Fresh Blood Transfusion Research Articles

Transfusion-Associated Graft-Versus-Host Disease in Adults.

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare but fatal complication of blood transfusion that usually develops two to 30 days following a blood transfusion giving rise to graft versus host disease (GVHD) clinical features that are consisting of fever, skin rash, jaundice, diarrhea, and pancytopenia. The disease is fulminant in most patients with a mortality rate of >90% of cases. The main aim of this review is to enhance awareness among medical practitioners about this fatal disease. Data were extracted manually from the main medical databases (Medline, Scopus, and Google Scholar) after the revision of selected articles and assessed for their contribution to the knowledge of TA-GVHD. TA-GVHD occurs when the viable donor T-cells in the blood or blood products attack the recipient's tissues which his/her immune system is incapable to destroy due to several reasons. The recipient's tissues that are usually involved in TA-GVHD include the liver, intestine, skin, lungs, and bone marrow. Any blood component either whole blood, packed red blood cells (RBCs), platelets, or fresh non-frozen plasma that contains viable T lymphocytes can cause TA-GVHD. Host immunodeficiency, transfusion of fresh blood, and partial human leukocyte antigen (HLA) matching between the donors and the recipients represent the major risk factors of TA-GVHD. Partial HLA matching includes immunocompetent recipients who receive blood from a first-degree relative also, seen in genetically homogenous populations because of high rates of consanguineous marriage. The diagnosis of TA-GVHD is mainly suspected based on clinical manifestations. However, a histopathological study of either skin or rectal biopsy is diagnostic. The treatment of TA-GVHD is generally not effective, unless the patient received emergency stem cell transplantation, while prevention via irradiation of blood or blood products represents the standard of care for this disease. In conclusion, medical practitioners should have a high index of suspicion for this disease. Moreover, future clinical trials targeting and comparing the outcomes of the different therapeutic options for TA-GVHD are required.

BIOCHEMICAL CHANGES IN THE STORED WHOLE BLOOD ASSESSED AT PERIODIC INTERVALS IN CPDA-1 ANTICOAGULANT CONTAINING BLOOD BAGS: A STUDY AT THE BLOOD BANK OF TERTIARY CARE HOSPITAL OF SOUTHERN RAJASTHAN

Objectives: The objectives of this study were to study the various biochemical changes occurring in a stored whole blood unit at day 0, day 17th, and the 35th day in full blood bag containing citrate phosphate dextrose adenine-1 anticoagulant. Methods: A cross-sectional descriptive study had been carried out among 110 healthy volunteer donors in the Department of Transfusion Medicine, RNT Medical College, Udaipur, between August 2019 and July 2020. A 10 mL blood sample from each bag containing anti-coagulated blood being collected, and the level of sodium, potassium, chloride, total protein, and albumin were measured on days 0, 17th, and the 35th. Mean and standard deviation had been calculated for the parameters, a one-way analysis of variance test was applied to compare the differences, and a p<0.05 was considered statistically significant. Results: A higher proportion of males in the age group 18–27 years, and a generally steady increase in serum potassium level with a steady decrease in serum sodium, chloride, total protein, and albumin levels over the 35-day storage period. Conclusions: In this study, stored whole blood undergoing changes in its biochemical parameters had been studied and found to be significant. The study also recommends transfusion of fresh blood for high-risk patients.

Fresh autologous blood transfusion reverses erythrocytes damage by reducing oxidative stress via promoting mitochondrial metabolism and M2 macrophages polarization

