Prestorage leukocyte filtration may reduce leukocyte-derived bioactive substance accumulation in patients operated for burn trauma.
Adverse effects of perioperative blood transfusion appear to be storage-time-dependent and may be related to extracellular accumulation of bioactive substances in blood products. In this study the clinical effects of leukofiltered and non-filtered blood products in patients undergoing surgery for burn trauma are investigated. 24 consecutive patients were randomly selected to receive transfusion with non-filtered blood components (group A, n = 12) or similar products, which were prestorage leukofiltered (group B, n = 12). The burn injury was scored using the Bull and Fischer index of age and burn surface area. Histamine, interleukin-6 (IL-6), plasminogen activator inhibitor-1 (PAI-1), eosinophil cationic protein (ECP) and myeloperoxidase (MPO) were analysed in plasma or serum collected from all patients 30 min before skin incision, at skin incision and 5, 10 and 30 min and thereafter every 30 min after skin incision until the grafts were secured by wrapping. Samples were also taken 8 h after skin incision and in the morning of postoperative days 1-5. The amount of blood products transfused from admission until day 5 postoperatively was recorded. All patients were followed until discharge or death. The Bull and Fischer index was comparable in the two groups. Prestorage leukofiltration reduced the amount of blood products required for transfusion significantly (p < 0.05) compared with non-filtered products. The levels of the various bioactive substances changed during and after the operation. In particular, ECP and MPO levels increased significantly (p < 0.05) in group A patients compared with unchanged (ECP) or decreased (MPO) levels in group B patients. IL-6 analyses showed, that the trauma had more severe impact on group B patients than on group A patients. Nevertheless, 4 patients died in group A and 2 in group B; all with a Bull and Fischer index between 1.0 and 2.0. Prestorage leukocyte filtration may reduce transfusion related accumulation of various bioactive substances and the requirement for blood in burn trauma patients.
Nielsen
H J
HJ
Department of Surgical Gastroenterology, Hvidovre University Hospital, Denmark. h.j.nielsen@forum.dk
Hammer
J H
JH
Krarup
A L
AL
Nielsen
L M
LM
Reimert
C M
CM
Pedersen
A N
AN
Dybkjaer
E
E
Partoft
S
S
Alsbjørn
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001793:Blood Preservation / Q000379:methods*; D001798:Blood Proteins / Q000378:metabolism; D001803:Blood Transfusion / Q000379:methods*; D002056:Burns / Q000097:blood / Q000628:therapy*; D047091:Eosinophil Granule Proteins; D004804:Eosinophils / Q000378:metabolism; D005500:Follow-Up Studies; D006632:Histamine / Q000097:blood; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007937:Leukapheresis; D007962:Leukocytes / Q000378:metabolism*; D008875:Middle Aged; D009195:Peroxidase / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D012260:Ribonucleases; D016038:Skin Transplantation
D001798:Blood Proteins; D047091:Eosinophil Granule Proteins; D015850:Interleukin-6; D017395:Plasminogen Activator Inhibitor 1; D006632:Histamine; D009195:Peroxidase; D012260:Ribonucleases