title: Red blood cell transfusion is associated with increased hemolysis and an acute phase response in a subset of critically ill children.
abstract: In healthy adults, transfusion of older stored red blood cells (RBCs) produces extravascular hemolysis and circulating non-transferrin-bound iron. In a prospective, observational study of critically ill children, we examined the effect of RBC storage duration on the extent of hemolysis by comparing laboratory measurements obtained before, and 4 hr after, RBC transfusion (N = 100) or saline/albumin infusion (N = 20). Transfusion of RBCs stored for longer than 4 weeks significantly increased plasma free hemoglobin (P < 0.05), indirect bilirubin (P < 0.05), serum iron (P < 0.001), and non-transferrin-bound iron (P < 0.01). However, days of storage duration poorly correlated (R(2) <0.10) with all measured indicators of hemolysis and inflammation. These results suggest that, in critically ill children, most effects of RBC storage duration on post-transfusion hemolysis are overwhelmed by recipient and/or donor factors. Nonetheless, we identified a subset of patients (N = 21) with evidence of considerable extravascular hemolysis (i.e., increased indirect bilirubin ≥0.4 mg/dL). In these patients, transfusion-associated hemolysis was accompanied by increases in circulating non-transferrin-bound iron and free hemoglobin and by an acute phase response, as assessed by an increase in median C-reactive protein levels of 21.2 mg/L (P < 0.05). In summary, RBC transfusions were associated with an acute phase response and both extravascular and intravascular hemolysis, which were independent of RBC storage duration. The 21% of transfusions that were associated with substantial hemolysis conferred an increased risk of inducing an acute phase response.
authors.affiliation: Department of Medical Surgical Pathophysiology and Organ Transplantation, Universita' Degli Studi Di Milano, Milan, Italy.|Department of Pathology and Cell Biology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York.
authors.forename: Camilla
authors.initials: C
authors.lastname: L'Acqua
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York.
authors.forename: Sheila
authors.initials: S
authors.lastname: Bandyopadhyay
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York.
authors.forename: Richard O
authors.initials: RO
authors.lastname: Francis
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: McMahon
authors.affiliation: Department of Pediatrics, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Marianne
authors.initials: M
authors.lastname: Nellis
authors.affiliation: Department of Pediatrics, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Sujit
authors.initials: S
authors.lastname: Sheth
authors.affiliation: Department of, Pediatrics, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Kernie
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York.|Department of, Pediatrics, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Brittenham
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Spitalnik
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York.
authors.forename: Eldad A
authors.initials: EA
authors.lastname: Hod
mesh_terms: D000210:Acute-Phase Reaction / Q000097:blood* / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D001782:Blood Donors; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D006461:Hemolysis; D006801:Humans; D007223:Infant; D011446:Prospective Studies