IntroductionSystemic inflammatory and immune suppressive incidents constitute a significant hallmark of red blood cell transfusion's adverse effects. These adverse side effects are seemingly associated with old blood transfusion; therefore, we aim to investigate the underlying mechanism of fresh autologous blood transfusion (fABT) and its subsequent effect in diabetic mice.Material and methodsIn the present study, we utilized 60 Swiss male mice aged 6-8 weeks, categorized into normal, diabetic, and freshly transfused with autologous blood. After treating the mice accordingly, further experimentations took place as we assessed the M1/M2 macrophage polarization concerning CD16/CD32/CD206 cells by flow cytometry, determined the mitochondrial metabolism using Lowry's analysis, measured hepatic oxidative stress using MDA and SOD assays, and examined the erythrocytic oxygen-carrying capacity (Q value) and oxygen consumption rate (OCR) and osmotic fragility.ResultsResults showed that fresh autologous blood transfusion markedly reduced M2 macrophage polarization, enhanced hepatic mitochondrial metabolism, reduced hepatic oxidative stress, and promoted red blood cells' oxygen-carrying capacity while reducing its osmotic fragility and oxygen consumption. Moreover, we found that fABT promoted the IGF2/PI3K signaling pathway, These results indicate the vital necessity of providing fresh autologous blood transfusion during therapy or surgeries.ConclusionsIn conclusion, our results are the first to highlight the underlying mechanism in which how fABT modulates physiological patterns in diabetic animals model, proposing a sound basis for utilizing fABT in clinical applications.

Expanded dengue syndrome presenting with acute liver failure, acute kidney injury, pancreatic involvement, coagulopathy, and multiple intracranial hemorrhages in a young child: a case report

BackgroundDengue is a mosquito-borne viral infection that typically occurs in tropical and subtropical countries. The clinical manifestations of dengue infection range from an asymptomatic subclinical course to severe dengue shock syndrome. Besides, dengue can affect any organ in the body and can present with atypical manifestations.Case presentationWe report a 6-year-old previously healthy Tamil child who had dengue complicated with multiorgan involvement. She initially presented with high fever, headache, body aches for 5 days, blood and mucus diarrhea, hematuria, and right knee joint swelling for 2 days. Dengue NS1 antigen was positive on day 2 of febrile illness. She was managed symptomatically in the local hospital for 3 days and transferred to the tertiary care hospital for further management. She was eventually diagnosed as having dengue hemorrhagic fever complicated with multiorgan involvement including acute liver failure, pancreatic involvement, coagulopathy, arthritis, acute kidney injury, and multiple intracranial hemorrhages. The constellation of disease manifestations was identified as expanded dengue syndrome. She was managed with fresh blood, platelet, and cryoprecipitate transfusions and intravenous antibiotics in addition to renal and liver support in the intensive care unit. On day 14 of illness, she deteriorated while on the ventilator and died due to multiple intracranial hemorrhages.ConclusionThe reported child with dengue hemorrhagic fever developed several unusual presentations such as acute liver and renal failure, disseminated intravascular coagulopathy, pancreatic involvement, and multiple intracranial hemorrhages, which form part of expanded dengue syndrome. In the seriously unwell child, it is important to look for unusual complications actively to improve outcomes.

The clinical characteristics, putative drugs, and optimal management of 62 patients with stevens-johnson syndrome and/or toxic epidermal necrolysis: A retrospective observational study

Background:Case reviews of severe cutaneous adverse drug reactions (ADRs) such as SJS/TEN provide useful insights for clinical characteristics, putative drugs, and management protocols.Patients and Methods:Medical charts of 62 (m:f- 20:42) patients with SJS/TEN hospitalized between 2010 and 2019 were analyzed retrospectively for clinical attributes, putative drugs and their indications, extracutaneous complications, and therapeutic outcome. The diagnosis was clinical based on established criteria. WHO-UMC scale for reporting ADR and ALDEN algorithm score were used for causality assessment. Therapies were customized based on in-house resources and affordability.Results:Cases included were SJS (41.9%), SJS/TEN overlap (33.9%), and TEN (24.2%) aged 4–85 years. Complications included transaminitis (69.4%), lymphadenopathy (15.5%), septicemia (11.3%), and wound infections (4.8%). Aromatic anticonvulsants (37.1%), disease-modifying antirheumatic drugs (25.8%), antiretroviral drugs (12.9%), non-steroidal anti-inflammatory drugs (8.1%), antimicrobials (4.8%), and trihexyphenidyl (3.2%) were major putative drugs. The mean latent period was 16.6 days. The observed 8% mortality was because of primary comorbidities or multiorgan failure. Addition of fresh blood transfusion (BT, n = 11) or IVIg (n = 7) to systemic corticosteroids showed early relief in skin tenderness, improvement in general condition, and re-epithelialization. Only 16% of patients developed sequelae.Conclusion:Aromatic anticonvulsants, allopurinol, nevirapine, cotrimoxazole, paracetamol, and diclofenac remain the most implicated drugs. Sulfasalazine, leflunomide, ethambutol, and trihexyphenidyl were uncommon additions. A short course of high-dose dexamethasone in the early stage was useful. Addition of BT or IVIg provided rapid relief. Preexisting HIV disease, kidney disease, and sepsis remain important for in-hospital deaths. Retrospective study design and small number of cases remain major limitations.

