No Early Effect of Storage Time of Transfused Red Blood Cells on Fatigue and Plasma Cytokines in Patients with Anaemia from Non-Acute Gastrointestinal Bleeding

Abstract

Background: Fatigue in anaemia is empirically reduced byblood transfusion. Long storage time of red cells may be associatedwith immunomodulatory effects, and blood stored for along time may cause tissue hypoxia upon transfusion. Patientsand Methods: 22 patients admitted with haemoglobin < 6.0mmol/l, complaints of fatigue and no active bleeding were included.Eleven patients received two red cells units (SAGM)stored less than 1 week (short storage time, S), and 11 patientsreceived two units stored more than 3 weeks (long storagetime, L). Fatigue was self-estimated on a visual analogue scale.Clinical observations and blood samples were obtained beforetransfusion was started, and were repeated 2-8 h after transfusionof the 2nd unit. Measured plasma parameters included IL-1ß, IL-6, IL-8, IL-10, IL-12 and TNF-a. Results: There were no significantdifferences between group S and L (nsSL) in demographicdata, observational data and blood plasma values.Haemoglobin increased from mean (± SD) 5.2 ± 0.6 to 6.4 ± 0.7mmol/l after transfusion (nsSL). Fatigue score significantly decreasedfrom a pre-transfusion median 6.6 (range 0.1-9.9) topost-transfusion 4.7 (0.6-10.0) (p = 0.02) for all patients (nsSL).Beside increase in haemoglobin the only significant change inblood parameters after transfusion was a decrease in thrombocytecount (nsSL). No significant differences were seen in concentrationsof cytokines before and after transfusion. Conclusion:Transfusion of two units of red cells relieved self-estimatedfatigue, independent of blood storage time. Thrombocytecount decreased after transfusion, probably due to dilution bytransfused blood. Aged red cells may not, or only sparsely, directlytrigger the interleukin cascade.