Stored packed red blood cells contain a procoagulant phospholipid reducible by leukodepletion filters and washing

Cardo, Lisa J.; Hmel, Peter J.; Wilder, Donna M.

doi:10.1016/j.transci.2007.09.006

Cited by 45 publications

(50 citation statements)

References 35 publications

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“…44 During storage, RBCs become less deformable, undergo ATP and 2,3-diphosphoglycerate depletion, lose their ability to generate nitric oxide, have increased adhesiveness to vascular endothelium, release procoagulant phospholipids, and accumulate proinflammatory molecules, as well as free iron and hemoglobin. [45][46][47][48] As a result, transfused stored RBCs may impair tissue oxygen delivery, promote a proinflammatory state, exacerbate tissue oxidative stress, and activate leukocytes and the coagulation cascade. 45,46,48 In susceptible patients, such as those undergoing cardiac surgery, these changes can lead to organ dysfunction, with the kidney seemingly at particularly high risk for injury.…”

Section: Rbc Transfusionmentioning

confidence: 99%

“…[45][46][47][48] As a result, transfused stored RBCs may impair tissue oxygen delivery, promote a proinflammatory state, exacerbate tissue oxidative stress, and activate leukocytes and the coagulation cascade. 45,46,48 In susceptible patients, such as those undergoing cardiac surgery, these changes can lead to organ dysfunction, with the kidney seemingly at particularly high risk for injury. 44 …”

Section: Rbc Transfusionmentioning

confidence: 99%

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Acute Kidney Injury After Cardiac Surgery

et al. 2009

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Background-Acute kidney injury (AKI) after cardiac surgery is a major health issue. Lacking effective therapies, risk factor modification may offer a means of preventing this complication. The objective of the present study was to identify and determine the prognostic importance of such risk factors. Methods and Results-Data from a multicenter cohort of 3500 adult patients who underwent cardiac surgery at 7 hospitals during 2004 were analyzed (using multivariable logistic regression modeling) to determine the independent relationships between 3 thresholds of AKI (Ͼ25%, Ͼ50%, and Ͼ75% decrease in estimated glomerular filtration rate within 1 week of surgery or need for postoperative dialysis) with death rates, as well as to identify modifiable risk factors for AKI. The 3 thresholds of AKI occurred in 24% (nϭ829), 7% (nϭ228), and 3% (nϭ119) of the cohort, respectively. All 3 thresholds were independently associated with a Ͼ4-fold increase in the odds of death and could be predicted with several perioperative variables, including preoperative intra-aortic balloon pump use, urgent surgery, and prolonged cardiopulmonary bypass. In particular, 3 potentially modifiable variables were also independently and strongly associated with AKI. These were preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration. Conclusions-AKI after cardiac surgery is highly prevalent and prognostically important. Therapies aimed at mitigating preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration may offer protection against this complication. (Circulation. 2009;119:495-502.)

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Section: Rbc Transfusionmentioning

confidence: 99%

Section: Rbc Transfusionmentioning

confidence: 99%

Acute Kidney Injury After Cardiac Surgery

et al. 2009

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“…For instance, it has been observed that stored RBCs develop a "procoagulant activity." [18][19][20][21] If such activity correlates to the promotion of clotting in vivo, then such procoagulant activity may simultaneously be therapeutic to a patient suffering hemorrhage and lethal to a patient suffering thrombosis. This is both a concern as far as adjusting medical practice to individual patient needs, but also for the validity of clinical trials in which patients with diseases of different pathologies are included together in groups assessing medical outcomes.…”

Section: Diverse Conditions Variable Practice and Changing Landscapesmentioning

confidence: 99%

Established and theoretical factors to consider in assessing the red cell storage lesion

