Prestorage versus Bedside White Blood Cell Filtration of Red Blood Cell Concentrates

Kristiansson, Marianne; Soop, M.; Shanwell, Agneta; Kg, Sundqvist

doi:10.1097/00005373-199603000-00009

Cited by 25 publications

(5 citation statements)

References 36 publications

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“…Because other investigators have reported that LR diminishes the cytokine content of PRBCs, 7,11 and because both LR and NLR supernatants induced T regs to a similar degree, only LR PRBC supernatants from 1-day and 42-day were evaluated for cytokines still present after prestorage leukocyte filtration. Levels of all seven cytokines were detectable in the 1-day LR PRBC supernatant, but were reduced after prolonged storage of 42 days, reaching statistical significance for all cytokines except transforming growth factor – β for the small number of supernatants assayed (n = 3; p < 0.05; Fig.…”

Section: Resultsmentioning

confidence: 99%

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Stored Red Blood Cell Transfusion Induces Regulatory T Cells

Baumgartner

Silliman²,

Moore

et al. 2009

Journal of the American College of Surgeons

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BACKGROUND Allogeneic blood transfusion mediates immunosuppression in transfused recipients by an unknown mechanism. Regulatory T cells (Tregs) are suppressive CD4+CD25+Foxp3+ cells with a central role in immunosuppression in trauma victims, cancer patients, and transplant recipients. We hypothesized that transfusion-related immunosuppression is, in part, mediated by induction of Tregs, and this induction is attenuated with prestorage leukoreduction and accentuated with prolonged storage. STUDY DESIGN Packed red blood cell (PRBC) units were obtained and 50% of PRBCs were leukoreduced (LR) before routine storage for 1 day or 42 days and the supernatant was collected. Normal human peripheral blood mononuclear cells (PBMCs) were exposed to 1-day NLR, 42-day NLR, 1-day LR, or 42-day LR PRBC supernatants or to PRBC storage solution or washed PRBC supernatant ± anti-CD3 stimulation, and analyzed by flow cytometry for Foxp3+ Tregs or CD25+-activated T cells. PRBC supernatants and cell culture supernatants were analyzed by immunoassay for interleukin (IL)-1β, IL-2, IL-4, IL-10, interferon-γ, tumor necrosis factor–α, and transforming growth factor–β. Treg activity was evaluated by suppression assay. RESULTS All PRBC groups induced Tregs compared with control media in anti–CD3-stimulated PBMCs, without alteration by LR or prolonged storage. PRBC supernatant did not alter nonspecific T-cell activation from control media. PRBC-induced Tregs were suppressive, inhibiting proliferation of T-responder cells. All cytokines measured decreased with storage in LR PRBC units and no cytokines were substantially elevated in cell supernatants exposed to PRBC supernatant. PRBC storage solution did not reproduce the effects of PRBC supernatant, and washed PRBC supernatant attenuated Treg induction. CONCLUSIONS PRBC supernatant induces Tregs, but this induction is not altered by LR or prolonged storage. This induction appears to be independent of cytokines and is attenuated with washed PRBCs, implicating the plasma fraction.

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Section: Resultsmentioning

confidence: 99%

“…7–10 Prestorage leukoreduction (LR) has been proposed to ameliorate immunosuppression from donor leukocytes or donor leukocyte-derived mediators. LR diminishes the amount of transfused cytokines and other immunologic mediators, and this can attenuate the immunosuppressive effects of ABT by reduction of functional defects in the immune response.…”

mentioning

confidence: 99%

Stored Red Blood Cell Transfusion Induces Regulatory T Cells

Baumgartner

Silliman²,

Moore

et al. 2009

Journal of the American College of Surgeons

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“…The Food and Drug Administration permits the storage of additive solution-preserved packed red cell units for up to 42 days, and the mean calculated age at transfusion is 19.5 days in the U.S. 11 . Whether or not the age of the transfused RBCs contributed to the patient’s acute exacerbation remains unclear, but soluble mediators with neutrophil activating potential are known to accumulate with increased storage duration 12 and to a greater degree in non-leukoreduced versus pre-storage leukoreduced RBC units 13-15 . Storage also promotes the loss of RBC chemokine scavenging property 16 , and the accumulation of free hemoglobin which can scavenge nitric oxide, mediate cytotoxic and pro-oxidant effects in vivo through its breakdown products heme and free iron 17 .…”

