Abstract 16233: Improving Transfusion Related Adverse Outcomes in Cardiac Surgery. The Role of RBC Rejuvenation
Background: Allogenic RBC transfusion is associated with an increase in pulmonary morbidity after cardiac surgery. We have previously shown that removal of the storage supernatant by washing of stored RBC attenuates post transfusion acute lung injury (TRALI) in a swine model. Our objectives were to assess whether rejuvenation of RBC ATP levels using a modified additive solution; Rejuvesol™ (Citra Labs) can afford advantage beyond washing alone.
Materials and Methods: Thirty six (n=36) pigs were randomised to: Sham, Sham + transfusion of 1-day old RBC’s, Sham + transfusion of 14-day stored RBC’s, Sham + transfusion of washed, 14-day stored RBC’s, Sham + transfusion of washed, 14-day stored RBC’s but treated with Rejuvesol. All pigs were anaesthetised, invasively monitored, post intervention recovered, re-anesthetized and re-evaluated at 24hr for measures of pulmonary dysfunction, platelet reactivity and inflammation. Groups were analysed using ANOVA with Bonferroni adjustment. The effect sizes are reported as mean (SD).
Results: Day 14 RBC demonstrated reductions in ATP and 2,3 DPG which were restored by Rejuvesol. Transfusion of 14 Day RBC caused TRALI manifest as hypoxia (diminished FiO2/PaO2 ratio), and increased ALI score. This was associated with platelet and monocyte activation, inflammation and pulmonary vascular endothelial dysfunction. Washing day 14RBC attenuated post transfusion ALI (hypoxia and ALI scores), but not platelet activation or pulmonary vascular endothelial dysfunction. Rejuvesol prevented pulmonary vascular dysfunction and inflammation, however this did not result in a measureable improvement in PaO2/FiO2 ratio.
Conclusions: In this translational model of post cardiac surgery end organ injury, red cell ATP rejuvenation has shown to convey advantages beyond cell washing alone. The clinical relevance of these findings requires further evaluation.
- © 2013 by American Heart Association, Inc.