HAEMATOLOGICAL AND BIOCHEMICAL EFFECTS OF TRANSFUSION OF STORED BLOOD IN TRANSFUSION-DEPENDENT THALASSEMIA PATIENTS

Background: Thalassemia is a genetic disease in which there is an imbalance in the synthesis of globin polypeptide chains. The current study aimed to determine the haematological and biochemical effects of transfusion of seven days stored blood in transfusion-dependent thalassemia patients. Methods: A quasi-experimental study was conducted between January and July 2021 at Muhammad College of Medicine, Peshawar. A total of 20 transfusion-dependent thalassemia patients were selected. The impact of transfusion of 7-days old blood on haemoglobin levels, serum LDH, serum electrolytes, serum-free haemoglobin, serum bilirubin, serum-free iron, serum ferritin, and C-reactive protein were measured. Variations in pre-transfusion and post-transfusion samples were determined using paired-samples t-test, and p<0.05 was considered significant. Results: There was a non-significant difference in increase of haemoglobin levels (p=0.543) after transfusion of fresh and stored blood. Similarly, RBC counts, MCV, MCH, MCHC showed a slightly lower increase as compared to fresh blood. No differences were seen in platelet count between the two groups. However, the rise in white cells was significantly higher after transfusion of 7-days stored blood as compared to fresh blood (p=0.002). A non-significant increase in post-transfusion LDH (p=0.13), direct bilirubin (p=0.76) and indirect bilirubin (p=0.45) was seen. No differences in creatinine, glucose, and uric acid variations were found. Levels of C-reactive protein showed a significantly higher raise when 7-days stored blood was transfused in comparison with fresh blood (p=0.012). Conclusion: At least seven days stored blood can be safely transfused to transfusion-dependent thalassemia patients.

Honoring Emil J. Freireich: A Visionary Medical Cancer Researcher-March 21, 1927-February 1, 2021.

![][1] Dr. Emil Freireich at MD Anderson in 2018, in conversation with Lauren Gobert, a leukemia physician assistant who had childhood acute lymphoblastic leukemia cured by combination therapy developed as a result of Dr. Freireich's research. Emil J, Freireich, a founding father of