Section: Discussionmentioning

confidence: 99%

Acute exacerbation of subclinical pulmonary fibrosis after red blood cell transfusion: a case report

Woodske

Donahoe²,

Yazer³

et al. 2011

Transfusion

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Background Red cell transfusion is associated with lung injury in susceptible hosts, although many cases do not meet criteria for transfusion related acute lung injury. Patients with underlying pulmonary fibrosis can exhibit precipitous deteriorations in respiratory status of unknown etiology defined as acute exacerbations due to superimposed lung injury syndrome. It is unclear whether red cell transfusion is associated with acute exacerbation of underlying pulmonary fibrosis. Case Report We describe a patient who underwent an uneventful elective left total hip replacement but developed anemia post-operatively. Twenty-four hours following transfusion of her fifth non-leukoreduced AS-5 red cell unit, she developed new bilateral airspace infiltrates associated with progressive hypoxemia. These RBC units were 35-38 days old. Despite supportive care and diuresis, patient remained profoundly hypoxemic with infiltrates that progressed to fibrosis. Results The patient had mild sub-clinical lower-lobe predominant interstitial pulmonary fibrosis but developed diffuse bilateral ground glass opacities with areas of consolidation 24 h after receiving her last RBC unit. Transbronchial biopsy of the right lower lobe showed active organizing pneumonia and underlying interstitial fibrosis, supporting the clinical diagnosis of acute exacerbation of pulmonary fibrosis. The bronchoalveolar lavage showed progressive bloody effluent, consistent with diffuse alveolar hemorrhage, a marker of lung injury. There was no evidence of viral inclusions, fungal elements, pneumocystis, or bacterial organisms. Conclusion Transfusion of multiple units of aged RBCs was temporally associated with an acute exacerbation and rapid progression of underlying sub-clinical pulmonary fibrosis.

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“…There is an increase in cytokines such as interleukin-1, IL-8 and tumor necrosis factor (TNF) associated with transfusion of stored red cells that is associated with febrile reactions during transfusion [47]. Increases in inflammatory mediators can exacerbate myocardial ischemia [48].…”

Section: Pathophysiology Of Adverse Events Following Bleeding and Tramentioning

confidence: 99%

Transfusion associated microchimerism: a heretofore little recognized complication following transfusion

Kunadian

Zorkun

Gibson

et al. 2008

J Thromb Thrombolysis

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Potent antiplatelet and antithrombotic agents have significantly reduced mortality in the setting of acute coronary syndromes and percutaneous coronary intervention. However these agents are associated with increased bleeding which is in turn associated with adverse clinical outcomes. In many centers, transfusion is often used to correct for blood loss. Blood transfusion in the setting of acute coronary syndrome has been associated with adverse clinical outcomes including increased mortality. Transfusion associated microchimerism (TA-MC) is a newly recognized complication of blood transfusion. There is engraftment of the donor's hematopoietic stem cells in patients who then develop microchimerism. This article discusses the association of bleeding/blood transfusion with adverse outcomes and the potential role of TA-MC in clinical outcomes.

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Prestorage versus Bedside White Blood Cell Filtration of Red Blood Cell Concentrates

Cited by 25 publications

References 36 publications

Stored Red Blood Cell Transfusion Induces Regulatory T Cells

Stored Red Blood Cell Transfusion Induces Regulatory T Cells

Acute exacerbation of subclinical pulmonary fibrosis after red blood cell transfusion: a case report

Transfusion associated microchimerism: a heretofore little recognized complication following transfusion

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