Abstract
To review preclinical and clinical studies that have evaluated the effects of red cell rejuvenation in vivo and in vitro and to assess the potential risks and benefits from their clinical use. A systematic review and narrative synthesis of the intervention of red cell rejuvenation using a red cell processing solution containing inosine, pyruvate, phosphate and adenine. Outcomes of interest in vitro were changes in red cell characteristics including adenosine triphosphate (ATP), 2,3-diphosphoglycerate (2,3-DPG), deformability and the accumulation of oxidized lipids and other reactive species in the red cell supernatant. Outcomes in vivo were 24-h post-transfusion survival and the effects on oxygen delivery, organ function and inflammation in transfused recipients. The literature search identified 49 studies evaluating rejuvenated red cells. In vitro rejuvenation restored cellular properties including 2,3-DPG and ATP to levels similar to freshly donated red cells. In experimental models, in vivo transfusion of rejuvenated red cells improved oxygen delivery and myocardial, renal and pulmonary function when compared to stored red cells. In humans, in vivo 24-h survival of rejuvenated red cells exceeded 75%. In clinical studies, rejuvenated red cells were found to be safe, with no reported adverse effects. In one adult cardiac surgery trial, transfusion of rejuvenated red cells resulted in improved myocardial performance. Transfusion of rejuvenated red cells reduces organ injury attributable to the red cell storage lesion without adverse effects in experimental studies in vivo. The clinical benefits of this intervention remain uncertain.
Highlights
Background and ObjectivesTo review pre-clinical and clinical studies that have evaluated the effects of red cell rejuvenation in vivo and in vitro and to assess the potential risks and benefits from their clinical use
In 1 adult cardiac surgery trial, transfusion of rejuvenated red cells resulted in improved myocardial performance
The Serious Hazards of Transfusion (SHOT) scheme estimated that in 2015, the number of SHOT reports received in the UK for red cells was approximately 1.89 million, or, approximately 73% of all SHOT reports for blood components [3]
Summary
Background and ObjectivesTo review pre-clinical and clinical studies that have evaluated the effects of red cell rejuvenation in vivo and in vitro and to assess the potential risks and benefits from their clinical use. The Serious Hazards of Transfusion (SHOT) scheme estimated that in 2015, the number of SHOT reports received in the UK for red cells was approximately 1.89 million, or, approximately 73% of all SHOT reports for blood components [3]. Observational cohort studies demonstrate strong associations between red cell transfusion and major morbidity including sepsis, lung, myocardial or kidney injury, and death [4]. These associations have been attributed to pathological changes that occur in red cell units during storage, commonly referred to as the ‘storage lesion’ [5].
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