title: Washing older blood units before transfusion reduces plasma iron and improves outcomes in experimental canine pneumonia.
abstract: In a randomized controlled blinded trial, 2-year-old purpose-bred beagles (n = 24), with Staphylococcus aureus pneumonia, were exchanged-transfused with either 7- or 42-day-old washed or unwashed canine universal donor blood (80 mL/kg in 4 divided doses). Washing red cells (RBC) before transfusion had a significantly different effect on canine survival, multiple organ injury, plasma iron, and cell-free hemoglobin (CFH) levels depending on the age of stored blood (all, P < .05 for interactions). Washing older units of blood improved survival rates, shock score, lung injury, cardiac performance and liver function, and reduced levels of non-transferrin bound iron and plasma labile iron. In contrast, washing fresh blood worsened all these same clinical parameters and increased CFH levels. Our data indicate that transfusion of fresh blood, which results in less hemolysis, CFH, and iron release, is less toxic than transfusion of older blood in critically ill infected subjects. However, washing older blood prevented elevations in plasma circulating iron and improved survival and multiple organ injury in animals with an established pulmonary infection. Our data suggest that fresh blood should not be washed routinely because, in a setting of established infection, washed RBC are prone to release CFH and result in worsened clinical outcomes.
authors.affiliation: Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD;
authors.forename: Irene
authors.initials: I
authors.lastname: Cortés-Puch
authors.forename: Dong
authors.initials: D
authors.lastname: Wang
authors.forename: Junfeng
authors.initials: J
authors.lastname: Sun
authors.forename: Steven B
authors.initials: SB
authors.lastname: Solomon
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Remy
authors.forename: Melinda
authors.initials: M
authors.lastname: Fernandez
authors.forename: Jing
authors.initials: J
authors.lastname: Feng
authors.forename: Tamir
authors.initials: T
authors.lastname: Kanias
authors.forename: Landon
authors.initials: L
authors.lastname: Bellavia
authors.forename: Derek
authors.initials: D
authors.lastname: Sinchar
authors.forename: Andreas
authors.initials: A
authors.lastname: Perlegas
authors.forename: Michael A
authors.initials: MA
authors.lastname: Solomon
authors.forename: Walter E
authors.initials: WE
authors.lastname: Kelley
authors.forename: Mark A
authors.initials: MA
authors.lastname: Popovsky
authors.forename: Mark T
authors.initials: MT
authors.lastname: Gladwin
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Kim-Shapiro
authors.forename: Harvey G
authors.initials: HG
authors.lastname: Klein
authors.forename: Charles
authors.initials: C
authors.lastname: Natanson
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology / Q000401:mortality; D000818:Animals; D001793:Blood Preservation; D001800:Blood Specimen Collection / Q000379:methods*; D004195:Disease Models, Animal; D004285:Dogs; D015536:Down-Regulation; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000379:methods*; D004912:Erythrocytes / Q000166:cytology*; D007501:Iron / Q000097:blood* / Q000302:isolation & purification; D010949:Plasma / Q000737:chemistry*; D011023:Pneumonia, Staphylococcal / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D007501:Iron