title: Autologous transfusion of stored red blood cells increases pulmonary artery pressure.
abstract: BACKGROUND
  Transfusion of erythrocytes stored for prolonged periods is associated with increased mortality. Erythrocytes undergo hemolysis during storage and after transfusion. Plasma hemoglobin scavenges endogenous nitric oxide leading to systemic and pulmonary vasoconstriction.
  
  
  OBJECTIVE
  We hypothesized that transfusion of autologous blood stored for 40 days would increase the pulmonary artery pressure in volunteers with endothelial dysfunction (impaired endothelial production of nitric oxide). We also tested whether breathing nitric oxide before and during transfusion could prevent the increase of pulmonary artery pressure.
  
  
  METHODS
  Fourteen obese adults with endothelial dysfunction were enrolled in a randomized crossover study of transfusing autologous, leukoreduced blood stored for either 3 or 40 days. Volunteers were transfused with 3-day blood, 40-day blood, and 40-day blood while breathing 80 ppm nitric oxide.
  
  
  RESULTS
  The age of volunteers was 41 ± 4 years (mean ± SEM), and their body mass index was 33.4 ± 1.3 kg/m(2). Plasma hemoglobin concentrations increased after transfusion with 40-day and 40-day plus nitric oxide blood but not after transfusing 3-day blood. Mean pulmonary artery pressure, estimated by transthoracic echocardiography, increased after transfusing 40-day blood (18 ± 2 to 23 ± 2 mm Hg; P < 0.05) but did not change after transfusing 3-day blood (17 ± 2 to 18 ± 2 mm Hg; P = 0.5). Breathing nitric oxide decreased pulmonary artery pressure in volunteers transfused with 40-day blood (17 ± 2 to 12 ± 1 mm Hg; P < 0.05).
  
  
  CONCLUSIONS
  Transfusion of autologous leukoreduced blood stored for 40 days was associated with increased plasma hemoglobin levels and increased pulmonary artery pressure. Breathing nitric oxide prevents the increase of pulmonary artery pressure produced by transfusing stored blood. Clinical trial registered with www.clinicaltrials.gov (NCT 01529502).
authors.affiliation: 1 Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care and Pain Medicine.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Berra
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pinciroli
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Stowell
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.forename: Binglan
authors.initials: B
authors.lastname: Yu
authors.forename: Bernadette O
authors.initials: BO
authors.lastname: Fernandez
authors.forename: Martin
authors.initials: M
authors.lastname: Feelisch
authors.forename: Cristina
authors.initials: C
authors.lastname: Mietto
authors.forename: Eldad A
authors.initials: EA
authors.lastname: Hod
authors.forename: Daniel
authors.initials: D
authors.lastname: Chipman
authors.forename: Marielle
authors.initials: M
authors.lastname: Scherrer-Crosbie
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Bloch
authors.forename: Warren M
authors.initials: WM
authors.lastname: Zapol
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects*; D001804:Blood Transfusion, Autologous / Q000009:adverse effects* / Q000379:methods; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000494:pharmacology; D018592:Cross-Over Studies; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology*; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage / Q000494:pharmacology; D009765:Obesity / Q000150:complications; D011651:Pulmonary Artery / Q000187:drug effects / Q000503:physiopathology*; D013997:Time Factors; D014661:Vasoconstriction / Q000187:drug effects
chemical_list: D001993:Bronchodilator Agents; D009569:Nitric Oxide
keywords: echocardiography; endothelium; hemoglobins; nitric oxide; pulmonary hypertension