title: Transfusion of stored autologous blood does not alter reactive hyperemia index in healthy volunteers.
abstract: BACKGROUND
  Transfusion of human blood stored for more than 2 weeks is associated with increased mortality and morbidity. During storage, packed erythrocytes progressively release hemoglobin, which avidly binds nitric oxide. We hypothesized that the nitric oxide mediated hyperemic response after ischemia would be reduced after transfusion of packed erythrocytes stored for 40 days.
  
  
  RESULTS
  We conducted a crossover randomized interventional study, enrolling 10 healthy adults. Nine volunteers completed the study. Each volunteer received one unit of 40-day and one of 3-day stored autologous leukoreduced packed erythrocytes, on different study days according to a randomization scheme. Blood withdrawal and reactive hyperemia index measurements were performed before and 10 min, 1 h, 2 h, and 4 h after transfusion. The reactive hyperemia index during the first 4 h after transfusion of 40-day compared with 3-day stored packed erythrocytes was unchanged. Plasma hemoglobin and bilirubin concentrations were higher after transfusion of 40-day than after 3-day stored packed erythrocytes (P = 0.02, [95% CI difference 10-114 mg/l] and 0.001, [95% CI difference 0.6-1.5 mg/dl], respectively). Plasma concentrations of potassium, lactate dehydrogenase, haptoglobin, and cytokines, as well as blood pressure, did not differ between the two transfusions and remained within the normal range. Plasma nitrite concentrations increased after transfusion of 40-day stored packed erythrocytes, but not after transfusion of 3-day stored packed erythrocytes (P = 0.01, [95% CI difference 0.446-0.66 μM]).
  
  
  CONCLUSIONS
  Transfusion of autologous packed erythrocytes stored for 40 days is associated with increased hemolysis, an unchanged reactive hyperemia index, and increased concentrations of plasma nitrite.
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School at Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Berra
authors.forename: Andrea
authors.initials: A
authors.lastname: Coppadoro
authors.forename: Binglan
authors.initials: B
authors.lastname: Yu
authors.forename: Chong
authors.initials: C
authors.lastname: Lei
authors.forename: Ester
authors.initials: E
authors.lastname: Spagnolli
authors.forename: Andrea U
authors.initials: AU
authors.lastname: Steinbicker
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Bloch
authors.forename: Tian
authors.initials: T
authors.lastname: Lin
authors.forename: Fatima Y
authors.initials: FY
authors.lastname: Sammy
authors.forename: H Shaw
authors.initials: HS
authors.lastname: Warren
authors.forename: Bernadette O
authors.initials: BO
authors.lastname: Fernandez
authors.forename: Martin
authors.initials: M
authors.lastname: Feelisch
authors.forename: Walter H
authors.initials: WH
authors.lastname: Dzik
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Stowell
authors.forename: Warren M
authors.initials: WM
authors.lastname: Zapol
mesh_terms: D000328:Adult; D001793:Blood Preservation; D001804:Blood Transfusion, Autologous / Q000009:adverse effects*; D018592:Cross-Over Studies; D005260:Female; D006461:Hemolysis; D006801:Humans; D006940:Hyperemia / Q000209:etiology*; D008297:Male; D009569:Nitric Oxide / Q000378:metabolism; D009573:Nitrites / Q000097:blood
chemical_list: D009573:Nitrites; D009569:Nitric Oxide