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Autologous transfusion of stored red blood cells increases pulmonary artery pressure

Autologous transfusion of stored red blood cells increases pulmonary artery pressure
Autologous transfusion of stored red blood cells increases pulmonary artery pressure
RATIONALE: Transfusion of erythrocytes stored for prolonged periods is associated with increased mortality. Erythrocytes undergo hemolysis during storage and after transfusion. Plasma hemoglobin scavenges endogenous nitric oxide leading to systemic and pulmonary vasoconstriction.

OBJECTIVES: We hypothesized that transfusion of autologous blood stored for 40 days would increase the pulmonary artery pressure in volunteers with endothelial dysfunction (impaired endothelial production of nitric oxide). We also tested whether breathing nitric oxide before and during transfusion could prevent the increase of pulmonary artery pressure.

METHODS: Fourteen obese adults with endothelial dysfunction were enrolled in a randomized crossover study of transfusing autologous, leukoreduced blood stored for either 3 or 40 days. Volunteers were transfused with 3-day blood, 40-day blood, and 40-day blood while breathing 80 ppm nitric oxide.

MEASUREMENTS AND MAIN RESULTS: The age of volunteers was 41 ± 4 years (mean ± SEM), and their body mass index was 33.4 ± 1.3 kg/m(2). Plasma hemoglobin concentrations increased after transfusion with 40-day and 40-day plus nitric oxide blood but not after transfusing 3-day blood. Mean pulmonary artery pressure, estimated by transthoracic echocardiography, increased after transfusing 40-day blood (18 ± 2 to 23 ± 2 mm Hg; P < 0.05) but did not change after transfusing 3-day blood (17 ± 2 to 18 ± 2 mm Hg; P = 0.5). Breathing nitric oxide decreased pulmonary artery pressure in volunteers transfused with 40-day blood (17 ± 2 to 12 ± 1 mm Hg; P < 0.05).

CONCLUSIONS: Transfusion of autologous leukoreduced blood stored for 40 days was associated with increased plasma hemoglobin levels and increased pulmonary artery pressure. Breathing nitric oxide prevents the increase of pulmonary artery pressure produced by transfusing stored blood. Clinical trial registered with www.clinicaltrials.gov (NCT 01529502).
hemoglobins, pulmonary hypertension, nitric oxide, endothelium, echocardiography
1073-449X
800-807
Berra, Lorenzo
f3f7e3e3-33d0-4857-aa47-f9c227f1e647
Pinciroli, Riccardo
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Stowell, Christopher P.
88c69410-d25e-437b-90fd-ee314bea5a77
Wang, Lin
82527212-6487-4bb9-85d2-5e186ac79df1
Yu, Binglan
e1d2bb81-ec7d-475d-b459-fe1adc66fcde
Fernandez, Bernadette O.
27babc73-7646-4908-86e2-6c29d79fb938
Feelisch, Martin
8c1b9965-8614-4e85-b2c6-458a2e17eafd
Mietto, Cristina
e544b743-ae64-4e4a-959c-ad3eed56b059
Hod, Eldad A.
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Chipman, Daniel
f508d7eb-b16d-42a6-a90b-80e939d2ee24
Scherrer-Crosbie, Marielle
907894b6-2f74-45ae-a0e9-d8353d0d6823
Bloch, Kenneth D.
25d43ddf-77d4-448b-b618-079a0492aba1
Zapol, Warren M.
84efe66d-166f-4b1d-8db2-b48586aea27e
Berra, Lorenzo
f3f7e3e3-33d0-4857-aa47-f9c227f1e647
Pinciroli, Riccardo
0dc8516d-ef30-4189-adf2-4fcfed5d177e
Stowell, Christopher P.
88c69410-d25e-437b-90fd-ee314bea5a77
Wang, Lin
82527212-6487-4bb9-85d2-5e186ac79df1
Yu, Binglan
e1d2bb81-ec7d-475d-b459-fe1adc66fcde
Fernandez, Bernadette O.
27babc73-7646-4908-86e2-6c29d79fb938
Feelisch, Martin
8c1b9965-8614-4e85-b2c6-458a2e17eafd
Mietto, Cristina
e544b743-ae64-4e4a-959c-ad3eed56b059
Hod, Eldad A.
2c1c9e39-53ac-461c-8bde-080f83eb7fd4
Chipman, Daniel
f508d7eb-b16d-42a6-a90b-80e939d2ee24
Scherrer-Crosbie, Marielle
907894b6-2f74-45ae-a0e9-d8353d0d6823
Bloch, Kenneth D.
25d43ddf-77d4-448b-b618-079a0492aba1
Zapol, Warren M.
84efe66d-166f-4b1d-8db2-b48586aea27e

