Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery

M J Wozniak, N Sullo, S Qureshi, W Dott, R Cardigan, M Wiltshire, T Morris, M Nath, N Bittar, S K Bhudia, T Kumar, A H Goodall, G J Murphy (Corresponding Author)

Research output: Contribution to journalArticle

Abstract

Background: Experimental studies suggest that mechanical cell washing to remove pro-inflammatory components that accumulate in the supernatant of stored donor red blood cells (RBCs) might reduce inflammation and organ injury in transfused patients.

Methods: Cardiac surgery patients at increased risk of large-volume RBC transfusion were eligible. Participants were randomized to receive either mechanically washed allogenic RBCs or standard care RBCs. The primary outcome was serum interleukin-8 measured at baseline and at four postsurgery time points. A mechanism substudy evaluated the effects of washing on stored RBCs in vitro and on markers of platelet, leucocyte, and endothelial activation in trial subjects.

Results: Sixty adult cardiac surgery patients at three UK cardiac centres were enrolled between September 2013 and March 2015. Subjects received a median of 3.5 (interquartile range 2-5.5) RBC units, stored for a mean of 21 ( sd 5.2) days, within 48 h of surgery. Mechanical washing reduced concentrations of RBC-derived microvesicles but increased cell-free haemoglobin concentrations in RBC supernatant relative to standard care RBC supernatant. There was no difference between groups with respect to perioperative serum interleukin-8 values [adjusted mean difference 0.239 (95% confidence intervals -0.231, 0.709), P =0.318] or concentrations of plasma RBC microvesicles, platelet and leucocyte activation, plasma cell-free haemoglobin, endothelial activation, or biomarkers of heart, lung, or kidney injury.

Conclusions: These results do not support a hypothesis that allogenic red blood cell washing has clinical benefits in cardiac surgery.

Clinical trial registration: ISRCTN 27076315.

Original languageEnglish
Pages (from-to)689-698
Number of pages10
JournalBritish Journal of Anaesthesia
Volume118
Issue number5
Early online date13 Dec 2017
DOIs
Publication statusPublished - 2017

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Thoracic Surgery
Erythrocytes
Wounds and Injuries
Interleukin-8
Hemoglobins
Leukocytes
Erythrocyte Transfusion
Platelet Activation
Plasma Cells
Serum
Blood Platelets
Biomarkers
Tissue Donors
Clinical Trials
Confidence Intervals
Inflammation
Kidney
Lung

Keywords

  • Aged
  • Aged, 80 and over
  • Blood Preservation
  • Cardiac Surgical Procedures/adverse effects
  • Endothelium, Vascular
  • Erythrocyte Transfusion/adverse effects
  • Erythrocytes
  • Female
  • Hemoglobins/analysis
  • Humans
  • Interleukin-8/blood
  • Leukocytes/drug effects
  • Male
  • Middle Aged
  • Platelet Activation
  • Postoperative Complications/prevention & control
  • Single-Blind Method
  • Treatment Outcome

Cite this

Wozniak, M. J., Sullo, N., Qureshi, S., Dott, W., Cardigan, R., Wiltshire, M., ... Murphy, G. J. (2017). Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery. British Journal of Anaesthesia, 118(5), 689-698. https://doi.org/10.1093/bja/aex083

Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery. / Wozniak, M J; Sullo, N; Qureshi, S; Dott, W; Cardigan, R; Wiltshire, M; Morris, T; Nath, M; Bittar, N; Bhudia, S K; Kumar, T; Goodall, A H; Murphy, G J (Corresponding Author).

In: British Journal of Anaesthesia, Vol. 118, No. 5, 2017, p. 689-698.

