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. 2012 Aug;73(2 Suppl 1):S128-33.
doi: 10.1097/TA.0b013e3182606301.

Resuscitation with washed aged packed red blood cell units decreases the proinflammatory response in mice after hemorrhage

Ritha M Belizaire  1 , Amy T Makley, Eric M Campion, Dennis I Sonnier, Michael D Goodman, Warren C Dorlac, Lou Ann Friend, Alex B Lentsch, Timothy A Pritts
Affiliations

Resuscitation with washed aged packed red blood cell units decreases the proinflammatory response in mice after hemorrhage

Ritha M Belizaire et al. J Trauma Acute Care Surg. 2012 Aug.

Abstract

Background: Resuscitation with blood products instead of crystalloid in the treatment of hemorrhagic shock has been associated with improved outcomes in trauma patients requiring massive transfusions and transfusion of fresh products results in reduced morbidity and mortality compared with aged blood. Processes to eliminate harmful components of aged blood are under investigation. We hypothesized that washing blood would reduce levels of proinflammatory mediators in stored units, and resuscitation with washed units would attenuate the proinflammatory response in mice after hemorrhagic shock.

Methods: Mice underwent pressure-controlled hemorrhage and resuscitation with fresh packed red blood cells (pRBCs) or 15-day-old washed or unwashed pRBCs. Cytokine concentrations in donor samples and recipient serum were measured. In addition, cytokine concentrations were measured in 15-day-old units that underwent three interval washes versus one poststorage wash.

Results: Blood stored for 15 days demonstrated increased levels of interleukin 1α, keratinocyte chemoattractant, macrophage inflammatory protein 1α, and macrophage inflammatory protein 2 compared with fresh units. Washing 15-day-old pRBCs reduced concentrations of these cytokines. Cytokine levels in stored units that underwent multiple washes versus a single wash were not different. Mice resuscitated with 15-day-old unwashed pRBCs had increased levels of serum cytokines compared with mice resuscitated with fresh and 15-day-old washed pRBCs.

Conclusion: Aged pRBC units have elevated levels of proinflammatory cytokines compared with fresh units, and washing aged units after storage reduces cytokine concentrations. Resuscitation with washed units blunts the proinflammatory response in mice after hemorrhage. Washing aged pRBCs may improve the safety profile of aged units and may result in improved outcomes in subjects after hemorrhagic shock and resuscitation.

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Figures

Figure 1
Figure 1
Cytokine concentrations in donor pRBC samples. *p < 0.05 versus other groups, **p < 0.05 versus fresh blood, n = 4 samples for each group.
Figure 2
Figure 2
SBP during of mice undergoing hemorrhagic shock and resuscitation versus sham mice. *p < 0.001 versus hemorrhage group, n = 5 mice for each group.
Figure 3
Figure 3
Shed blood and resuscitation volumes for mice undergoing hemorrhage and resuscitation, n = 5 mice for each group.
Figure 4
Figure 4
Cytokine concentrations in recipient serum after hemorrhage and resuscitation. *p < 0.05 versus other groups, **p < 0.05 versus sham, n = 5 for each group.
See this image and copyright information in PMC

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