title: Haemostatic function and biomarkers of endothelial damage before and after RBC transfusion in patients with haematologic disease.
abstract: OBJECTIVE
  Transfusion of red blood cells (RBC) is beneficial for the patient but can also be harmful, as randomized trials have demonstrated increased infection rates, bleeding and mortality. The study aim was to investigate the response of the vascular system (the haemostatic function and the endothelium) to RBC transfusion.
  
  
  METHODS
  Blood was sampled from patients with various transfusion-dependent haematologic diseases before 1 and 24 h after RBC transfusion. Primary and secondary haemostasis was evaluated by whole-blood impedance aggregometry (Multiplate) and by thromboelastography (TEG). Samples were analysed by ELISA for biomarkers reflecting endothelial activation and damage (sICAM-1, syndecan-1, sThrombomodulin (sTM), sVE-Cadherin), platelet activation (sCD40L) and inflammation (hsCRP).
  
  
  RESULTS
  A total of 58 patients were enrolled in the study. Median age was 71 years. Compared to before transfusion, patients had slightly reduced coagulability 1 h after RBC transfusion, assessed by TEG. However, transfusion of older RBC products (>14 days) was associated with increased coagulability (all P < 0·05). The level of syndecan-1 increased slightly 24 h after transfusion (median 12·4 (IQR 9-23) vs. 13·2 (9-25) ng/ml, P < 0·01), indicating increased glycocalyx degradation.
  
  
  CONCLUSIONS
  Overall, RBC transfusion was associated with reduced coagulability and endothelial glycocalyx degradation. Transfusion of older RBCs was however associated with increased coagulability. The changes observed were small to moderate and the clinical relevance of these findings should be investigated in larger studies.
authors.affiliation: Department of Haematology, Copenhagen University Hospital, Herlev, Denmark.
authors.forename: A M
authors.initials: AM
authors.lastname: Larsen
authors.affiliation: Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: E B
authors.initials: EB
authors.lastname: Leinøe
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.|Department of Surgery, Division of Acute Care Surgery, Centre for Translational Injury Research, CeTIR, University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: P I
authors.initials: PI
authors.lastname: Johansson
authors.affiliation: Department of Haematology, Copenhagen University Hospital, Herlev, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Birgens
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: S R
authors.initials: SR
authors.lastname: Ostrowski
mesh_terms: D000328:Adult; D000368:Aged; D015703:Antigens, CD / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D023201:CD40 Ligand / Q000097:blood; D015820:Cadherins / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D017707:Erythrocyte Transfusion; D004912:Erythrocytes / Q000166:cytology; D005260:Female; D006402:Hematologic Diseases / Q000473:pathology / Q000628:therapy*; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D053668:Syndecan-1 / Q000097:blood; D013916:Thrombelastography; D018180:Thrombomodulin / Q000097:blood; D000099152:Cadherin 5
chemical_list: D015703:Antigens, CD; D015415:Biomarkers; D002097:C-Reactive Protein; D023201:CD40 Ligand; D015820:Cadherins; D018799:Intercellular Adhesion Molecule-1; D053668:Syndecan-1; D018180:Thrombomodulin; D000099152:Cadherin 5; C573420:ICAM1 protein, human
keywords: RBC transfusion; haematologic disease; haemostasis; the vascular endothelium