Mortality increases after massive exchange transfusion with older stored blood in canines with experimental pneumonia

Steven B. Solomon, Junfeng Sun, Tamir Kanias, Jing Feng, Christine C. Helms, Michael A. Solomon, Meghna Alimchandani, Martha Quezado, Mark T. Gladwin, Daniel B. Kim-Shapiro, Harvey G. Klein, Charles Natanson

Research output: Contribution to journalArticle

Abstract

Two-year-old purpose-bred beagles (n = 24) infected with Staphylococcus aureus pneumonia were randomized in a blinded fashion for exchange transfusion with either 7- or 42-day-old canine universal donor blood (80 mL/kg in 4 divided doses). Older blood increased mortality (P = .0005), the arterial alveolar oxygen gradient (24-48 hours after infection; P ≥ .01), systemic and pulmonary pressures during transfusion (4-16 hours) and pulmonary pressures for ̃ 10 hours afterward (all P ≥ .02). Further, older blood caused more severe lung damage, evidenced by increased necrosis, hemorrhage, and thrombosis (P = .03) noted at the infection site postmortem. Plasma cell-free hemoglobin and nitric oxide (NO) consumption capability were elevated and haptoglobin levels were decreased with older blood during and for 32 hours after transfusion (all P ≥ .03). The low haptoglobin (r = 0.61; P = .003) and high NO consumption levels at 24 hours (r = 0.76; P <.0001) were associated with poor survival. Plasma nontransferrin-bound and labile iron were significantly elevated only during transfusion (both P = .03) and not associated with survival (P = NS). These data from canines indicate that older blood after transfusion has a propensity to hemolyze in vivo, releases vasoconstrictive cell-free hemoglobin over days, worsens pulmonary hypertension, gas exchange, and ischemic vascular damage in the infected lung, and thereby increases the risk of death from transfusion.

Original languageEnglish (US)
Pages (from-to)1663-1672
Number of pages10
JournalBlood
Volume121
Issue number9
DOIs
StatePublished - Feb 28 2013
Externally publishedYes

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Canidae
Pneumonia
Blood
Lung
Haptoglobins
Mortality
Staphylococcal Pneumonia
Pulmonary Gas Exchange
Pressure
Plasmas
Infection
Plasma Cells
Blood Donors
Pulmonary Hypertension
Blood Transfusion
Blood Vessels
Nitric Oxide
Hemoglobins
Thrombosis
Necrosis

ASJC Scopus subject areas

  • Hematology
  • Biochemistry
  • Cell Biology
  • Immunology

Cite this

Solomon, S. B., Sun, J., Kanias, T., Feng, J., Helms, C. C., Solomon, M. A., ... Natanson, C. (2013). Mortality increases after massive exchange transfusion with older stored blood in canines with experimental pneumonia. Blood, 121(9), 1663-1672. https://doi.org/10.1182/blood-2012-10-462945

Mortality increases after massive exchange transfusion with older stored blood in canines with experimental pneumonia. / Solomon, Steven B.; Sun, Junfeng; Kanias, Tamir; Feng, Jing; Helms, Christine C.; Solomon, Michael A.; Alimchandani, Meghna; Quezado, Martha; Gladwin, Mark T.; Kim-Shapiro, Daniel B.; Klein, Harvey G.; Natanson, Charles.

In: Blood, Vol. 121, No. 9, 28.02.2013, p. 1663-1672.

Research output: Contribution to journalArticle

Solomon, SB, Sun, J, Kanias, T, Feng, J, Helms, CC, Solomon, MA, Alimchandani, M, Quezado, M, Gladwin, MT, Kim-Shapiro, DB, Klein, HG & Natanson, C 2013, 'Mortality increases after massive exchange transfusion with older stored blood in canines with experimental pneumonia', Blood, vol. 121, no. 9, pp. 1663-1672. https://doi.org/10.1182/blood-2012-10-462945
Solomon, Steven B. ; Sun, Junfeng ; Kanias, Tamir ; Feng, Jing ; Helms, Christine C. ; Solomon, Michael A. ; Alimchandani, Meghna ; Quezado, Martha ; Gladwin, Mark T. ; Kim-Shapiro, Daniel B. ; Klein, Harvey G. ; Natanson, Charles. / Mortality increases after massive exchange transfusion with older stored blood in canines with experimental pneumonia. In: Blood. 2013 ; Vol. 121, No. 9. pp. 1663-1672.
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abstract = "Two-year-old purpose-bred beagles (n = 24) infected with Staphylococcus aureus pneumonia were randomized in a blinded fashion for exchange transfusion with either 7- or 42-day-old canine universal donor blood (80 mL/kg in 4 divided doses). Older blood increased mortality (P = .0005), the arterial alveolar oxygen gradient (24-48 hours after infection; P ≥ .01), systemic and pulmonary pressures during transfusion (4-16 hours) and pulmonary pressures for ̃ 10 hours afterward (all P ≥ .02). Further, older blood caused more severe lung damage, evidenced by increased necrosis, hemorrhage, and thrombosis (P = .03) noted at the infection site postmortem. Plasma cell-free hemoglobin and nitric oxide (NO) consumption capability were elevated and haptoglobin levels were decreased with older blood during and for 32 hours after transfusion (all P ≥ .03). The low haptoglobin (r = 0.61; P = .003) and high NO consumption levels at 24 hours (r = 0.76; P <.0001) were associated with poor survival. Plasma nontransferrin-bound and labile iron were significantly elevated only during transfusion (both P = .03) and not associated with survival (P = NS). These data from canines indicate that older blood after transfusion has a propensity to hemolyze in vivo, releases vasoconstrictive cell-free hemoglobin over days, worsens pulmonary hypertension, gas exchange, and ischemic vascular damage in the infected lung, and thereby increases the risk of death from transfusion.",
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