Polymerized Hemoglobin Maintains Cardiac Function After Extreme Anemia

BackgroundBlood transfusion as a treatment for anemia is vital in ensuring oxygen (O2) carrying capacity. However, fears of blood shortages and adverse reactions to stored blood transfusion have driven the development of oxygen carrying alternatives to blood. One class of alternatives to blood for transfusion medicine are hemoglobin (Hb) based oxygen carriers (HBOCs), which have been in development for decades. A recent advancement in the development of HBOCs is the discovery that their O2 affinity can be tightly regulated by locking Hb in the T state (low O2 affinity), or R state (high O2 affinity). By regulating O2 affinity, O2 extraction by tissues can be controlled, and targeted O2 delivery to hypoxic tissues is made possible. As the heart is one of the most sensitive organs to changes in oxygenation due to its high metabolic rate, the objective of this study was to test the efficacy of high and low O2 affinity HBOCs in maintaining cardiac function and systemic O2 delivery during severe anemia.MethodsPolymerized hemoglobin (PolyHb), the most scalable method of producing HBOCs, was synthesized in the high and low O2 affinity state (R and T, respectively) with glutaraldehyde and then subjected to 8–9 cycles of diafiltration as previously described. This resulted in a PolyHb solution containing only polymerized Hb molecules > 500kDa suspended in Lactated Ringers solution. Rats were instrumented with a pressure‐volume catheter to monitor cardiac function. Severe anemia was induced via a 50% isovolumic hemodilution with 5% human serum albumin. Rats were then resuscitated by a 40% isovolumic infusion of a 10 g/dL solution of R PolyHb, T PolyHb, or fresh blood (drawn from the animal during the first exchange).ResultsSevere anemia resulted in impaired cardiac function and O2 delivery. Transfusion of fresh blood, T PolyHb, and R PolyHb restored vascular resistance, blood pressure, and cardiac contractility. T PolyHb also promoted increased O2 extraction and myocardial energy utilization. Severe anemia did not cause significant changes in blood electrolytes relative to baseline. Severe anemia resulted in blood acidification that only recovered for animals resuscitated with T PolyHb. Furthermore, resuscitation with T PolyHb resulted in higher arterial pO2 and lower pCO2 than other groups. R PolyHb increased lactate and glucose, suggesting that the high O2 affinity prevented proper O2 release to some tissues, despite maintaining cardiac function.ConclusionsBoth T and R PolyHb maintain myocardial O2 extraction compared to fresh blood. T PolyHb appears to be the optimal molecule for increasing O2 delivery during anemic conditions. Although R PolyHb apparently decreased systemic O2 extraction during anemia, it can be potentially useful to increase O2 uptake in the lungs during hypoxic‐hypoxia. This study indicates that PolyHb is as efficacious as fresh blood in restoring cardiac function and oxygenation in rats during severe anemia.Support or Funding InformationThis work was supported by the NIH Heart Lung and Blood Institute under Grants T32‐HL105373, R01‐HL126945, and R01‐HL138116.

Complications of Total Laryngectomy

Objective: To observe Post-operative complications of Total Laryngectomy in advanced Laryngeal Carcinoma Patients.
 Methods: This prospective observational study was conducted in National Institute of ENT, Tejgaon, Dhaka. Study duration 3 years, from January 2015 to December 2017. 17 patients were selected who underwent total laryngectomy for histologically proven advanced carcinoma larynx. Patients were followed up monthly for 3 months & then after 6 months for life long.
 Results: The age of the patients ranged from 39 to 66 years. The mean age was 47 years. Most of the cases are supraglottic carcinoma 12 (70.59%), Glottic carcinoma in 5 (29.41%) & no subglottic carcinoma. In this study, out of 12 supraglottic cases, 4 patients were presented in stage III & 8 in stage IV. Among the glottic cases 1 patient presented in stage I, 2 in stage III & 2 patients presented in stage IV. Patients were followed up monthly for 3 months & then after 6 months for life long. 2 patients (11.76%) developed pharyngocutaneous fistula within 7th to 15th post-operative day & these patients were managed conservatively which involved adequate drainage, frequent dressing & fresh blood transfusion. With these conservative management fistula healed completely within 3 to 4 weeks. 3 patients (17.65%) developed wound infection. Wound swab was sent for culture & sensitivity and antibiotics changed accordingly. Wound healed within 2-3 weeks with conservative treatment & adequate aseptic dressing. 1 patient (5.88%) developed postoperative hematoma which was drained immediately. This patient developed wound infection later on & was managed conservatively. 2 patients (11.76%) developed stomal recurrence 4 months after surgery, which was confirmed by biopsy. The cases were inoperable & were sent for radiotherapy. 2 patients (11.76%) developed dysphagia due to pharyngeal stenosis 4 months after surgery.
 Conclusion: The most frequent troublesome immediate complication is pharyngocutaneous fistula all of which have been treated conservatively with satisfactory result. Preoperative radiotherapy is an important risk factor for the development of pharyngocutaneous fistula in total laryngectomy.
 Bangladesh J Otorhinolaryngol; April 2019; 25(1): 10-18

