title: Resuscitation with washed aged packed red blood cell units decreases the proinflammatory response in mice after hemorrhage.
abstract: BACKGROUND
  Resuscitation with blood products instead of crystalloid in the treatment of hemorrhagic shock has been associated with improved outcomes in trauma patients requiring massive transfusions and transfusion of fresh products results in reduced morbidity and mortality compared with aged blood. Processes to eliminate harmful components of aged blood are under investigation. We hypothesized that washing blood would reduce levels of proinflammatory mediators in stored units, and resuscitation with washed units would attenuate the proinflammatory response in mice after hemorrhagic shock.
  
  
  METHODS
  Mice underwent pressure-controlled hemorrhage and resuscitation with fresh packed red blood cells (pRBCs) or 15-day-old washed or unwashed pRBCs. Cytokine concentrations in donor samples and recipient serum were measured. In addition, cytokine concentrations were measured in 15-day-old units that underwent three interval washes versus one poststorage wash.
  
  
  RESULTS
  Blood stored for 15 days demonstrated increased levels of interleukin 1α, keratinocyte chemoattractant, macrophage inflammatory protein 1α, and macrophage inflammatory protein 2 compared with fresh units. Washing 15-day-old pRBCs reduced concentrations of these cytokines. Cytokine levels in stored units that underwent multiple washes versus a single wash were not different. Mice resuscitated with 15-day-old unwashed pRBCs had increased levels of serum cytokines compared with mice resuscitated with fresh and 15-day-old washed pRBCs.
  
  
  CONCLUSIONS
  Aged pRBC units have elevated levels of proinflammatory cytokines compared with fresh units, and washing aged units after storage reduces cytokine concentrations. Resuscitation with washed units blunts the proinflammatory response in mice after hemorrhage. Washing aged pRBCs may improve the safety profile of aged units and may result in improved outcomes in subjects after hemorrhagic shock and resuscitation.
authors: Institute of Military Medicine, Department of Surgery, University of Cincinnati, Ohio 45267-0558, USA.
authors: Ritha M
authors: RM
authors: Belizaire
authors: Amy T
authors: AT
authors: Makley
authors: Eric M
authors: EM
authors: Campion
authors: Dennis I
authors: DI
authors: Sonnier
authors: Michael D
authors: MD
authors: Goodman
authors: Warren C
authors: WC
authors: Dorlac
authors: Lou Ann
authors: LA
authors: Friend
authors: Alex B
authors: AB
authors: Lentsch
authors: Timothy A
authors: TA
authors: Pritts
mesh_terms: D000818:Animals; D054405:Chemokine CCL3 / Q000097:blood; D054426:Chemokine CXCL2 / Q000097:blood; D016207:Cytokines / Q000097:blood; D017707:Erythrocyte Transfusion / Q000379:methods*; D007249:Inflammation / Q000517:prevention & control; D053582:Interleukin-1alpha / Q000097:blood; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D012151:Resuscitation / Q000379:methods; D012771:Shock, Hemorrhagic / Q000628:therapy*
chemical_list: D054405:Chemokine CCL3; D054426:Chemokine CXCL2; D016207:Cytokines; D053582:Interleukin-1alpha