. 2019 May 9:6:1124-1132.

doi: 10.1016/j.mex.2019.05.005. eCollection 2019.

Pre-clinical study protocol: Blood transfusion in endotoxaemic shock

Nchafatso G Obonyo^{1

2}, Liam Byrne^{1

3

4}, John-Paul Tung^{1

5

6

7}, Gabriela Simonova^{1

5

6}, Sara D Diab^{1

6}, Kimble R Dunster^{1

7}, Margaret R Passmore^{1

6}, Ai-Ching Boon^{1

6}, Louise See Hoe^{1

6}, Sanne Engkilde-Pedersen^{1

5

7}, Arlanna Esguerra-Lallen^{1

5}, Mohd H Fauzi⁸, Leticia P Pimenta¹, Jonathan E Millar^{1

6}, Jonathon P Fanning^{1

6}, Frank Van Haren^{3

4

9}, Chris M Anstey¹⁰, Louise Cullen^{6

11}, Jacky Suen^{1

6}, Kiran Shekar^{1

6

12}, Kathryn Maitland^{2

13}, John F Fraser^{1

6

7

12}

Affiliations

¹ Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.
² IDeAL/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
³ The Canberra Hospital Intensive Care, Garran, ACT, Australia.
⁴ Australia National University, Canberra, ACT, Australia.
⁵ Australian Red Cross Blood Service, Kelvin Grove, Brisbane, Queensland, Australia.
⁶ University of Queensland, Brisbane, QLD, Australia.
⁷ Queensland University of Technology, Brisbane City, QLD Australia.
⁸ School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kelantan, Malaysia.
⁹ The University of Canberra, Bruce, ACT, Australia.
¹⁰ Sunshine Coast University Hospital Intensive Care, Birtinya, Qld, Australia.
¹¹ Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
¹² Adult Intensive Care, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.
¹³ Department of Paediatrics, Faculty of Medicine, Imperial College London, United Kingdom.

PMID: 31193460
PMCID: PMC6529713
DOI: 10.1016/j.mex.2019.05.005

Pre-clinical study protocol: Blood transfusion in endotoxaemic shock

Nchafatso G Obonyo et al. MethodsX. 2019.

. 2019 May 9:6:1124-1132.

doi: 10.1016/j.mex.2019.05.005. eCollection 2019.

Authors

Affiliations

¹ Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.
² IDeAL/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
³ The Canberra Hospital Intensive Care, Garran, ACT, Australia.
⁴ Australia National University, Canberra, ACT, Australia.
⁵ Australian Red Cross Blood Service, Kelvin Grove, Brisbane, Queensland, Australia.
⁶ University of Queensland, Brisbane, QLD, Australia.
⁷ Queensland University of Technology, Brisbane City, QLD Australia.
⁸ School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kelantan, Malaysia.
⁹ The University of Canberra, Bruce, ACT, Australia.
¹⁰ Sunshine Coast University Hospital Intensive Care, Birtinya, Qld, Australia.
¹¹ Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
¹² Adult Intensive Care, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.
¹³ Department of Paediatrics, Faculty of Medicine, Imperial College London, United Kingdom.

PMID: 31193460
PMCID: PMC6529713
DOI: 10.1016/j.mex.2019.05.005

Abstract

The Surviving Sepsis Campaign (SCC) and the American College of Critical Care Medicine (ACCM) guidelines recommend blood transfusion in sepsis when the haemoglobin concentration drops below 7.0 g/dL and 10.0 g/dL respectively, while the World Health Organisation (WHO) guideline recommends transfusion in septic shock 'if intravenous (IV) fluids do not maintain adequate circulation', as a supportive measure of last resort. Volume expansion using crystalloid and colloid fluid boluses for haemodynamic resuscitation in severe illness/sepsis, has been associated with adverse outcomes in recent literature. However, the volume expansion effect(s) following blood transfusion for haemodynamic circulatory support, in severe illness remain unclear with most previous studies having focused on evaluating effects of either different RBC storage durations (short versus long duration) or haemoglobin thresholds (low versus high threshold) pre-transfusion. •We describe the protocol for a pre-clinical randomised controlled trial designed to examine haemodynamic effect(s) of early volume expansion using packed RBCs (PRBCs) transfusion (before any crystalloids or colloids) in a validated ovine-model of hyperdynamic endotoxaemic shock.•Additional exploration of mechanisms underlying any physiological, haemodynamic, haematological, immunologic and tissue specific-effects of blood transfusion will be undertaken including comparison of effects of short (≤5 days) versus long (≥30 days) storage duration of PRBCs prior to transfusion.

Keywords: Blood transfusion; Endotoxaemic shock; Guidelines; Haemoglobin threshold; Packed red blood cells (PRBCs); Sepsis; Storage duration.

PubMed Disclaimer

Figures

**Fig. 1**
Pre-clinical trial study design examining a two-hit hypothesis of sepsis and transfusion with fresh versus stored ovine packed red blood cells (ovPRBCs). *Fresh ovPRBCs ≤5 days; stored ovPRBCs ≥30 days.****SF,****sepsis-fresh;*SA, sepsis-aged;HF, healthy-fresh;HA, healthy-aged.

See this image and copyright information in PMC

Cited by

Is haemoglobin below 7.0 g/dL an optimal trigger for allogenic red blood cell transfusion in patients admitted to intensive care units? A meta-analysis and systematic review.
Yao RQ, Ren C, Zhang ZC, Zhu YB, Xia ZF, Yao YM. Yao RQ, et al. BMJ Open. 2020 Feb 5;10(2):e030854. doi: 10.1136/bmjopen-2019-030854. BMJ Open. 2020. PMID: 32029484 Free PMC article.

References

1. Byrne L., Obonyo N.G., Diab S., Dunster K., Passmore M., Boon A.C., Hoe L.S., Hay K., Van Haren F., Tung J.P. An ovine model of hyperdynamic endotoxemia and vital organ metabolism. Shock. 2018;49(1):99–107. - PMC - PubMed
1. Dellinger R.P., Levy M.M., Rhodes A., Annane D., Gerlach H., Opal S.M., Sevransky J.E., Sprung C.L., Douglas I.S., Jaeschke R. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit. Care Med. 2013;41(2):580–637. - PubMed
1. Rhodes A., Evans L.E., Alhazzani W., Levy M.M., Antonelli M., Ferrer R., Kumar A., Sevransky J.E., Sprung C.L., Nunnally M.E. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304–377. - PubMed
1. Davis A.L., Carcillo J.A., Aneja R.K., Deymann A.J., Lin J.C., Nguyen T.C., Okhuysen-Cawley R.S., Relvas M.S., Rozenfeld R.A., Skippen P.W. American college of critical care medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit. Care Med. 2017;45(6):1061–1093. - PubMed
1. Karam O., Tucci M., Ducruet T., Hume H.A., Lacroix J., Gauvin F., Canadian Critical Care Trials G, Network P Red blood cell transfusion thresholds in pediatric patients with sepsis. Pediatr. Crit. Care Med. 2011;12(5):512–518. - PubMed

Grants and funding

LinkOut - more resources

Full Text Sources
Research Materials
- NCI CPTC Antibody Characterization Program

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Pre-clinical study protocol: Blood transfusion in endotoxaemic shock

Affiliations

Pre-clinical study protocol: Blood transfusion in endotoxaemic shock

Authors

Affiliations

Abstract

Figures

Similar articles

Cited by

References

Grants and funding

LinkOut - more resources

Full Text Sources

Research Materials

Abstract

Figures

Similar articles

Cited by

References

Related information

Grants and funding

LinkOut - more resources

Full Text Sources

Research Materials