Age of Red Cells for Transfusion and Outcomes in Critically Ill Patients: A Meta-Analysis

Objective: Whether the age of red blood cells (RBCs) affects mortality after transfusion in critically ill patients is controversial. Methods: We searched MEDLINE, EMBASE, PubMed, Web of Science, and the Cochrane Library Central Register of Controlled Trials databases from inception to January 10, 2018 to identify systematic reviews or meta-analyses and published randomized controlled trials of the effects of fresh versus older blood transfusion on mortality of adults in the intensive care unit (ICU). There were no date restrictions, but the language was restricted to English. The primary outcome was mortality. Risk ratios (RR) and 95% confidence intervals (CI) were calculated. Results: We included six trials that enrolled 8,467 critically ill patients and compared fresh RBC transfusion with current standard practice. There were no significant differences in 90-day mortality (RR 1.04, 95% CI 0.97, 1.12), 28/30-day mortality (RR 1.04, 95% CI 0.96, 1.13), in-hospital mortality (RR 1.06, 95% CI 0.94, 1.19), and in-ICU mortality (RR 1.11, 95% CI 0.97, 1.27) with fresh RBC transfusion compared with older blood transfusion. Conclusions: The study concluded that age of red cells for transfusion did not affect the outcomes in critically ill patients.

Biochemical responses, blood gas, oxidative stress and lipid peroxidation of goats transfused with fresh or stored whole homologous blood

ABSTRACT: Blood transfusion is a therapeutic procedure of great importance for veterinary medicine, in spite of only few studies in the literature on hemotherapy in goats. We aimed to evaluate the biochemical, blood gas, oxidative stress and lipid peroxidation of goats submitted to homologous transfusion of fresh whole blood or stored for 15 and 35 days. Eighteen adult male goats were submitted to a single phlebotomy to remove 30% of the blood volume, and we transfused 20mL/kg of whole blood stored in CPDA-1 bags according to the experimental group, being: G0 composed goats who received fresh blood, G15 and G35 goats that received blood stored for 15 and 35 days, respectively. For the biochemical evaluation, blood gas, oxidative stress and lipid peroxidation, blood samples were collected at the following moments: before the induction of anemia (TC0); 6 hours after phlebotomy and before transfusion (TC1); 1, 6, 12, 24 and 96 hours after transfusion (T1, T6, T12, T24 and T96 respectively); 8, 16 and 32 days after transfusion (T8d, T16d and T32d respectively). Before transfusion, blood samples were also withdrawn from the bags for the same analyzes. Statistical analyzes were performed in the statistical program GRAPHPAD PRISM 5.0, adopting a significance level of 5%. The bags of blood stored for 15 and 35 days showed more biochemical changes, blood gas, oxidative stress and lipid peroxidation than fresh blood bags. As for the biochemical analysis, after the transfusion was observed an increase of the total protein, albumin, glucose and creatine kinase in the 3 groups, and elevation of total bilirubin, direct bilirubin, and urea in G15 and G35. The changes observed in the blood gas analysis had no clinical significance, as they were within the reference values for the species. The goats that received stored blood showed disorder in their antioxidant system through alteration of the SOD activity. In the analysis of lipid peroxidation no difference between the groups for the concentration of malondialdehyde was found. Thus, it can be concluded that transfusion of whole fresh stored blood in goats did not compromise the blood gases, lipid peroxidation and liver and renal functions of the transfused animals. In addition, the method was proved to be efficient to restore, among other components, the total protein and albumin. The transfusion, as performed in this study, proved to be safe for used in the clinical practice of goats.