Research output: Contribution to journalArticle

Wozniak, MJ, Sullo, N, Qureshi, S, Dott, W, Cardigan, R, Wiltshire, M, Morris, T, Nath, M, Bittar, N, Bhudia, SK, Kumar, T, Goodall, AH & Murphy, GJ 2017, 'Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery' British Journal of Anaesthesia, vol. 118, no. 5, pp. 689-698. https://doi.org/10.1093/bja/aex083
Wozniak, M J ; Sullo, N ; Qureshi, S ; Dott, W ; Cardigan, R ; Wiltshire, M ; Morris, T ; Nath, M ; Bittar, N ; Bhudia, S K ; Kumar, T ; Goodall, A H ; Murphy, G J. / Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery. In: British Journal of Anaesthesia. 2017 ; Vol. 118, No. 5. pp. 689-698.
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abstract = "Background: Experimental studies suggest that mechanical cell washing to remove pro-inflammatory components that accumulate in the supernatant of stored donor red blood cells (RBCs) might reduce inflammation and organ injury in transfused patients.Methods: Cardiac surgery patients at increased risk of large-volume RBC transfusion were eligible. Participants were randomized to receive either mechanically washed allogenic RBCs or standard care RBCs. The primary outcome was serum interleukin-8 measured at baseline and at four postsurgery time points. A mechanism substudy evaluated the effects of washing on stored RBCs in vitro and on markers of platelet, leucocyte, and endothelial activation in trial subjects.Results: Sixty adult cardiac surgery patients at three UK cardiac centres were enrolled between September 2013 and March 2015. Subjects received a median of 3.5 (interquartile range 2-5.5) RBC units, stored for a mean of 21 ( sd 5.2) days, within 48 h of surgery. Mechanical washing reduced concentrations of RBC-derived microvesicles but increased cell-free haemoglobin concentrations in RBC supernatant relative to standard care RBC supernatant. There was no difference between groups with respect to perioperative serum interleukin-8 values [adjusted mean difference 0.239 (95{\%} confidence intervals -0.231, 0.709), P =0.318] or concentrations of plasma RBC microvesicles, platelet and leucocyte activation, plasma cell-free haemoglobin, endothelial activation, or biomarkers of heart, lung, or kidney injury.Conclusions: These results do not support a hypothesis that allogenic red blood cell washing has clinical benefits in cardiac surgery.Clinical trial registration: ISRCTN 27076315.",
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AU - Sullo, N

AU - Qureshi, S

AU - Dott, W

AU - Cardigan, R

AU - Wiltshire, M

AU - Morris, T

AU - Nath, M

AU - Bittar, N

AU - Bhudia, S K

AU - Kumar, T

AU - Goodall, A H

AU - Murphy, G J

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N2 - Background: Experimental studies suggest that mechanical cell washing to remove pro-inflammatory components that accumulate in the supernatant of stored donor red blood cells (RBCs) might reduce inflammation and organ injury in transfused patients.Methods: Cardiac surgery patients at increased risk of large-volume RBC transfusion were eligible. Participants were randomized to receive either mechanically washed allogenic RBCs or standard care RBCs. The primary outcome was serum interleukin-8 measured at baseline and at four postsurgery time points. A mechanism substudy evaluated the effects of washing on stored RBCs in vitro and on markers of platelet, leucocyte, and endothelial activation in trial subjects.Results: Sixty adult cardiac surgery patients at three UK cardiac centres were enrolled between September 2013 and March 2015. Subjects received a median of 3.5 (interquartile range 2-5.5) RBC units, stored for a mean of 21 ( sd 5.2) days, within 48 h of surgery. Mechanical washing reduced concentrations of RBC-derived microvesicles but increased cell-free haemoglobin concentrations in RBC supernatant relative to standard care RBC supernatant. There was no difference between groups with respect to perioperative serum interleukin-8 values [adjusted mean difference 0.239 (95% confidence intervals -0.231, 0.709), P =0.318] or concentrations of plasma RBC microvesicles, platelet and leucocyte activation, plasma cell-free haemoglobin, endothelial activation, or biomarkers of heart, lung, or kidney injury.Conclusions: These results do not support a hypothesis that allogenic red blood cell washing has clinical benefits in cardiac surgery.Clinical trial registration: ISRCTN 27076315.

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KW - Female

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KW - Male

KW - Middle Aged

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DO - 10.1093/bja/aex083

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