title: In a canine pneumonia model of exchange transfusion, altering the age but not the volume of older red blood cells markedly alters outcome.
abstract: BACKGROUND
  Massive exchange transfusion of 42-day-old red blood cells (RBCs) in a canine model of Staphylococcus aureus pneumonia resulted in in vivo hemolysis with increases in cell-free hemoglobin (CFH), transferrin-bound iron (TBI), non-transferrin-bound iron (NTBI), and mortality. We have previously shown that washing 42-day-old RBCs before transfusion significantly decreased NTBI levels and mortality, but washing 7-day-old RBCs increased mortality and CFH levels. We now report the results of altering volume, washing, and age of RBCs.
  
  
  METHODS
  Two-year-old purpose-bred infected beagles were transfused with increasing volumes (5-10, 20-40, or 60-80 mL/kg) of either 42- or 7-day-old RBCs (n = 36) or 80 mL/kg of either unwashed or washed RBCs with increasing storage age (14, 21, 28, or 35 days; n = 40).
  
  
  RESULTS
  All volumes transfused (5-80 mL/kg) of 42-day-old RBCs resulted in alike (i.e., not significantly different) increases in TBI during transfusion as well as in CFH, lung injury, and mortality rates after transfusion. Transfusion of 80 mL/kg RBCs stored for 14, 21, 28, and 35 days resulted in increased CFH and NTBI in between levels found at 7 and 42 days of storage. However, washing RBCs of intermediate ages (14-35 days) does not alter NTBI and CFH levels or mortality rates.
  
  
  CONCLUSIONS
  Preclinical data suggest that any volume of 42-day-old blood potentially increases risks during established infection. In contrast, even massive volumes of 7-day-old blood result in minimal CFH and NTBI levels and risks. In contrast to the extremes of storage, washing blood stored for intermediate ages does not alter risks of transfusion or NTBI and CFH clearance.
authors.affiliation: Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland.
authors.forename: Irene
authors.initials: I
authors.lastname: Cortés-Puch
authors.affiliation: Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Remy
authors.affiliation: Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Solomon
authors.affiliation: Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland.
authors.forename: Junfeng
authors.initials: J
authors.lastname: Sun
authors.affiliation: Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland.
authors.forename: Dong
authors.initials: D
authors.lastname: Wang
authors.affiliation: Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland.
authors.forename: Mariam
authors.initials: M
authors.lastname: Al-Hamad
authors.affiliation: Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland.
authors.forename: Seth M
authors.initials: SM
authors.lastname: Kelly
authors.affiliation: Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Derek
authors.initials: D
authors.lastname: Sinchar
authors.affiliation: Department of Physics and the Translational Science Center, Wake Forest University, Winston-Salem, North Carolina.|Department of Physics, University of Findlay, Findlay, Ohio.
authors.forename: Landon
authors.initials: L
authors.lastname: Bellavia
authors.affiliation: Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Tamir
authors.initials: T
authors.lastname: Kanias
authors.affiliation: Haemonetics Corporation, Braintree, Massachusetts.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Popovsky
authors.affiliation: Department of Physics and the Translational Science Center, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Kim-Shapiro
authors.affiliation: Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, Maryland.
authors.forename: Harvey G
authors.initials: HG
authors.lastname: Klein
authors.affiliation: Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland.
authors.forename: Charles
authors.initials: C
authors.lastname: Natanson
mesh_terms: D000818:Animals; D001793:Blood Preservation / Q000009:adverse effects; D004195:Disease Models, Animal; D004285:Dogs; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D004912:Erythrocytes / Q000166:cytology / Q000502:physiology*; D005078:Exchange Transfusion, Whole Blood / Q000009:adverse effects / Q000379:methods*; D011023:Pneumonia, Staphylococcal / Q000628:therapy*; D013997:Time Factors