title: Infusion of hemolyzed red blood cells within peripheral blood stem cell grafts in patients with and without sickle cell disease.
abstract: Peripheral blood stem cell (PBSC) infusions are associated with complications such as elevated blood pressure and decreased creatinine clearance. Patients with sickle cell disease experience similar manifestations, and some have postulated release of plasma-free hemoglobin with subsequent nitric oxide consumption as causative. We sought to evaluate whether the infusion of PBSC grafts containing lysed red blood cells (RBCs) leads to the toxicity observed in transplant subjects. We report a prospective cohort study of 60 subjects divided into 4 groups based on whether their infusions contained dimethyl sulfoxide (DMSO) and lysed RBCs, no DMSO and fresh RBCs, DMSO and no RBCs, or saline. Our primary end point, change in maximum blood pressure compared with baseline, was not significantly different among groups. Tricuspid regurgitant velocity and creatinine levels also did not differ significantly among groups. Our data do not support free hemoglobin as a significant contributor to toxicity associated with PBSC infusions. This study was registered at clinicaltrials.gov (NCT00631787).
authors.affiliation: Molecular and Clinical Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD 20892, USA.
authors.forename: Courtney D
authors.initials: CD
authors.lastname: Fitzhugh
authors.forename: Hayato
authors.initials: H
authors.lastname: Unno
authors.forename: Vincent
authors.initials: V
authors.lastname: Hathaway
authors.forename: Wynona A
authors.initials: WA
authors.lastname: Coles
authors.forename: Mary E
authors.initials: ME
authors.lastname: Link
authors.forename: R Patrick
authors.initials: RP
authors.lastname: Weitzel
authors.forename: Xiongce
authors.initials: X
authors.lastname: Zhao
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Wright
authors.forename: David F
authors.initials: DF
authors.lastname: Stroncek
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Kato
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hsieh
authors.forename: John F
authors.initials: JF
authors.lastname: Tisdale
mesh_terms: D000755:Anemia, Sickle Cell / Q000503:physiopathology* / Q000628:therapy*; D001794:Blood Pressure / Q000502:physiology; D004912:Erythrocytes / Q000502:physiology*; D006242:Haptoglobins / Q000378:metabolism; D006339:Heart Rate / Q000502:physiology; D006461:Hemolysis / Q000502:physiology*; D006801:Humans; D007262:Infusions, Intravenous; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D036102:Peripheral Blood Stem Cell Transplantation
chemical_list: D006242:Haptoglobins; D007770:L-Lactate Dehydrogenase