Plasma expander and blood storage effects on capillary perfusion in transfusion after hemorrhage

Abstract

Background: Treating hemorrhage with blood transfusions in subjects previously hemodiluted with different colloidal plasma expanders, using fresh autologous blood or blood that has been stored for 2 weeks, allows identifying the interaction between type of plasma expander and differences in blood storage.

Study design and methods: Studies used the hamster window chamber model. Fresh autologous plasma, 130-kDa starch-based plasma expander (hydroxyethyl starch [HES]), or 4% polyethylene glycol-conjugated albumin (PEG-Alb) was used for 20% of blood volume (BV) hemodilution. Hemodilution was followed by a 55% by BV 40-minute hemorrhagic shock period, treated with transfusion of fresh or blood that was stored for 2 weeks. Outcome was evaluated 1 hour after blood transfusion in terms of microvascular and systemic variables.

Results: Results were principally dependent on the type of colloidal solution used during hemodilution, 4% PEG-Alb yielding the best microvascular recovery evaluated in terms of the functional capillary density. This result was consistent whether fresh blood or stored blood was used in treating the subsequent shock period. Fresh blood results were significantly better in systemic and microvascular terms relative to stored blood. HES and fresh plasma hemodilution yielded less favorable results, a difference that was enhanced when fresh versus stored blood was compared in their efficacy of correcting the subsequent hemorrhage.

Conclusion: The type of plasma expander used for hemodilution influences the short-term outcome of subsequent volume resuscitation using blood transfusion, 4% PEG-Alb providing the most favorable outcome by comparison to HES or fresh plasma.

Figure 1

The experimental protocol. Time course of the acute isovolemic exchange transfusion/hemodilution with 4% PEG-Albumin, Hydroxyethyl starch, or plasma, the two-step hemorrhage procedure, and resuscitation with either fresh autologous or stored whole blood.

Figure 2

Changes in hematocrit due to hemodilution. Baseline hematocrit (n=36): 48.0 ± 2.2%. Analysis within treatment groups: p < 0.05 *vs. baseline. Analysis between treatments at the same time point: p < 0.05 ^a vs. PEG-Alb Fresh blood; ^b vs. HES Fresh blood; ^c vs. HES Stored blood; ^d vs. Plasma Fresh blood. 4% PEG-Albumin (PEG); Hydroxyethyl starch (HES); Plasma (PLS).

Figure 3

Effect of hemodilution, hemorrhage and resuscitation on blood pressure. Baseline MAP (n=36): 112.8 ± 9.6 mmHg. Analysis within treatment groups: p < 0.05 *vs. baseline; † vs. hemodilution; ‡ vs. 15% H. Analysis between treatments at the same time point: p < 0.05 ^a vs. PEG-Alb Fresh blood. 4% PEG-Albumin (PEG); Hydroxyethyl starch (HES); Plasma (PLS).

Figure 4

Effect of hemodilution, hemorrhage and resuscitation on heart rate. Baseline HR (n=36): 464.8 ± 49.1 beats/min. Analysis within treatment groups: p < 0.05 *vs. baseline; † vs. hemodilution; ‡ vs. 15% H. Analysis between treatments at the same time point: p < 0.05 ^a vs. PEG-Alb Fresh blood; ^b vs. HES Fresh Blood. 4% PEG-Albumin (PEG); Hydroxyethyl starch (HES); Plasma (PLS).

Figure 5

Effect of hemorrhage and resuscitation on arterial PO₂. Baseline (n=36): PO₂ 56.5 ± 5.8 mmHg. Analysis within treatment groups: p < 0.05 *vs. baseline; ‡ vs. 15% H. Analysis between treatments at the same time point: p < 0.05 ^a vs. PEG-Alb Fresh blood. Hemorrhage (H) and 60 min post resuscitation (R60). 4% PEG-Albumin (PEG); Hydroxyethyl starch (HES); Plasma (PLS).

Figure 6

Effect of hemorrhage and resuscitation on arterial base excess. Baseline (n=36):Base excess 5.8 ± 2.0. Analysis within treatment groups: p < 0.05 *vs. baseline; ‡ vs. 15% H. Analysis between treatments at the same time point: p < 0.05 ^a vs. PEG-Alb Fresh blood. Hemorrhage (H) and 60 min post resuscitation (R60). 4% PEG-Albumin (PEG); Hydroxyethyl starch (HES); Plasma (PLS).

Figure 7

Fresh autologous blood versus stored blood. Analysis within the same treatment group 4% PEG-Albumin (A), HES (B), or fresh plasma (C): P < 0.05 relative to BL (*), Post Hemodilution (†), Post15% Hemorrhage (‡). Analysis between treatments at the same time point: P < 0.05 (§). 4% PEG-Albumin (PEG-Alb); Hydroxyethyl starch (HES); Fresh autologous blood (FB); Stored blood (SB).

Figure 8

Fresh autologous/stored blood: 4% Peg-Albumin vs. HES vs. plasma. Analysis between treatments at the same time point of animals resuscitated with fresh autologous (A) or stored (B) blood: P < 0.05 (§). 4% Peg-Albumin (Peg-Alb); Hydroxyethyl starch (HES); Fresh autologous blood (FB); Stored blood (SB).