Recipient's effects on stored red blood cell performance: the case of uremic plasma

Abstract

BACKGROUND: Despite universal administration of erythropoiesis-stimulating agents, patients with endstage renal disease (ESRD) are at high risk for presenting persistent anemia. Due to ambiguities in optimal hemoglobin targets and evidence of recombinant human erythropoietin (EPO)-related toxicity, an increase in blood transfusions has been observed in chronic renal disease over the past years. The probable effects of uremic plasma on the performance of stored red blood cells (RBCs) after transfusion have not been investigated. STUDY DESIGN AND METHODS: LeukoreducedRBCs after short or long storage in CPD-SAGM (n = 5) were assessed for hemolysis, surface removal signaling, reactive oxygen species (ROS) accumulation, and shape distortions before and after reconstitution with healthy (n = 10) or uremic plasma from ESRD patients (n = 20) for 24 hours at physiologic temperature, by using a previously reported in vitro model of transfusion. ABBREVIATIONS: ESA(s) = erythropoiesis-stimulating agent(s); ESRD = end-stage renal disease; HD = hemodialysis; iROS = induced reactive oxygen species; PS = phosphatidylserine; ROS = reactive oxygen species; tBHP = tert-butyl hydroperoxide; UA = uric acid. From the

Tools and metrics for the assessment of post‐storage performance of red blood cells: no one is left over

“…Consistent with this observation, incubating donor RBCs with plasma from SCD patients having VOC crises was previously shown to increase RBC phosphatidylserine exposure 49 . In another study, plasma from patients with end‐stage renal disease was shown to reduce the susceptibility of stored RBCs to hemolysis compared with plasma from healthy subjects 50 . Moreover, in the case of RBC donors heterozygous for beta thalassemia mutations, intrinsic features of their physiology drive lower spontaneous and stressed hemolysis compared to control RBCs when reconstituted with plasma from either healthy donors or transfusion‐dependent thalassemia patients 25 .…”

“…49 In another study, plasma from patients with end-stage renal disease was shown to reduce the susceptibility of stored RBCs to hemolysis compared with plasma from healthy subjects. 50 Moreover, in the case of RBC donors heterozygous for beta thalassemia mutations, intrinsic features of their physiology drive lower spontaneous and stressed hemolysis compared to control RBCs when reconstituted with plasma from either healthy donors or transfusion-dependent thalassemia patients. 25 These effects appear to translate into better RBC recovery in animal models.…”

Prevalence, associated factors and cardiocerebral vascular prognosis of anaemia among patients on chronic haemodialysis in South Guangdong, China

“…Strategies have been proposed to increase the Hb level of patients on haemodialysis, including short daily haemodialysis, haemodiafiltration and intensive treatment of hyperparathyroidism. [9][10][11] Short daily haemodialysis had been demonstrated to be associated with an improvement of hyperphosphataemia, secondary hyperparathyroidism, fluid management, left ventricular hypertrophy, blood pressure control, restless legs syndrome and sleep disturbances. 8,[20][21][22] A recent study also found that short daily haemodialysis might improve nutritional status, which would promote anaemia improvement, compared with conventional haemodialysis in Chinese patients undergoing maintenance haemodialysis.…”

“…5 The common correlative factors of anaemia in patients on haemodialysis include relative erythropoietin deficiency, impairment of intestinal iron absorption and release, recurrent blood loss, reduced erythrocyte survival duration, accumulation of uraemic toxins, microinflammation and hyperparathyroidism. 6,7 Several strategies for increasing the Hb level in patients on haemodialysis have been recommended, including optimal intravenous iron dosing, rational use of erythropoiesis-stimulating agents (ESAs), 8 improvement of dialysis adequacy by application of short daily haemodialysis and haemodiafiltration 9,10 and intensive treatment of hyperparathyroidism. 11 The management of anaemia in patients on haemodialysis is thought to be comprehensive.…”