title: Stored blood transfusion induces transient pulmonary arterial hypertension without impairing coagulation in an ovine model of nontraumatic haemorrhage.
abstract: OBJECTIVE
  Transfusion of blood products in particular older products is associated with patient morbidity. Previously, we demonstrated a higher incidence of acute lung injury in lipopolysaccharide-treated sheep transfused with stored blood products. As transfusion following haemorrhage is more common, we aimed to determine whether a 'first hit' of isolated haemorrhage would precipitate similar detrimental effects following transfusion and also disrupt haemostasis.
  
  
  METHODS
  Anaesthetized sheep had 33% of their total blood volume collected into Leukotrap bags (Pall Medical), which were processed into packed red blood cells and cross-matched for transfusion into other sheep. After 30 mins, the sheep were resuscitated with either: fresh (<5 days old) or stored (35-42 days old) ovine blood followed by 4% albumin to replacement volume, albumin alone or normal saline alone and monitored for 4 h.
  
  
  RESULTS
  The first hit of haemorrhage precipitated substantial decreases in mean arterial pressure however haemostasis was preserved. Transfusion of stored ovine blood induced (1) transient pulmonary arterial hypertension but no oedema and (2) reduced fibrinogen levels more than fresh blood, but neither induced coagulopathy. Thus, transfusion of stored blood affected pulmonary function even in the absence of overt organ injury.
  
  
  CONCLUSIONS
  The fact that stored blood transfusions: (1) did not induce acute lung injury in contrast to previous lipopolysaccharide-primed animal models identifies the 'first hit' as an important determinant of the severity of transfusion-mediated injury; (2) impaired pulmonary dynamics verifies the sensitivity and vulnerability of the pulmonary system to injury.
authors: Critical Care Research Group, University of Queensland and The Prince Charles Hospital, Brisbane, QLD, Australia. lin_fung@health.qld.gov.au
authors: Y L
authors: YL
authors: Fung
authors: J P
authors: JP
authors: Tung
authors: S R
authors: SR
authors: Foley
authors: G
authors: G
authors: Simonova
authors: O
authors: O
authors: Thom
authors: A
authors: A
authors: Staib
authors: J
authors: J
authors: Collier
authors: K R
authors: KR
authors: Dunster
authors: C
authors: C
authors: Solano
authors: K
authors: K
authors: Shekar
authors: M S
authors: MS
authors: Chew
authors: J F
authors: JF
authors: Fraser
mesh_terms: D055371:Acute Lung Injury / Q000097:blood / Q000209:etiology; D000818:Animals; D001793:Blood Preservation; D004195:Disease Models, Animal; D017707:Erythrocyte Transfusion; D006470:Hemorrhage / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D006976:Hypertension, Pulmonary / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D008297:Male; D012756:Sheep; D013997:Time Factors
keywords: TRALI; hemostasis; red cell components; transfusion reactions