• Critical care medicine · Jun 2016

    Randomized Controlled Trial

    Transfusion of 35-Day Stored RBCs in the Presence of Endotoxemia Does Not Result in Lung Injury in Humans.

    • Anna L Peters, Maike E van Hezel, Bart Cortjens, Anita M Tuip-de Boer, Robin van Bruggen, Dirk de Korte, René E Jonkers, Peter I Bonta, Sacha S Zeerleder, Rene Lutter, Nicole P Juffermans, and Alexander P J Vlaar.
    • 1Laboratory of Experimental Intensive Care and Anesthesia, Academic Medical Centre, Amsterdam, The Netherlands. 2Department of Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands. 3Department of Blood Cell Research, Sanquin Blood Supply, Amsterdam, The Netherlands. 4Department of Pediatric Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands. 5Department Product and Process Development, Sanquin Blood Supply, Amsterdam, The Netherlands. 6Department of Respiratory Medicine, Academic Medical Centre, Amsterdam, The Netherlands. 7Department of Haematology, Academic Medical Centre, Amsterdam. The Netherlands. 8Department of Immunopathology, Sanquin Research, Plesmanlaan, Amsterdam, The Netherlands. 9Department of Experimental Immunology, Academic Medical Centre, Amsterdam, The Netherlands.
    • Crit. Care Med. 2016 Jun 1; 44 (6): e412-9.

    ObjectiveTransfusion-related acute lung injury is the leading cause of transfusion-related mortality. Preclinical studies have shown that aged RBCs can induce transfusion-related acute lung injury in the presence of a "first hit" (e.g., sepsis). Clinical studies, however, show conflicting results on this matter. We tested whether maximally stored RBCs are able to induce lung injury in the presence of a "first hit" in humans (Dutch Trial Register: NTR4455).DesignOpen-label, randomized controlled trial.PatientsHealthy male volunteers.InterventionsEighteen healthy male volunteers donated one unit of autologous RBCs 2 or 35 days before the experiment. The experiment was started by infusion of 2 ng/kg lipopolysaccharide ("first hit"). After 2 hours, volunteers received normal saline (n = 6), 2-day stored transfusion (n = 6), or 35-day stored transfusion (n = 6) ("second hit"). Blood was sampled hourly. Six hours after transfusion, the diffusion capacity of the lungs for carbon monoxide was tested and volunteers underwent spirometry, chest x-ray study, and a bronchoalveolar lavage.Measurements And Main ResultsAll volunteers fulfilled sepsis criteria after lipopolysaccharide injection. The stored blood transfusion did not result in significant changes in either hemodynamic or respiratory variables compared with the control groups. Furthermore, chest x-rays, lung function, and PaO2/FIO2 ratios did not differ between groups. Transfusion of stored autologous RBCs did not result in an increased level of protein in the lungs or neutrophil influx.ConclusionsTransfusion of 35-day stored autologous RBCs in the presence of endotoxemia does not result in lung injury in humans.

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