Transfusion of Cryopreserved Packed RBCs After Trauma
Transfusion of Cryopreserved Packed RBCs After Trauma
Two hundred fifty-six patients were randomized and received blood (84 young LPRBCs, 86 old LPRBCs, and 86 CPRBCs). Sex, age, and ISS did not differ between groups ( Table 1 ). The population was moderately injured with a mean ISS of 19. There were no differences in hospital length of stay, intensive care unit length of stay, ventilator days, median systolic blood pressure before transfusion or after transfusion between groups ( Table 1 ). The median age of LPRBCs was 32 days in the old group and 7.5 days in the young group. CPRBCs were transfused a median of 1 day after thawing and deglycerolization. Patients in all groups received the same number of RBC units after randomization and there were no differences in the number of patients in each group who received 1 unit or to 5 units or more. There was also no difference in the day of admission the first randomized unit was given ( Table 2 ). There were no differences in adverse clinical outcomes including mortality between groups ( Table 3 ). There were also no differences in outcomes in the subgroup of patients in each group who received to 5 units or more. No transfusion reactions were reported in this study.
Changes in StO2 over the course of 3 hours are shown in Figure 1. Utilizing area under the curve measurements, there were no differences in the change in StO2 from baseline within or between groups.
(Enlarge Image)
Figure 1.
Mean percent change in tissue oxygenation over time in patients who received old PRBCS (black line), young PRBCS (gray and white line), or CPRBCs (dashed line).
Biochemical and inflammatory markers that influence RBC function were measured in the units of PRBCs ( Table 4 ). Similar to our previous study, CPRBCs contained lower concentrations of α2-macroglobulin, haptoglobin, c-reactive protein (CRP), and serum amyloid P (P < 0.001 vs old and young PRBCS). CPRBCs and young LPRBCs also had higher levels of 2,3-DPG (P < 0.01 vs old PRBCs), which facilitates O2 delivery from RBCs to tissues. Free Hb levels were lower in the young LPRBC group, and similar in CPRBCs and old LPRBCs. Anti-inflammatory cytokines IL-4 and IL-10 were increased in CPRBCs (P < 0.001 vs old and new PRBCs). Inflammatory markers GMCSF and IFN-γ and IL-6 levels were elevated in CPRBCs compared with old LPRBCs (P < 0.001); however, IL-6 and IFN-γ were barely detectable in any of the specimens.
Biochemical markers and cytokine levels were also measured in patient specimens ( Table 5 ). Patients in the CPRBC group had lower CRP levels at baseline compared with the old LPRBC group (P < 0.05). There were no differences between or within groups with respect to α2-macroglobulin, haptoglobin, or 2,3-DPG. IL-2 levels were increased in patients who received CPRBCs at 12 hours (P < 0.05). There were significant increases in free Hb noted in the old LPRBC group during transfusion, but not in the other groups (P < 0.05 vs baseline). Standard coagulation assays (PT/INR, aPTT, fibrinogen, and D-dimers) and thrombelastogram parameters (r value, k, α-angle, maximal amplitude, and LY30) did not differ between or within groups and median values were all within normal limits (data not shown).
Results
Two hundred fifty-six patients were randomized and received blood (84 young LPRBCs, 86 old LPRBCs, and 86 CPRBCs). Sex, age, and ISS did not differ between groups ( Table 1 ). The population was moderately injured with a mean ISS of 19. There were no differences in hospital length of stay, intensive care unit length of stay, ventilator days, median systolic blood pressure before transfusion or after transfusion between groups ( Table 1 ). The median age of LPRBCs was 32 days in the old group and 7.5 days in the young group. CPRBCs were transfused a median of 1 day after thawing and deglycerolization. Patients in all groups received the same number of RBC units after randomization and there were no differences in the number of patients in each group who received 1 unit or to 5 units or more. There was also no difference in the day of admission the first randomized unit was given ( Table 2 ). There were no differences in adverse clinical outcomes including mortality between groups ( Table 3 ). There were also no differences in outcomes in the subgroup of patients in each group who received to 5 units or more. No transfusion reactions were reported in this study.
Changes in StO2 over the course of 3 hours are shown in Figure 1. Utilizing area under the curve measurements, there were no differences in the change in StO2 from baseline within or between groups.
(Enlarge Image)
Figure 1.
Mean percent change in tissue oxygenation over time in patients who received old PRBCS (black line), young PRBCS (gray and white line), or CPRBCs (dashed line).
Biochemical and inflammatory markers that influence RBC function were measured in the units of PRBCs ( Table 4 ). Similar to our previous study, CPRBCs contained lower concentrations of α2-macroglobulin, haptoglobin, c-reactive protein (CRP), and serum amyloid P (P < 0.001 vs old and young PRBCS). CPRBCs and young LPRBCs also had higher levels of 2,3-DPG (P < 0.01 vs old PRBCs), which facilitates O2 delivery from RBCs to tissues. Free Hb levels were lower in the young LPRBC group, and similar in CPRBCs and old LPRBCs. Anti-inflammatory cytokines IL-4 and IL-10 were increased in CPRBCs (P < 0.001 vs old and new PRBCs). Inflammatory markers GMCSF and IFN-γ and IL-6 levels were elevated in CPRBCs compared with old LPRBCs (P < 0.001); however, IL-6 and IFN-γ were barely detectable in any of the specimens.
Biochemical markers and cytokine levels were also measured in patient specimens ( Table 5 ). Patients in the CPRBC group had lower CRP levels at baseline compared with the old LPRBC group (P < 0.05). There were no differences between or within groups with respect to α2-macroglobulin, haptoglobin, or 2,3-DPG. IL-2 levels were increased in patients who received CPRBCs at 12 hours (P < 0.05). There were significant increases in free Hb noted in the old LPRBC group during transfusion, but not in the other groups (P < 0.05 vs baseline). Standard coagulation assays (PT/INR, aPTT, fibrinogen, and D-dimers) and thrombelastogram parameters (r value, k, α-angle, maximal amplitude, and LY30) did not differ between or within groups and median values were all within normal limits (data not shown).
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