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. 2022 Mar;117(3):371-378.
doi: 10.1111/vox.13191. Epub 2021 Aug 15.

Differential effects of speed and volume on transfusion-associated circulatory overload: A randomized study in rats

Robert B Klanderman  1   2   3 , Marije Wijnberge  3 , Joachim J Bosboom  3 , Joris J T H Roelofs  4 , Dirk de Korte  5   6 , Robin van Bruggen  6 , Markus W Hollmann  2   3 , Margreeth B Vroom  1 , Denise P Veelo  3 , Nicole P Juffermans  1   2 , Bart F Geerts  3 , Alexander P J Vlaar  1   2
Affiliations

Differential effects of speed and volume on transfusion-associated circulatory overload: A randomized study in rats

Robert B Klanderman et al. Vox Sang. 2022 Mar.

Abstract

Background and objectives: Transfusion-associated circulatory overload (TACO) is the primary cause of transfusion-related mortality. Speed and volume of transfusion are major risk factors. The aim of this study was to investigate the interaction of red blood cell (RBC) transfusion speed and volume on the development of TACO.

Materials and methods: A validated model for TACO in anaemic Lewis rats with an acute myocardial infarction was used. The effect on pulmonary hydrostatic pressure of one, two or four units of packed RBCs transfused in either 30 or 60 min was evaluated (3.3-26.6 ml·kg-1 ·hr-1 ). Pulmonary capillary pressure was measured as left ventricular end-diastolic pressure (LVEDP). Cardiac stress biomarkers atrial natriuretic-peptide (ANP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured 1-h post-transfusion.

Results: Thirty animals were included (n = 5 per group). Transfusion of RBCs increased LVEDP in a volume-dependent manner (ΔLVEDP [mmHg]: -0.95, +0.50, +6.26, p < 0.001). Fast transfusion increased overall ΔLVEDP by +3.5 mmHg and up to +11.8 mmHg in the four units' group (p = 0.016). Doubling transfusion speed increased ΔLVEDP more than doubling volume in the larger volume groups. No difference in ANP or NT-proBNP were seen in high transfusion volume or groups.

Conclusion: Transfusion volume dose-dependently increased LVEDP, with speed of transfusion rapidly elevating LVEDP at higher transfusion volumes. ANP and NT-proBNP were not impacted by transfusion volume or speed in this model. TACO is seen as purely volume overload, however, this study emphasizes that limiting transfusion speed, as a modifiable risk factor, might aid in preventing TACO.

Keywords: TACO; animal; hemodynamics; pulmonary edema; transfusion reaction.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

FIGURE 1
FIGURE 1
Experiment design comparing speed versus volume of transfusion. A two‐hit model for TACO in anaemic rats was employed. The first hit, an MI results in volume incompliance. Animals were randomized to speed of transfusion (30 or 60 min) and further randomized to receive one, two or four units – a total of six groups. Art.line, Arterial cannula; CVC, Central venous cannula; LAD, Left anterior descending coronary artery; PV‐Catheter, Pressure‐volume (catheter)
FIGURE 2
FIGURE 2
Change in LVEDP per transfusion volume and speed. Data presented in a Tukey boxplot. ∆LVEDP increases significantly with more units transfused (top brackets). Speed was significantly associated with an increase in ∆LVEDP only in the group transfused with four units. *: p < 0.05; **: p < 0.01; ***: p < 0.001
FIGURE 3
FIGURE 3
Volume overload biomarkers. Data presented in a Tukey boxplot
See this image and copyright information in PMC

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