title: Impact of red blood cell transfusion on platelet aggregation and inflammatory response in anemic coronary and noncoronary patients: the TRANSFUSION-2 study (impact of transfusion of red blood cell on platelet activation and aggregation studied with flow cytometry use and light transmission aggregometry).
abstract: OBJECTIVE
  This study sought to determine whether red blood cell (RBC) transfusion increases in vivo platelet aggregation and inflammation in coronary and noncoronary patients.
  
  
  BACKGROUND
  RBC transfusion increases in vitro platelet activation and aggregation in healthy volunteers, providing a possible explanation for the increase in recurrent ischemic events and mortality reported after RBC transfusion in patients with acute coronary syndromes (ACS).
  
  
  METHODS
  Platelet reactivity was measured before and after RBC transfusion in 61 patients (33 with ACS patients and 28 without ACS). Relative changes between baseline and post-transfusion measurements of maximal and residual platelet aggregation were considered with different agonists as well as changes in vasodilator-stimulated phosphoprotein platelet reactivity index and P-selectin expression. Inflammatory and thrombotic biomarkers were also measured before and after transfusion.
  
  
  RESULTS
  After RBC transfusion, platelet reactivity was increased when measured using adenosine diphosphate-induced light transmission aggregometry (11.6% relative increase in maximal platelet aggregation, p = 0.004; 10.8% increase in residual platelet aggregation, p = 0.005) and vasodilator-stimulated phosphoprotein platelet reactivity index (20.7% relative increase, p = 0.002), and there was a nonsignificant trend toward an increase in P-selectin expression. Similar results were found with the nonspecific agonist thrombin receptor-activated peptide (relative increases of 11.7% for maximal platelet aggregation, p = 0.04, and 12.7% for residual platelet aggregation, p = 0.02) but not with collagen or arachidonic acid agonists. There were no significant differences in inflammatory and thrombotic biomarkers before and after transfusion.
  
  
  CONCLUSIONS
  After RBC transfusion, there is an increase in platelet reactivity, especially with tests measuring the adenosine diphosphate-P2Y12 receptor pathway, without significant variations in inflammatory or thrombotic biomarkers. This in vivo effect may account for the excess of ischemic events observed in the context of patients with ACS treated using percutaneous coronary intervention and P2Y12 inhibitors.
authors.affiliation: Institut de Cardiologie, Institut National de la Santé et de la Recherche Médicale CMR937, Allies in Cardiovascular Trials Initiatives and Organized Networks Group, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France.
authors.forename: Johanne
authors.initials: J
authors.lastname: Silvain
authors.affiliation: Institut de Cardiologie, Institut National de la Santé et de la Recherche Médicale CMR937, Allies in Cardiovascular Trials Initiatives and Organized Networks Group, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Abtan
authors.affiliation: Institut de Cardiologie, Institut National de la Santé et de la Recherche Médicale CMR937, Allies in Cardiovascular Trials Initiatives and Organized Networks Group, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Kerneis
authors.affiliation: Institut de Cardiologie, Institut National de la Santé et de la Recherche Médicale CMR937, Allies in Cardiovascular Trials Initiatives and Organized Networks Group, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France.
authors.forename: Réjane
authors.initials: R
authors.lastname: Martin
authors.affiliation: Institut de Cardiologie, Institut National de la Santé et de la Recherche Médicale CMR937, Allies in Cardiovascular Trials Initiatives and Organized Networks Group, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Finzi
authors.affiliation: Institut de Cardiologie, Institut National de la Santé et de la Recherche Médicale CMR937, Allies in Cardiovascular Trials Initiatives and Organized Networks Group, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Vignalou
authors.affiliation: Institut de Cardiologie, Institut National de la Santé et de la Recherche Médicale CMR937, Allies in Cardiovascular Trials Initiatives and Organized Networks Group, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Barthélémy
authors.affiliation: Institut de Cardiologie, Institut National de la Santé et de la Recherche Médicale CMR937, Allies in Cardiovascular Trials Initiatives and Organized Networks Group, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: O'Connor
authors.affiliation: Service de Réanimation Médicale, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France.
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
authors.affiliation: Service de Réanimation Médicale, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Brechot
authors.affiliation: Etablissement Français du Sang Ile-de-France, CR4, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Mercadier
authors.affiliation: Institut de Cardiologie, Institut National de la Santé et de la Recherche Médicale CMR937, Allies in Cardiovascular Trials Initiatives and Organized Networks Group, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Brugier
authors.affiliation: Institut de Cardiologie, Institut National de la Santé et de la Recherche Médicale CMR937, Allies in Cardiovascular Trials Initiatives and Organized Networks Group, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Galier
authors.affiliation: Institut de Cardiologie, Institut National de la Santé et de la Recherche Médicale CMR937, Allies in Cardiovascular Trials Initiatives and Organized Networks Group, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.affiliation: Service de Réanimation Médicale, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.affiliation: Institut de Cardiologie, Institut National de la Santé et de la Recherche Médicale CMR937, Allies in Cardiovascular Trials Initiatives and Organized Networks Group, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France. Electronic address: gilles.montalescot@psl.aphp.fr.
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D000740:Anemia / Q000097:blood / Q000150:complications / Q000628:therapy; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications; D003430:Cross-Sectional Studies; D017707:Erythrocyte Transfusion / Q000379:methods; D005434:Flow Cytometry / Q000379:methods; D005500:Follow-Up Studies; D015539:Platelet Activation; D010974:Platelet Aggregation / Q000502:physiology; D010979:Platelet Function Tests; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: ACS; clopidogrel; platelet response; transfusion