title: Rapid clearance of transfused murine red blood cells is associated with recipient cytokine storm and enhanced alloimmunogenicity.
abstract: BACKGROUND
  Fourteen-day stored red blood cells (RBCs) containing an RBC-specific transgenic antigen (HOD) induce a recipient proinflammatory cytokine storm and are significantly more immunogenic compared to fresh RBCs. Given that recipient mice clear transfused stored RBCs more rapidly than fresh RBCs, we hypothesized that rapid RBC clearance was associated with adverse transfusion outcomes.
  
  
  METHODS
  HOD RBCs were treated by two distinct methods known to lead to rapid posttransfusion RBC clearance: phenylhydrazine or heat. HOD antigen expression was analyzed on the treated cells before transfusion, and RBC recovery, recipient cytokine response, and recipient anti-HOD alloimmunization response were measured after transfusion.
  
  
  RESULTS
  Phenylhydrazine and heat treatment each led to near complete RBC clearance in recipients by 24 hours posttransfusion, without significantly altering HOD antigen expression on the transfused RBCs. Recipients of phenylhydrazine- or heat-treated RBCs had elevated circulating levels of keratinocyte-derived chemokine/CXCL-1, monocyte chemoattractant protein-1, and interleukin-6 after transfusion. Furthermore, phenylhydrazine- or heat-treated RBCs were significantly more immunogenic than control RBCs, with a mean 25.1- and 10.3-fold enhancement, respectively, of anti-HOD alloimmunization magnitude by flow cytometric crossmatch.
  
  
  CONCLUSIONS
  Three separate insults to RBCs (storage, phenylhydrazine, or heat treatment) result in rapid posttransfusion clearance, with a recipient proinflammatory cytokine storm and enhanced alloimmunogenicity. These data are consistent with the hypothesis that rapid clearance of RBCs is causally involved in these outcomes and suggest that human donor RBCs with favorable posttransfusion clearance profiles may be less immunogenic.
authors.affiliation: Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Jeanne E
authors.initials: JE
authors.lastname: Hendrickson
authors.forename: Eldad A
authors.initials: EA
authors.lastname: Hod
authors.forename: Chantel M
authors.initials: CM
authors.lastname: Cadwell
authors.forename: Stephanie C
authors.initials: SC
authors.lastname: Eisenbarth
authors.forename: David A
authors.initials: DA
authors.lastname: Spiegel
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Tormey
authors.forename: Steven L
authors.initials: SL
authors.lastname: Spitalnik
authors.forename: James C
authors.initials: JC
authors.lastname: Zimring
mesh_terms: D000818:Animals; D016207:Cytokines / Q000096:biosynthesis*; D017707:Erythrocyte Transfusion; D004912:Erythrocytes / Q000276:immunology*; D005260:Female; D018398:Homeodomain Proteins; D006358:Hot Temperature; D007518:Isoantibodies / Q000276:immunology*; D051379:Mice; D008810:Mice, Inbred C57BL; D010659:Phenylhydrazines / Q000494:pharmacology
chemical_list: D016207:Cytokines; C473013:Hod protein, mouse; D018398:Homeodomain Proteins; D007518:Isoantibodies; D010659:Phenylhydrazines; C030299:phenylhydrazine