The deleterious effect of red blood cell storage on microvascular response to transfusion

Jordan A. Weinberg, Paul A. MacLennan, Marianne J. Vandromme-Cusick, Louis J. Magnotti, Jeffrey D. Kerby, Loring W. Rue, Jonathan M. Angotti, Cristen A. Garrett, Leah E. Hendrick, Martin Croce, Timothy Fabian, Scott R. Barnum, Rakesh P. Patel

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: The transfusion of relatively older red blood cells (RBCs) has been associated with both morbidity and mortality in trauma patients in observational studies. Although the mechanisms responsible for this phenomenon remain unclear, alterations in the microcirculation as a result of the transfusion of relatively older blood may be a causative factor. To assess this hypothesis, we evaluated microvascular perfusion in trauma patients during RBC transfusion. METHODS: Anemic but otherwise stable trauma intensive care unit patients with orders for transfusion were identified. Thenar muscle tissue oxygen saturation (StO2) was measured continuously by near-infrared spectroscopy during the course of transfusion of one RBC unit. Sublingual microcirculation was observed by sidestream dark-field illumination microscopy before and after transfusion of one RBC unit. Thenar muscle StO2 was recorded during the course of transfusion. Pretransfusion and posttransfusion perfused capillary vascular density (PCD) was determined by semiquantitative image analysis. Changes in StO2 and PCD relative to age of RBC unit were evaluated using mixed models that adjusted for baseline StO2 and Spearman correlation, respectively. RESULTS: Overall, 93 patients were recruited for study participation, 69% were male, and average Injury Severity Score (ISS) was 26.4. The average pretransfusion hemoglobin was 7.5 mg/dL, and the average age of RBC unit transfused was 29.4 days. The average peritransfusion StO2 was negatively associated with increasing RBC age (slope, j0.11; p = 0.0014). Change in PCD from pretransfusion to posttransfusion period was found to correlate negatively with RBC storage age (Spearman correlation, j0.27; p = 0.037). CONCLUSION: The transfusion of relatively older RBC units was associated with a decline in both StO2 and PCD. Collectively, these observations demonstrate that transfusions of older RBC units are associated with the inhibition of regional microvascular perfusion. In patients requiring multiple units of RBCs, alteration of the microcirculation by relatively older units could potentially contribute to adverse outcomes.

Original languageEnglish (US)
Pages (from-to)807-812
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number5
DOIs
StatePublished - Nov 1 2013

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Erythrocytes
Erythrocyte Transfusion
Blood Vessels
Microcirculation
Wounds and Injuries
Perfusion
Muscles
Specific Gravity
Injury Severity Score
Near-Infrared Spectroscopy
Lighting
Observational Studies
Intensive Care Units
Microscopy
Hemoglobins
Oxygen
Morbidity
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Weinberg, J. A., MacLennan, P. A., Vandromme-Cusick, M. J., Magnotti, L. J., Kerby, J. D., Rue, L. W., ... Patel, R. P. (2013). The deleterious effect of red blood cell storage on microvascular response to transfusion. Journal of Trauma and Acute Care Surgery, 75(5), 807-812. https://doi.org/10.1097/TA.0b013e3182a74a9b

The deleterious effect of red blood cell storage on microvascular response to transfusion. / Weinberg, Jordan A.; MacLennan, Paul A.; Vandromme-Cusick, Marianne J.; Magnotti, Louis J.; Kerby, Jeffrey D.; Rue, Loring W.; Angotti, Jonathan M.; Garrett, Cristen A.; Hendrick, Leah E.; Croce, Martin; Fabian, Timothy; Barnum, Scott R.; Patel, Rakesh P.

In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 5, 01.11.2013, p. 807-812.

Research output: Contribution to journalArticle

Weinberg, JA, MacLennan, PA, Vandromme-Cusick, MJ, Magnotti, LJ, Kerby, JD, Rue, LW, Angotti, JM, Garrett, CA, Hendrick, LE, Croce, M, Fabian, T, Barnum, SR & Patel, RP 2013, 'The deleterious effect of red blood cell storage on microvascular response to transfusion', Journal of Trauma and Acute Care Surgery, vol. 75, no. 5, pp. 807-812. https://doi.org/10.1097/TA.0b013e3182a74a9b
Weinberg JA, MacLennan PA, Vandromme-Cusick MJ, Magnotti LJ, Kerby JD, Rue LW et al. The deleterious effect of red blood cell storage on microvascular response to transfusion. Journal of Trauma and Acute Care Surgery. 2013 Nov 1;75(5):807-812. https://doi.org/10.1097/TA.0b013e3182a74a9b
Weinberg, Jordan A. ; MacLennan, Paul A. ; Vandromme-Cusick, Marianne J. ; Magnotti, Louis J. ; Kerby, Jeffrey D. ; Rue, Loring W. ; Angotti, Jonathan M. ; Garrett, Cristen A. ; Hendrick, Leah E. ; Croce, Martin ; Fabian, Timothy ; Barnum, Scott R. ; Patel, Rakesh P. / The deleterious effect of red blood cell storage on microvascular response to transfusion. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 5. pp. 807-812.
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AU - MacLennan, Paul A.

AU - Vandromme-Cusick, Marianne J.

AU - Magnotti, Louis J.

AU - Kerby, Jeffrey D.

AU - Rue, Loring W.

AU - Angotti, Jonathan M.

AU - Garrett, Cristen A.

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AU - Croce, Martin

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N2 - BACKGROUND: The transfusion of relatively older red blood cells (RBCs) has been associated with both morbidity and mortality in trauma patients in observational studies. Although the mechanisms responsible for this phenomenon remain unclear, alterations in the microcirculation as a result of the transfusion of relatively older blood may be a causative factor. To assess this hypothesis, we evaluated microvascular perfusion in trauma patients during RBC transfusion. METHODS: Anemic but otherwise stable trauma intensive care unit patients with orders for transfusion were identified. Thenar muscle tissue oxygen saturation (StO2) was measured continuously by near-infrared spectroscopy during the course of transfusion of one RBC unit. Sublingual microcirculation was observed by sidestream dark-field illumination microscopy before and after transfusion of one RBC unit. Thenar muscle StO2 was recorded during the course of transfusion. Pretransfusion and posttransfusion perfused capillary vascular density (PCD) was determined by semiquantitative image analysis. Changes in StO2 and PCD relative to age of RBC unit were evaluated using mixed models that adjusted for baseline StO2 and Spearman correlation, respectively. RESULTS: Overall, 93 patients were recruited for study participation, 69% were male, and average Injury Severity Score (ISS) was 26.4. The average pretransfusion hemoglobin was 7.5 mg/dL, and the average age of RBC unit transfused was 29.4 days. The average peritransfusion StO2 was negatively associated with increasing RBC age (slope, j0.11; p = 0.0014). Change in PCD from pretransfusion to posttransfusion period was found to correlate negatively with RBC storage age (Spearman correlation, j0.27; p = 0.037). CONCLUSION: The transfusion of relatively older RBC units was associated with a decline in both StO2 and PCD. Collectively, these observations demonstrate that transfusions of older RBC units are associated with the inhibition of regional microvascular perfusion. In patients requiring multiple units of RBCs, alteration of the microcirculation by relatively older units could potentially contribute to adverse outcomes.

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