title: Washing red blood cells and platelets transfused in cardiac surgery reduces postoperative inflammation and number of transfusions: results of a prospective, randomized, controlled clinical trial.
abstract: OBJECTIVE
  Children undergoing cardiac surgery with cardiopulmonary bypass are susceptible to additional inflammatory and immunogenic insults from blood transfusions. We hypothesize that washing red blood cells and platelets transfused to these patients will reduce postoperative transfusion-related immune modulation and inflammation.
  
  
  METHODS
  Prospective, randomized, controlled clinical trial.
  
  
  METHODS
  University hospital pediatric cardiac intensive care unit.
  
  
  METHODS
  Children from birth to 17 yrs undergoing cardiac surgery with cardiopulmonary bypass.
  
  
  METHODS
  Children were randomized to an unwashed or washed red blood cells and platelet transfusion protocol for their surgery and postoperative care. All blood was leuko-reduced, irradiated, and ABO identical. Plasma was obtained for laboratory analysis preoperatively, immediately, and 6 and 12 hrs after cardiopulmonary bypass. Primary outcome was the 12-hr postcardiopulmonary bypass interleukin-6-to-interleukin-10 ratio. Secondary measures were interleukin levels, C-reactive protein, and clinical outcomes.
  
  
  RESULTS
  One hundred sixty-two subjects were studied, 81 per group. Thirty-four subjects (17 per group) did not receive any blood transfusions. Storage duration of blood products was similar between groups. Among transfused subjects, the 12-hr interleukin ratio was significantly lower in the washed group (3.8 vs. 4.8; p = .04) secondary to lower interleukin-6 levels (after cardiopulmonary bypass: 65 vs.100 pg/mL, p = .06; 6 hrs: 89 vs.152 pg/mL, p = .02; 12 hrs: 84 vs.122 pg/mL, p = .09). Postoperative C-reactive protein was lower in subjects receiving washed blood (38 vs. 43 mg/L; p = .03). There was a numerical, but not statistically significant, decrease in total blood product transfusions (203 vs. 260) and mortality (2 vs. 6 deaths) in the washed group compared to the unwashed group.
  
  
  CONCLUSIONS
  Washed blood transfusions in cardiac surgery reduced inflammatory biomarkers, number of transfusions, donor exposures, and were associated with a nonsignificant trend toward reduced mortality. A larger study powered to test for clinical outcomes is needed to determine whether these laboratory findings are clinically significant.
authors.affiliation: Department of Pediatrics, University of Rochester, Rochester, NY, USA. Jill_Cholette@urmc.rochester.edu
authors.forename: Jill M
authors.initials: JM
authors.lastname: Cholette
authors.forename: Kelly F
authors.initials: KF
authors.lastname: Henrichs
authors.forename: George M
authors.initials: GM
authors.lastname: Alfieris
authors.forename: Karen S
authors.initials: KS
authors.lastname: Powers
authors.forename: Richard
authors.initials: R
authors.lastname: Phipps
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Spinelli
authors.forename: Michael
authors.initials: M
authors.lastname: Swartz
authors.forename: Francisco
authors.initials: F
authors.lastname: Gensini
authors.forename: L Eugene
authors.initials: LE
authors.lastname: Daugherty
authors.forename: Emily
authors.initials: E
authors.lastname: Nazarian
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Rubenstein
authors.forename: Dawn
authors.initials: D
authors.lastname: Sweeney
authors.forename: Michael
authors.initials: M
authors.lastname: Eaton
authors.forename: Norma B
authors.initials: NB
authors.lastname: Lerner
authors.forename: Neil
authors.initials: N
authors.lastname: Blumberg
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical; D001800:Blood Specimen Collection / Q000379:methods*; D002097:C-Reactive Protein / Q000378:metabolism; D006348:Cardiac Surgical Procedures / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D017713:Platelet Transfusion / Q000379:methods* / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D016753:Interleukin-10; D002097:C-Reactive Protein