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. 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 Fauzi  8 , Leticia P Pimenta  1 , Jonathan E Millar  1   6 , Jonathon P Fanning  1   6 , Frank Van Haren  3   4   9 , Chris M Anstey  10 , 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

Pre-clinical study protocol: Blood transfusion in endotoxaemic shock

Nchafatso G Obonyo et al. MethodsX. .

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.

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Figures

None
Graphical abstract
Fig. 1
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

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