Washing older blood units before transfusion reduces plasma iron and improves outcomes in experimental canine pneumonia
Washing older blood units before transfusion reduces plasma iron and improves outcomes in experimental canine pneumonia
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DOI：
10.1182/blood-2013-11-539353
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发表时间：
2014-02-27
期刊：
影响因子：
20.3
通讯作者：
Natanson, Charles
中科院分区：
文献类型：
--
作者：
Cortes-Puch, Irene;Wang, Dong;Natanson, Charles
在一项随机对照设盲试验中，对患有金黄色葡萄球菌肺炎的2岁专用饲养比格犬（n = 24）进行7天或42天龄清洗或未清洗犬通用供体血液（80 mL/kg，分4次给药）交换-输血。根据储存血液的年龄，输血前洗涤红细胞（RBC）对犬的存活率、多器官损伤、血浆铁和无细胞血红蛋白（CFH）水平有显著不同的影响（所有，相互作用P <0.05）。洗涤较旧单位的血液改善了存活率、休克评分、肺损伤、心脏功能和肝功能，并降低了非转铁蛋白结合铁和血浆不稳定铁的水平。相反，清洗新鲜血液使所有这些相同的临床参数恶化，并增加CFH水平。我们的数据表明，在重症感染受试者中，输注新鲜血液导致溶血、CFH和铁释放较少，比输注旧血毒性更低。然而，清洗陈旧血液可防止血浆循环铁升高，并改善肺部感染动物的存活率和多器官损伤。我们的数据表明，新鲜血液不应常规洗涤，因为在已建立的感染的情况下，洗涤的RBC容易释放CFH并导致临床结果恶化。
In a randomized controlled blinded trial, 2-year-old purpose-bred beagles (n = 24), with Staphylococcus aureus pneumonia, were exchanged-transfused with either 7- or 42-day-old washed or unwashed canine universal donor blood (80 mL/kg in 4 divided doses). Washing red cells (RBC) before transfusion had a significantly different effect on canine survival, multiple organ injury, plasma iron, and cell-free hemoglobin (CFH) levels depending on the age of stored blood (all, P < .05 for interactions). Washing older units of blood improved survival rates, shock score, lung injury, cardiac performance and liver function, and reduced levels of non-transferrin bound iron and plasma labile iron. In contrast, washing fresh blood worsened all these same clinical parameters and increased CFH levels. Our data indicate that transfusion of fresh blood, which results in less hemolysis, CFH, and iron release, is less toxic than transfusion of older blood in critically ill infected subjects. However, washing older blood prevented elevations in plasma circulating iron and improved survival and multiple organ injury in animals with an established pulmonary infection. Our data suggest that fresh blood should not be washed routinely because, in a setting of established infection, washed RBC are prone to release CFH and result in worsened clinical outcomes.