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Randomized Controlled Trial
. 2015 Apr;55(4):782-90.
doi: 10.1111/trf.12919. Epub 2014 Nov 13.

Effects of storage-aged red blood cell transfusions on endothelial function in hospitalized patients

Robert Neuman  1 , Salim Hayek  1 , Ayaz Rahman  1 , Joseph C Poole  1 , Vivek Menon  1 , Salman Sher  1 , James L Newman  2 , Sulaiman Karatela  2 , David Polhemus  3 , David J Lefer  3 , Christine De Staercke  4 , Craig Hooper  4 , Arshed A Quyyumi  1 , John D Roback  2
Affiliations
Randomized Controlled Trial

Effects of storage-aged red blood cell transfusions on endothelial function in hospitalized patients

Robert Neuman et al. Transfusion. 2015 Apr.

Abstract

Background: Clinical and animal studies indicate that transfusions of older stored red blood cells (RBCs) impair clinical outcomes as compared to fresh RBC transfusions. It has been suggested that this effect is due to inhibition of nitric oxide (NO)-mediated vasodilation after transfusion of older RBC units. However, to date this effect has not been identified in human transfusion recipients.

Study design and methods: Forty-three hospitalized patients with transfusion orders were randomly assigned to receive either fresh (<14 days) or older stored (>21 days) RBC units. Before transfusion, and at selected time points after the start of transfusion, endothelial function was assessed using noninvasive flow-mediated dilation assays.

Results: After transfusion of older RBC units, there was a significant reduction in NO-mediated vasodilation at 24 hours after transfusion (p = 0.045), while fresh RBC transfusions had no effect (p = 0.231).

Conclusions: This study suggests for the first time a significant inhibitory effect of transfused RBC units stored more than 21 days on NO-mediated vasodilation in anemic hospitalized patients. This finding lends further support to the hypothesis that deranged NO signaling mediates adverse clinical effects of older RBC transfusions. Future investigations will be necessary to address possible confounding factors and confirm these results.

Trial registration: ClinicalTrials.gov NCT00838331.

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Conflict of interest statement

Conflict of Interest Disclosures:

None of the authors have conflicts of interests to disclose.

Figures

Figure 1
Figure 1
Flow-Mediated Dilation during Transfusion of Storage-Aged and Fresh Blood Units. RBCs= packed red blood cells; saRBCs= storage-aged red blood cells. Values represent absolute change in FMD (%), adjusted for baseline brachial artery diameter using allometric scaling.
Figure 2
Figure 2
Change in 2,3-diphosphoglycerate Levels after Transfusion of Storage-aged and Fresh Blood Units. RBCs= packed red blood cells; saRBCs= storage-aged red blood cells. Values represented are mean change in 2,3-diphosphoglycerate (DPG) levels compared to baseline. The interaction of time point and blood age was statistically significant (p=0.042). Note the significant difference in the change in 2,3 DPG at 1 hour between recipients of saRBC and fresh RBC.
See this image and copyright information in PMC

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