Zimring

2015

Blood

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The collection and storage of red blood cells (RBCs) is a logistical necessity to provide sufficient blood products. However, RBC storage is an unnatural state, resulting in complicated biological changes, referred to collectively as the "storage lesion." Specifics of the storage lesion have been studied for decades, including alterations to cellular properties, morphology, molecular biology of carbohydrates, proteins and lipids, and basic metabolism. Recently, mass spectrometry-based "omics" technology has been applied to the RBC storage lesion, resulting in many new observations, the initial effects of which are more information than understanding. Meanwhile, clinical research on RBC transfusion is considering both the efficacy and also the potential untoward effects of transfusing stored RBCs of different ages and storage conditions. The myriad biological changes that have now been observed during the storage lesion have been extensively reviewed elsewhere. This article focuses rather on an analysis of our current understanding of the biological effects of different elements of the storage lesion, in the context of evolving new clinical understanding. A synopsis is presented of both established and theoretical considerations of the RBC storage lesion and ongoing efforts to create a safer and more efficacious product. (Blood. 2015;125(14):2185-2190 Biology of RBC storage: effect upon the red cell and effects upon the patientThe practice of storing red blood cells (RBCs) prior to transfusion has been in place for close to a century.

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“…In humans, an increase in phosphatidylserine (PS) expression on the red cell surface is a recognized storage lesion 9, 10, 11. PS is a negatively charged phospholipid, comprising a portion of the erythrocyte cell membrane.…”

mentioning

confidence: 99%

“…With the use of a leukoreduction filter before storage, the majority of leukocytes and platelets are extracted from the unit of blood, preventing these cells from influencing the environment within the pRBC unit, and decreasing the inflammatory response associated with transfusion 20. In units of stored human pRBCs, the removal of leukocytes and platelets by leukoreduction before storage causes a significant decrease in erythrocyte PS expression 10. A decrease in the concentrations of leukocytes and platelets in the unit also removes the main source of eicosanoid synthesis.…”

mentioning

confidence: 99%

Effects of Leukoreduction and Storage on Erythrocyte Phosphatidylserine Expression and Eicosanoid Concentrations in Units of Canine Packed Red Blood Cells

Muro

Lee

Ross

et al. 2017

Veterinary Internal Medicne

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BackgroundStorage of canine packed red blood cells (pRBCs) can increase erythrocyte phosphatidylserine (PS) expression and eicosanoid concentrations.Hypothesis/ObjectivesTo determine the effects of leukoreduction on erythrocyte PS expression and eicosanoid concentrations in stored units of canine pRBCs. Our hypothesis was that leukoreduction would decrease PS expression and eicosanoid concentrations.AnimalsEight healthy dogs.MethodsIn a cross‐over study, units of whole blood were leukoreduced (LR) or non‐LR and stored (10 and 21 days) as pRBCs. Samples were collected at donation, and before and after a simulated transfusion. PS expression was measured by flow cytometry, and concentrations of arachidonic acid (AA), prostaglandin F2α (PGF 2α), prostaglandin E2 (PGE 2), prostaglandin D2 (PGD 2), thromboxane B2 (TXB 2), 6‐keto‐prostaglandin F1α (6‐keto‐PGF 1α), and leukotriene B4 (LTB 4) were quantified by liquid chromatography–mass spectrometry.ResultsThere was no change in PS expression during leukoreduction, storage, and simulated transfusion for non‐LR and LR units. Immediately after leukoreduction, there was a significant increase in TXB 2 and PGF 2α concentrations, but during storage, these eicosanoids decreased to non‐LR concentrations. In both LR and non‐LR units, 6‐keto‐PGF 1α concentrations increased during storage and simulated transfusion, but there was no difference between unit type. There was no difference in AA, LTB 4, PGE 2, and PGD 2 concentrations between unit types.Conclusions and Clinical ImportanceLeukoreduction, storage, and simulated transfusion do not alter erythrocyte PS expression. Leukoreduction causes an immediate increase in concentrations of TXB 2 and PGF 2α, but concentrations decrease to non‐LR concentrations with storage. Leukoreduction does not decrease the accumulation of 6‐keto‐PGF 1α during storage.

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Stored packed red blood cells contain a procoagulant phospholipid reducible by leukodepletion filters and washing

Cited by 45 publications

References 35 publications

Acute Kidney Injury After Cardiac Surgery

Acute Kidney Injury After Cardiac Surgery

Established and theoretical factors to consider in assessing the red cell storage lesion

Effects of Leukoreduction and Storage on Erythrocyte Phosphatidylserine Expression and Eicosanoid Concentrations in Units of Canine Packed Red Blood Cells

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