Immunomodulatory Effects of Blood Transfusion on Tumor Size, Metastasis, and Survival in Experimental Fibrosarcoma.

In spite of efforts, blood transfusion is still accompanied with adverse effects such as transfusion-related immunomodulation (TRIM). The current study aimed to evaluate the effects of allogeneic, syngeneic, fresh and storage blood transfusion on the growth and metastasis of tumors and survival in fibrosarcoma bearing BALB/c mice. Twenty-five BALB/c mice were grouped into five groups of equal size. All groups were injected 1.2 × 106 WEHI-164 cells subcutaneously to induce fibrosarcoma tumor. After expansion of the tumor, in four groups (except for the control group), hemorrhage-induced anemia was developed. Twenty-four hours later, blood deficit was replaced by fresh allogeneic, storage allogeneic, fresh syngeneic and storage syngeneic blood transfusion, respectively. After a blood transfusion, for 13days, the tumor size and survival of the mice were evaluated. In the day 20, the mice were sacrificed and their spleen tissues were evaluated for TRIM induced metastasis. Tumor size increase in the groups that received allogeneic (fresh and storage) and storage syngeneic blood transfusion was significantly higher than the control group (P value < 0.05). However, no significant difference was present in survival between the experiment groups and the control group. There was no metastasis in none of groups at the end of the study. Allogeneic and storage blood transfusion could have immunomodulatory effects such as increased tumor size. However, it seems that fresh and syngeneic blood transfusion have no effects on tumor growth in fibrosarcoma bearing mice. Further evidence may prove that more attention is warranted in blood transfusion into cancer cases.

Age of transfused blood in critically ill adult trauma patients: a prespecified nested analysis of the Age of Blood Evaluation randomized trial.

Blood transfusion is common in the resuscitation of patients with traumatic injury. However, the clinical impact of the length of storage of transfused blood is unclear in this population. We undertook a prespecified nested analysis of 372 trauma victims of the 2510 critically ill patients from 64 centers treated as part of the Age of Blood Evaluation (ABLE) randomized controlled trial. Patients were randomized according to their trauma status to receive either a transfusion of fresh blood stored not more than 7 days or standard-issue blood. Our primary outcome was 90-day all-cause mortality. Overall, 186 trauma patients received fresh blood and 186 received standard-issue blood. Adherence to transfusion protocol was 94% (915/971) for all fresh blood transfused and 100% (753/753) for all standard-issue blood transfused. Mean±SD blood storage duration was 5.6±3.8 days in the fresh group and 22.7±8.4 days in the standard-issue group (p<0.001). Ninety-day mortality in the fresh group was 21% (38/185), compared to 16% (29/184) in the standard-issue group, with an unadjusted absolute risk difference of 5% (95% confidence interval [CI], -3.1 to 12.6) and an adjusted absolute risk difference of 2% (95% CI, -3.5 to 6.8). In critically ill trauma patients, transfusion of fresh blood did not decrease 90-day mortality or secondary outcomes, a finding similar to the overall population of the ABLE trial.

Transfusions of Fresh vs. Older Blood in Seriously Ill Patients

Standard blood bank practice is to release older units of red cells first (“first-in, first out”). Would acutely ill patients fare better if they were

The effect of fresh versus standard blood transfusion on microvascular endothelial function

The duration of red blood cell (RBC) storage may have a negative impact on endothelial nitric oxide bioavailability. We tested the hypothesis that transfused fresh blood will have a more favorable effect on microvascular endothelial function as compared to older standard issue blood. Participants requiring chronic RBC transfusions were enrolled in a crossover design study to receive fresh (<7 days of storage) or standard (up to 42 days of storage) blood on 2 separate visits. Endothelial function was assessed by reactive hyperemia peripheral arterial tonometry that was measured before and after transfusions. For each participant, the difference between endothelial function pretransfusion and posttransfusion was assessed in relation to blood storage time. Twenty-one patients (71 ± 16 years, 52% females) were enrolled. Mean age of fresh blood was 5.5 days (±1.0), and that of standard blood was 24.5 days (±7.9 days). The pretransfusion hemoglobin was 83.1 ± 2.5 g/L; and posttransfusion, 98.9 ± 2.6 g/L. An average of 2 U of packed RBCs was transfused. Microvascular endothelial function decreased more frequently after transfusion of standard blood compared to fresh blood. Standard issue blood transfusion was associated with decrease in reactive hyperemia peripheral arterial tonometry index (-0.25 ± 0.63) compared to fresh blood (+0.03 ± 0.49); P = .026. Transfusions of standard issue blood are associated with less favorable effect on microvascular endothelial function as compared to fresh blood.

