Transfusion of human volunteers with older, stored red blood cells produces extravascular hemolysis and circulating non-transferrin-bound iron.
Transfusions of RBCs stored for longer durations are associated with adverse effects in hospitalized patients. We prospectively studied 14 healthy human volunteers who donated standard leuko-reduced, double RBC units. One unit was autologously transfused "fresh" (3-7 days of storage), and the other "older" unit was transfused after 40 to 42 days of storage. Of the routine laboratory parameters measured at defined times surrounding transfusion, significant differences between fresh and older transfusions were only observed in iron parameters and markers of extravascular hemolysis. Compared with fresh RBCs, mean serum total bilirubin increased by 0.55 mg/dL at 4 hours after transfusion of older RBCs (P = .0003), without significant changes in haptoglobin or lactate dehydrogenase. In addition, only after the older transfusion, transferrin saturation increased progressively over 4 hours to a mean of 64%, and non-transferrin-bound iron appeared, reaching a mean of 3.2μM. The increased concentrations of non-transferrin-bound iron correlated with enhanced proliferation in vitro of a pathogenic strain of Escherichia coli (r = 0.94, P = .002). Therefore, circulating non-transferrin-bound iron derived from rapid clearance of transfused, older stored RBCs may enhance transfusion-related complications, such as infection.
Departments of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons–New York Presbyterian Hospital, New York, NY 10032, USA. eh2217@columbia.edu
Eldad A
EA
Hod
Gary M
GM
Brittenham
Genia B
GB
Billote
Richard O
RO
Francis
Yelena Z
YZ
Ginzburg
Jeanne E
JE
Hendrickson
Jeffrey
J
Jhang
Joseph
J
Schwartz
Shruti
S
Sharma
Sujit
S
Sheth
Anthony N
AN
Sireci
Hannah L
HL
Stephens
Brie A
BA
Stotler
Boguslaw S
BS
Wojczyk
James C
JC
Zimring
Steven L
SL
Spitalnik
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001424:Bacterial Infections / Q000209:etiology; D001772:Blood Cell Count; D001782:Blood Donors; D001793:Blood Preservation / Q000009:adverse effects / Q000379:methods*; D002712:Chlorides / Q000097:blood; D003404:Creatinine / Q000097:blood; D017707:Erythrocyte Transfusion / Q000379:methods*; D004912:Erythrocytes / Q000166:cytology* / Q000378:metabolism; D005260:Female; D006461:Hemolysis; D006805:Human Experimentation; D006801:Humans; D007249:Inflammation / Q000209:etiology; D007501:Iron / Q000097:blood* / Q000378:metabolism; D008297:Male; D011446:Prospective Studies; D012709:Serum Albumin / Q000378:metabolism; D012964:Sodium / Q000097:blood; D013997:Time Factors; D014168:Transferrin / Q000378:metabolism; D014182:Transplantation, Autologous; D055815:Young Adult
D002712:Chlorides; D012709:Serum Albumin; D014168:Transferrin; D012964:Sodium; D003404:Creatinine; D007501:Iron; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase