B-type natriuretic peptide and plasma hemoglobin levels following transfusion of shorter-storage versus longer-storage red blood cells: Results from the TOTAL randomized trial.
BACKGROUND
Prior studies have suggested that transfusion of stored red blood cells (RBCs) with increased levels of cell-free hemoglobin might reduce the bioavailability of recipient nitric oxide (NO) and cause myocardial strain.


METHODS
Ugandan children (ages 6-60 months) with severe anemia and lactic acidosis were randomly assigned to receive RBCs stored 1-10 days versus 25-35 days. B-type natriuretic peptide (BNP), vital signs, renal function test results, and plasma hemoglobin were measured. Most children had either malaria or sickle cell disease and were thus at risk for reduced NO bioavailability.


RESULTS
Seventy patients received RBCs stored 1-10 days, and 77 received RBCs stored 25-35 days. The median (interquartile range) cell-free hemoglobin was nearly 3 times higher in longer-storage RBCs (26.4 [15.5-43.4] μmol/L) than in shorter-storage RBCs (10.8 [7.8-18.6] μmol/L), P < .0001. Median (interquartile range) BNP 2 hours posttransfusion was 156 (59-650) pg/mL (shorter storage) versus 158 (59-425) pg/mL (longer storage), P = .76. BNP values 22 hours posttransfusion were 110 (46-337) pg/mL (shorter storage) versus 96 (49-310) pg/mL (longer storage), P = .76. Changes in BNP within individuals from pretransfusion to 2 hours (or 22 hours) posttransfusion were not significantly different between the study groups. BNP change following transfusion did not correlate with the concentration of cell-free hemoglobin in the RBC supernatant. Blood pressure, blood urea nitrogen, creatinine, and change in plasma hemoglobin were not significantly different in the 2 groups.


CONCLUSIONS
In a randomized trial among children at risk for reduced NO bioavailability, we found that BNP, blood pressure, creatinine, and plasma hemoglobin were not higher in patients receiving RBCs stored for 25-35 versus 1-10 days.
Child Health and Development Centre, Makerere University, Kampala, Uganda.
Aggrey
A
Dhabangi
Mulago Hospital, Kampala, Uganda.
Brenda
B
Ainomugisha
University Health Network Laboratory Medicine Program, University of Toronto, Toronto, Canada.
Christine
C
Cserti-Gazdewich
Uganda Cancer Institute, Makerere University, Kampala, Uganda.
Henry
H
Ddungu
Uganda National Blood Transfusion Service, Kampala, Uganda.
Dorothy
D
Kyeyune
Uganda National Blood Transfusion Service, Kampala, Uganda.
Ezra
E
Musisi
Mulago Hospital Department of Paediatrics, Makerere University, Kampala, Uganda.
Robert
R
Opoka
Massachusetts General Hospital Blood Transfusion Service, Harvard Medical School, Boston, MA.
Christopher P
CP
Stowell
Blood Transfusion Service, Room J-224, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114. Electronic address: sdzik@mgh.harvard.edu.
Walter H
WH
Dzik
D000140:Acidosis, Lactic / Q000628:therapy; D000740:Anemia / Q000097:blood / Q000628:therapy*; D001682:Biological Availability; D001793:Blood Preservation; D001794:Blood Pressure; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009569:Nitric Oxide / Q000378:metabolism; D013997:Time Factors; D014454:Uganda
D006454:Hemoglobins; D020097:Natriuretic Peptide, Brain; D009569:Nitric Oxide; D003404:Creatinine