Fresh Red Blood Transfusion as a Successful Erythrocyte Cholinesterase Supplement in Organophosphate Poisoning

Despite improvements to standard treatments (atropine, oxime) and intensive care management, the mortality associated with organophosphate (OP) poisoning has not substantially decreased. In this study, we evaluated the role of packed red blood cells (RBCs) transfusion in acute OP poisoning. Patients diagnosed with OP poisoning were included in this prospective study, and then were transfused with packed RBCs stored less than 10 days or 10 to 35 days. Cholinesterase (ChE) level in blood, atropine usage and durations were recorded. We found both shorter- and longer-storage RBCs (200~400 ml) significantly increased AChE level in blood, improved ChE recovery, and reduced the usage and shortened the duration of atropine and followed clinical recovery. Shorter-storage RBCs had better effect than longer-storage (longer storage) ones. Due to erythrocyte cholinesterase supplement, packed RBCs might be used as an alternative approach in patients with OP poisoning, especially at the early stages.

Effect of Red Blood Cell Transfusion on Unfavorable Neurologic Outcome and Symptomatic Vasospasm in Patients with Cerebral Aneurysmal Rupture: Old versus Fresh Blood

Red blood cell (RBC) transfusion, especially with "old" blood, is associated with adverse clinical outcomes. We compared the effects of fresh blood versus old blood transfusion on poor neurologic outcomes and symptomatic vasospasm in patients with ruptured cerebral aneurysms. In this retrospective study, 211 patients with aneurysmal rupture were divided into 3 groups: nontransfusion (n = 136), fresh blood (RBC storage ≤ 14 days) transfusion (n = 39), and old blood (RBC storage >14 days) transfusion (n = 36). Unfavorable neurologic outcomes (modified Rankin Scale score ≥ 3) and symptomatic cerebral vasospasm were assessed. The incidence of unfavorable neurologic outcomes was significantly higher in the fresh blood and old blood transfusion groups compared with the nontransfused group (71.8% and 58.3% vs. 21.3%; P < 0.01); the incidence of symptomatic vasospasm was significantly higher in the old blood group compared with the fresh blood and nontransfusion groups (57.1% vs. 26.7% and 22.2%; P < 0.05). On binary logistic regression, old age, Hunt and Hess grade 3-4, high postoperative C-reactive protein level, RBC transfusion, delayed infarction, and hydrocephalus were independent predictors of unfavorable neurologic outcomes. Young age, Fisher grade 3-4, old RBC transfusion, and surgical clipping were independent predictors of postoperative symptomatic vasospasm. RBC transfusion itself, regardless of the duration of RBC storage, was associated with unfavorable neurologic outcomes in patients with ruptured cerebral aneurysms. Also, old blood transfusion, but not fresh blood transfusion, was associated with increased symptomatic cerebral vasospasm.

Plasma free hemoglobin and microcirculatory response to fresh or old blood transfusions in sepsis.