Berra, Lorenzo, Pinciroli, Riccardo, Stowell, Christopher P., Wang, Lin, Yu, Binglan, Fernandez, Bernadette O., Feelisch, Martin, Mietto, Cristina, Hod, Eldad A., Chipman, Daniel, Scherrer-Crosbie, Marielle, Bloch, Kenneth D. and Zapol, Warren M. (2014) Autologous transfusion of stored red blood cells increases pulmonary artery pressure. American Journal of Respiratory and Critical Care Medicine, 190 (7), 800-807. (doi:10.1164/rccm.201405-0850OC). (PMID:25162920)

Record type: Article

Abstract

RATIONALE: Transfusion of erythrocytes stored for prolonged periods is associated with increased mortality. Erythrocytes undergo hemolysis during storage and after transfusion. Plasma hemoglobin scavenges endogenous nitric oxide leading to systemic and pulmonary vasoconstriction.

OBJECTIVES: We hypothesized that transfusion of autologous blood stored for 40 days would increase the pulmonary artery pressure in volunteers with endothelial dysfunction (impaired endothelial production of nitric oxide). We also tested whether breathing nitric oxide before and during transfusion could prevent the increase of pulmonary artery pressure.

METHODS: Fourteen obese adults with endothelial dysfunction were enrolled in a randomized crossover study of transfusing autologous, leukoreduced blood stored for either 3 or 40 days. Volunteers were transfused with 3-day blood, 40-day blood, and 40-day blood while breathing 80 ppm nitric oxide.

MEASUREMENTS AND MAIN RESULTS: The age of volunteers was 41 ± 4 years (mean ± SEM), and their body mass index was 33.4 ± 1.3 kg/m(2). Plasma hemoglobin concentrations increased after transfusion with 40-day and 40-day plus nitric oxide blood but not after transfusing 3-day blood. Mean pulmonary artery pressure, estimated by transthoracic echocardiography, increased after transfusing 40-day blood (18 ± 2 to 23 ± 2 mm Hg; P < 0.05) but did not change after transfusing 3-day blood (17 ± 2 to 18 ± 2 mm Hg; P = 0.5). Breathing nitric oxide decreased pulmonary artery pressure in volunteers transfused with 40-day blood (17 ± 2 to 12 ± 1 mm Hg; P < 0.05).

CONCLUSIONS: Transfusion of autologous leukoreduced blood stored for 40 days was associated with increased plasma hemoglobin levels and increased pulmonary artery pressure. Breathing nitric oxide prevents the increase of pulmonary artery pressure produced by transfusing stored blood. Clinical trial registered with www.clinicaltrials.gov (NCT 01529502).

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Accepted/In Press date: 25 August 2014
e-pub ahead of print date: 27 August 2014
Published date: 1 October 2014
Keywords: hemoglobins, pulmonary hypertension, nitric oxide, endothelium, echocardiography
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 368569
URI: http://eprints.soton.ac.uk/id/eprint/368569
ISSN: 1073-449X
PURE UUID: 0c8610f1-55b4-4720-8dd6-f7a0fb5d647f
ORCID for Martin Feelisch: ORCID iD orcid.org/0000-0003-2320-1158

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Date deposited: 04 Sep 2014 12:20
Last modified: 18 Feb 2021 17:18

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Contributors

Author: Lorenzo Berra
Author: Riccardo Pinciroli
Author: Christopher P. Stowell
Author: Lin Wang
Author: Binglan Yu
Author: Bernadette O. Fernandez
Author: Martin Feelisch ORCID iD
Author: Cristina Mietto
Author: Eldad A. Hod
Author: Daniel Chipman
Author: Marielle Scherrer-Crosbie
Author: Kenneth D. Bloch
Author: Warren M. Zapol

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