title: Resuscitation with aged blood exacerbates liver injury in a hemorrhagic rat model.
abstract: OBJECTIVE
  Blood loss and transfusion are frequent among patients undergoing liver surgery. Concerns have been raised about the safety and efficacy of transfusing stored blood. The influence of transfusing fresh vs. stored blood on the liver has not been studied to date. We tested the hypothesis that transfusion of stored, but not fresh blood, adversely affects liver outcome in vivo following acute hemorrhage. Additionally, possible mechanisms linking adverse liver outcome with increased storage duration were evaluated.
  
  
  METHODS
  Prospective, controlled, animal study.
  
  
  METHODS
  University research laboratory.
  
  
  METHODS
  Adult male Sprague-Dawley rats
  
  
  METHODS
  Anesthetized rats were randomized to control, hemorrhagic and shock group (acute bleeding; HSG), or hemorrhagic and blood resuscitation groups (BR) (with fresh blood [BR-d0], blood stored for 4 [BR-d4] or 7 [BR-d7] days, or packed RBCs stored for 7 days [packed RBC-d7]).
  
  
  RESULTS
  Administration of blood or packed RBC stored for 7 days exacerbated liver injury as reflected by liver necrosis and enhanced apoptosis (p < 0.001). Functional MRI analysis of the liver demonstrated significant improvement in liver perfusion with fresh blood (% change in functional MRI signal intensity due to hyperoxia was 16% ± 3% in BR-d0 vs. 4% ± 3% in hemorrhagic group, p < 0.001) but not with stored blood (12% ± 2% and 9% ± 5% for BR-d4 and BR-d7, respectively). Analysis of stored blood showed reduction in RBC deformability at 7 days of storage, reflecting a five-fold increase in the number of undeformable cells.
  
  
  CONCLUSIONS
  Liver injury is exacerbated by the transfusion of stored blood, primarily due to the change in the rheological properties of RBC. This data call for clinical studies in patients undergoing liver resection or transplantation.
authors: Department of Anesthesiology & Intensive Care, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors: Idit
authors: I
authors: Matot
authors: Miriam
authors: M
authors: Katz
authors: Orit
authors: O
authors: Pappo
authors: Orly
authors: O
authors: Zelig
authors: Nathalie
authors: N
authors: Corchia
authors: Shaul
authors: S
authors: Yedgar
authors: Gregory
authors: G
authors: Barshtein
authors: Elliot
authors: E
authors: Bennett-Guerrero
authors: Elliot Bennett
authors: EB
authors: Guerrero
authors: Rinat
authors: R
authors: Abramovitch
mesh_terms: D000818:Animals; D017209:Apoptosis; D001793:Blood Preservation / Q000009:adverse effects*; D004195:Disease Models, Animal; D004907:Erythrocyte Deformability; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D008099:Liver / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012771:Shock, Hemorrhagic / Q000628:therapy*