gonzalez and coworkers 28 who subjected rats to a 10% blood loss that were subsequently treated with fresh blood and 1‐ and 2‐week‐old stored blood.…”

Red Blood Cell Storage Duration and Trauma

“…Intravascular imaging microscopy and near-infrared tissue spectrometry in 93 anemic, although otherwise stable, severely injured trauma patients have suggested that significantly altered microvascular hemodynamics and tissue oxygen saturation may occur after transfusion of longer stored RBCs [26]. These findings are consistent with those from animal models of microvascular hemodynamics and the effects of transfusion of longer stored RBCs [119,120].…”