Transfusion of standard-issue packed red blood cells induces pulmonary vasoconstriction in critically ill patients after cardiac surgery-A randomized, double-blinded, clinical trial

• Published in: PloS one 2019-03, Vol.14 (3), p.e0213000
• Main Authors: Baron-Stefaniak, Joanna, Leitner, Gerda C, Küntzel, Nina K I, Meyer, Elias L, Hiesmayr, Michael J, Ullrich, Roman, Baron, David M
• Format: Article
• Language: English
• Subjects: Aged; Analysis; Bioavailability; Biology and Life Sciences; Blood; Blood cells; Blood transfusion; Cardiac patients; Cardiac Surgical Procedures - adverse effects; Clinical trials; Critical Illness - therapy; Critically ill persons; Diabetes; Double-Blind Method; Drug Storage; Endothelial Cells - cytology; Endothelial Cells - pathology; Erythrocyte Transfusion - adverse effects; Erythrocytes; Ethics; Female; Glycocalyx - pathology; Health aspects; Heart; Heart surgery; Hemodynamics; Heparan sulfate; Hospital patients; Humans; Intensive care; Male; Medical research; Medical statistics; Medicine; Medicine and Health Sciences; Middle Aged; Nitric oxide; Pain; Patients; Postoperative Hemorrhage - etiology; Postoperative Hemorrhage - therapy; Pulmonary arteries; Pulmonary artery; Pulmonary Artery - pathology; Pulmonary Artery - physiopathology; Pulmonary hypertension; Red blood cells; Statistical analysis; Storage; Studies; Surgery; Syndecan; Time Factors; Transfusion; Vascular Resistance; Vasoconstriction
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0213000

Experimental and volunteer studies have reported pulmonary vasoconstriction during transfusion of packed red blood cells (PRBCs) stored for prolonged periods. The primary aim of this study was to evaluate whether transfusion of PRBCs stored over 21 days (standard-issue, siPRBCs) increases pulmonary artery pressure (PAP) to a greater extent than transfusion of PRBCs stored for less then 14 days (fresh, fPRBCs) in critically ill patients following cardiac surgery. The key secondary aim was to assess whether the pulmonary vascular resistance index (PVRI) increases after transfusion of siPRBCs to a greater extent than after transfusion of fPRBCs. The study was performed as a single-center, double-blinded, parallel-group, randomized clinical trial. Leukoreduced PRBCs were transfused while continuously measuring hemodynamic parameters. Systemic concentrations of syndecan-1 were measured to assess glycocalyx injury. After randomizing 19 patients between January 2014 and June 2016, the study was stopped due to protracted patient recruitment. Of 19 randomized patients, 11 patients were transfused and included in statistical analyses. Eight patients were excluded prior to transfusion, 6 patients received fPRBCs (10±3 storage days), whereas 5 patients received siPRBCs (33±4 storage days). The increase in PAP (7±3 vs. 2±2 mmHg, P = 0.012) was greater during transfusion of siPRBCs than during transfusion of fPRBCs. In addition, the change in PVRI (150±89 vs. -4±37 dyn·s·cm-5·m2, P = 0.018) was greater after transfusion of siPRBCs than after transfusion of fPRBCs. The increase in PAP correlated with the change of systemic syndecan-1 concentrations at the end of transfusion (R = 0.64,P = 0.034). Although this study is underpowered and results require verification in larger clinical trials, our findings suggest that transfusion of siPRBCs increases PAP and PVRI to a greater extent than transfusion of fPRBCs in critically ill patients following cardiac surgery. Glycocalyx injury might contribute to pulmonary vasoconstriction associated with transfusion of stored blood.