title: Transfusion-related acute lung injury in a rat model of trauma-hemorrhage.
abstract: BACKGROUND
  Major trauma often causes hemorrhage and predisposes to transfusion-related acute lung injury (TRALI). TRALI is a leading cause of transfusion-related deaths; however, its pathophysiology is uncertain. In the existing two-event models of TRALI, infection (lipopolysaccharide injection) is followed by the infusion of aged blood products. Our objective was to develop a trauma-relevant two-event model of TRALI by examining the effect of aged packed red blood cells (PRBC) on lung injury in rats with trauma-hemorrhage.
  
  
  METHODS
  Male Lewis rats were used. Rat PRBC were prepared similar to human PRBC. Recipients were implanted with femoral arterial and venous catheters (isoflurane anesthesia) and then subjected to 30% controlled arterial hemorrhage after 16-hour recovery. After a 60-minute shock period, rats were resuscitated with crystalloid and PRBC (0-35 days old; 3:1 ratio) and followed for up to 6 hours. Lung edema was evaluated by Evans blue dye (EBD), protein, and cytokine-induced neutrophil chemoattractant-1 (CINC-1) accumulation in bronchoalveolar lavage fluid, and arterial blood gases were measured (iSTAT).
  
  
  RESULTS
  CINC-1 levels increased over time in our PRBC stored for over 21 days. Transfusion survival was reduced, and Evans blue dye, protein, and CINC-1 accumulation in bronchoalveolar lavage fluid were increased in rats transfused with 28-day-old and 35-day-old PRBC compared with the 0-day group. Arterial PO2 and O2 saturation were decreased in rats transfused with 28-day-old and 35-day-old PRBC. However, pH and PCO2 were not different between groups.
  
  
  CONCLUSIONS
  These results suggest that transfusion of 28-day-old and 35-day-old PRBC reliably promotes lung edema in a rat model of catheter surgery and hemorrhage. We propose that this model can be used as a trauma-relevant two-event model of TRALI.
authors.affiliation: Division of Trauma and Emergency Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA.
authors.forename: Susannah E
authors.initials: SE
authors.lastname: Nicholson
authors.forename: Robert A
authors.initials: RA
authors.lastname: Johnson
authors.forename: Teresa
authors.initials: T
authors.lastname: Craig
authors.forename: John G
authors.initials: JG
authors.lastname: Myers
authors.forename: William
authors.initials: W
authors.lastname: Durante
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Stewart
authors.forename: Fruzsina K
authors.initials: FK
authors.lastname: Johnson
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology* / Q000503:physiopathology; D000818:Animals; D001784:Blood Gas Analysis; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D054360:Chemokine CXCL1 / Q000032:analysis; D004195:Disease Models, Animal; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D058734:Exsanguination / Q000150:complications / Q000628:therapy*; D008297:Male; D011654:Pulmonary Edema / Q000209:etiology / Q000503:physiopathology; D051381:Rats; D011917:Rats, Inbred Lew; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*
chemical_list: D054360:Chemokine CXCL1; C513297:Cxcl1 protein, rat