The Effect of Washing of Stored Red Blood Cell Transfusion Units on Post Transfusion Recovery and Outcome in a Pneumosepsis Animal Model

Abstract

Background: Septic patients are often anemic, requiring red blood cell (RBC) transfusions. However, RBC transfusions are associated with organ injury. The mechanisms of RBC-induced organ injury are unknown, but increased clearance of donor RBCs from the circulation with trapping in the organs could play a role. We hypothesized that washing of RBCs prior to transfusion may reduce clearance and trapping of donor cells and thereby reduce organ injury. Methods: Sprague-Dawley rats were inoculated intratracheally with 107 colony-forming units (CFU) of Streptococcus pneumoniae or vehicle as a control and transfused with either a washed or standard (non-washed) biotinylated RBC transfusion from syngeneic rats. Controls received saline. Blood samples were taken directly after transfusion and at 24 h to calculate the 24 h post transfusion recovery (PTR). After sacrifice, flow cytometry was used to detect donor RBCs in organs and blood. The organs were histologically scored by a pathologist and CFUs in the lung and blood were counted. Results: The 24h-PTR was similar between healthy and pneumoseptic rats after a standard transfusion. In healthy rats, a washed transfusion resulted in a higher PTR and less accumulation of donor RBCs in the organs compared with a standard transfusion. However, during pneumonia, this effect of washing was not seen. Transfusion did not further augment lung injury induced by pneumonia, but washing decreased bacterial outgrowth in the lungs associated with reduced lung injury. Conclusion: In healthy recipients, washing increased 24h-PTR of donor RBCs and decreased trapping in organs. In pneumoseptic rats, washing reduced bacterial outgrowth and lung injury, but did not improve PTR.

The effects of resuscitation with different plasma products on endothelial permeability and organ injury in a rat pneumosepsis model

“…The left inferior lobe of the right lung was fixed in 10% formaldehyde and embedded in paraffin, after which 4-µm-thick sections were cut and stained with haematoxylin and eosin (H&E). A pathologist blinded for treatment allocation evaluated the lung tissue for the presence of oedema, bronchitis, endothelialitis, interstitial inflammation and thrombi formation on a scale of 0–4 (0 = absent, 1 = mild, 2 = moderate, 3 = severe, 4 = very severe), as described previously [ 25 , 26 ]. For the full scoring list, see the supplement (Additional file 1 : Table S1).…”

Washed red cells: theory and practice

“…In a rodent model, in healthy animals, washing increased the recovery of red cells following infusion and decreased trapping of RBC in organs. This was not observed in rats with pneumonia, [48] but in these animals washing reduced bacterial outgrowth and lung injury.…”

Diseased Erythrocyte Enrichment Based on I-Shaped Pillar DLD Arrays

“…Erythrocyte samples were obtained from fresh venous blood of volunteers. The venous blood underwent centrifugation to produce an erythrocyte suspension with isotonic PBS buffer, which was then refrigerated at 4 • C [10,24,25]. To make hardened erythrocytes, erythrocyte samples stored for 1 day (1D) and 7 days (7D) were selected for control tests [26,27].…”