Effects of storage-aged red blood cell transfusions on endothelial function in hospitalized patients.
BACKGROUND
Clinical and animal studies indicate that transfusions of older stored red blood cells (RBCs) impair clinical outcomes as compared to fresh RBC transfusions. It has been suggested that this effect is due to inhibition of nitric oxide (NO)-mediated vasodilation after transfusion of older RBC units. However, to date this effect has not been identified in human transfusion recipients.


METHODS
Forty-three hospitalized patients with transfusion orders were randomly assigned to receive either fresh (<14 days) or older stored (>21 days) RBC units. Before transfusion, and at selected time points after the start of transfusion, endothelial function was assessed using noninvasive flow-mediated dilation assays.


RESULTS
After transfusion of older RBC units, there was a significant reduction in NO-mediated vasodilation at 24 hours after transfusion (p = 0.045), while fresh RBC transfusions had no effect (p = 0.231).


CONCLUSIONS
This study suggests for the first time a significant inhibitory effect of transfused RBC units stored more than 21 days on NO-mediated vasodilation in anemic hospitalized patients. This finding lends further support to the hypothesis that deranged NO signaling mediates adverse clinical effects of older RBC transfusions. Future investigations will be necessary to address possible confounding factors and confirm these results.
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Robert
R
Neuman
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Salim
S
Hayek
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Ayaz
A
Rahman
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Joseph C
JC
Poole
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Vivek
V
Menon
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Salman
S
Sher
Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, Georgia.
James L
JL
Newman
Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, Georgia.
Sulaiman
S
Karatela
Department of Pharmacology, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
David
D
Polhemus
Department of Pharmacology, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
David J
DJ
Lefer
National Center on Birth Defects and Developmental Disabilities, Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia.
Christine
C
De Staercke
National Center on Birth Defects and Developmental Disabilities, Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia.
Craig
C
Hooper
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Arshed A
AA
Quyyumi
Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, Georgia.
John D
JD
Roback
D019794:2,3-Diphosphoglycerate / Q000097:blood; D000255:Adenosine Triphosphate / Q000097:blood; D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D001793:Blood Preservation; D001916:Brachial Artery / Q000000981:diagnostic imaging; D018932:Chemokine CCL2 / Q000097:blood; D004730:Endothelium, Vascular / Q000503:physiopathology*; D004905:Erythrocyte Aging; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D006801:Humans; D007297:Inpatients; D007376:Interleukin-2 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D009569:Nitric Oxide / Q000502:physiology; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D014463:Ultrasonography; D014664:Vasodilation
C111835:CCL2 protein, human; D018932:Chemokine CCL2; C508600:IL6 protein, human; D007376:Interleukin-2; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D019794:2,3-Diphosphoglycerate; D009569:Nitric Oxide; D000255:Adenosine Triphosphate