BackgroundFree hemoglobin (fHb) may induce vasoconstriction by scavenging nitric oxide. It may increase in older blood units due to storage lesions. This study evaluated whether old red blood cell transfusion increases plasma fHb in sepsis and how the microvascular response may be affected.MethodsThis is a secondary analysis of a randomized study. Twenty adult septic patients received either fresh or old (<10 or >15 days storage, respectively) RBC transfusions. fHb was measured in RBC units and in the plasma before and 1 hour after transfusion. Simultaneously, the sublingual microcirculation was assessed with sidestream-dark field imaging. The perfused boundary region was calculated as an index of glycocalyx damage. Tissue oxygen saturation (StO2) and Hb index (THI) were measured with near-infrared spectroscopy and a vascular occlusion test was performed.ResultsSimilar fHb levels were found in the supernatant of fresh and old RBC units. Despite this, plasma fHb increased in the old RBC group after transfusion (from 0.125 [0.098–0.219] mg/mL to 0.238 [0.163–0.369] mg/mL, p = 0.006). The sublingual microcirculation was unaltered in both groups, while THI increased. The change in plasma fHb was inversely correlated with the changes in total vessel density (r = -0.57 [95% confidence interval -0.82, -0.16], p = 0.008), De Backer score (r = -0.63 [95% confidence interval -0.84, -0.25], p = 0.003) and THI (r = -0.72 [95% confidence interval -0.88, -0.39], p = 0.0003).ConclusionsOld RBC transfusion was associated with an increase in plasma fHb in septic patients. Increasing plasma fHb levels were associated with decreased microvascular density.Trial RegistrationClinicalTrials.gov NCT01584999

Hemoperitoneum - A rare complication in Subserous Uterine Fibroid

Rupture of veins on the surface of sub-serous uterine fibroid is an uncommon cause of hemo-peritoneum. It is usually a silent and serious life threatening gynaecological emergency. We report a case of severe intra-abdominal bleeding secondary to rupture of veins on the surface of subserous fibroid. There was more than two litres of hemoperitoneum with active bleeding from the surface vein of sub-serous fibroid. Total abdominal hysterectomy was done. She received 5 units of fresh blood transfusion The postoperative period was uneventful. A differential diagnosis of rupture of surface vessel of uterine fibroid must be kept, while dealing with a case of hemoperitoneum with pelvic mass.

Hemorrhagic shock resuscitation using a polymerized hemoglobin oxygen carrier versus whole blood (707.5)

The development of an efficient alternative to blood transfusion to treat severe hemorrhage is of great public health importance, especially in far forward scenarios where blood is not available. Hemoglobin (Hb) based oxygen (O2) carriers (HBOCs) have been developed to address this need. Hemopure® (HBOC‐201, bovine Hb glutamer‐250, OPK Biotech,Cambridge, MA, USA), a polymerized Hb based HBOC, has been approved for clinical use in South Africa and Russia. At the time of its approval, however, few studies aimed to understand Hemopure’s function, administration, and adverse effects compared to blood. We have used intravital microscopy to study the microcirculation hemodynamics (arteriolar and venular diameters and blood flow and functional capillary density (FCD)) and oxygenation outcomes of Hemopure® administration at different Hb concentrations _4, 8, and 12 gHb/dL_ compared to fresh blood transfusion for resuscitation from hemorrhagic shock. Experiments are performed in unanesthetized hamsters instrumented with a skinfold window chamber, subjected to hemorrhage (50% of the blood volume, BV), followed by 1 hour hypovolemic shock and fluid resuscitation (50% of the shed volume). Our results show that fluid resuscitation with Hemopure® or blood restored systemic and microvascular parameters. O2 delivery in the microcirculation was directly correlated with Hemopure® concentration, however,increased vasoconstriction was as well. FCD reflected the balance between enhanced O2 transport and reduced blood flow: 12 gHb/dL of Hemopure® and blood had lower FCD compared to the lower concentrations of Hemopure® (p&lt;0.05). The balance between O2 transport and tissue perfusion can provide superior resuscitation from hemorrhagic shock compared to blood transfusion by using a low Hb concentration of HBOCs relative to blood.Grant Funding Source: Supported by: NIH R01 HL52684, R01 HL064395 and R01 HL062318 and ARMY: W81XWH‐11‐2‐0012