Aggrey Dhabangi1, Brenda Ainomugisha2, Christine Cserti-Gazdewich3, Henry Ddungu4, Dorothy Kyeyune5, Ezra Musisi5, Robert Opoka6, Christopher P Stowell7, Walter H Dzik8. 1. Child Health and Development Centre, Makerere University, Kampala, Uganda. 2. Mulago Hospital, Kampala, Uganda. 3. University Health Network Laboratory Medicine Program, University of Toronto, Toronto, Canada. 4. Uganda Cancer Institute, Makerere University, Kampala, Uganda. 5. Uganda National Blood Transfusion Service, Kampala, Uganda. 6. Mulago Hospital Department of Paediatrics, Makerere University, Kampala, Uganda. 7. Massachusetts General Hospital Blood Transfusion Service, Harvard Medical School, Boston, MA. 8. Blood Transfusion Service, Room J-224, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114. Electronic address: sdzik@mgh.harvard.edu.
Abstract
BACKGROUND: Prior studies have suggested that transfusion of stored red blood cells (RBCs) with increased levels of cell-free hemoglobin might reduce the bioavailability of recipient nitric oxide (NO) and cause myocardial strain. METHODS:Ugandan children (ages 6-60 months) with severe anemia and lactic acidosis were randomly assigned to receive RBCs stored 1-10 days versus 25-35 days. B-type natriuretic peptide (BNP), vital signs, renal function test results, and plasma hemoglobin were measured. Most children had either malaria or sickle cell disease and were thus at risk for reduced NO bioavailability. RESULTS: Seventy patients received RBCs stored 1-10 days, and 77 received RBCs stored 25-35 days. The median (interquartile range) cell-free hemoglobin was nearly 3 times higher in longer-storage RBCs (26.4 [15.5-43.4] μmol/L) than in shorter-storage RBCs (10.8 [7.8-18.6] μmol/L), P < .0001. Median (interquartile range) BNP 2 hours posttransfusion was 156 (59-650) pg/mL (shorter storage) versus 158 (59-425) pg/mL (longer storage), P = .76. BNP values 22 hours posttransfusion were 110 (46-337) pg/mL (shorter storage) versus 96 (49-310) pg/mL (longer storage), P = .76. Changes in BNP within individuals from pretransfusion to 2 hours (or 22 hours) posttransfusion were not significantly different between the study groups. BNP change following transfusion did not correlate with the concentration of cell-free hemoglobin in the RBC supernatant. Blood pressure, blood urea nitrogen, creatinine, and change in plasma hemoglobin were not significantly different in the 2 groups. CONCLUSION: In a randomized trial among children at risk for reduced NO bioavailability, we found that BNP, blood pressure, creatinine, and plasma hemoglobin were not higher in patients receiving RBCs stored for 25-35 versus 1-10 days.
RCT Entities:
BACKGROUND: Prior studies have suggested that transfusion of stored red blood cells (RBCs) with increased levels of cell-free hemoglobin might reduce the bioavailability of recipient nitric oxide (NO) and cause myocardial strain. METHODS: Ugandan children (ages 6-60 months) with severe anemia and lactic acidosis were randomly assigned to receive RBCs stored 1-10 days versus 25-35 days. B-type natriuretic peptide (BNP), vital signs, renal function test results, and plasma hemoglobin were measured. Most children had either malaria or sickle cell disease and were thus at risk for reduced NO bioavailability. RESULTS: Seventy patients received RBCs stored 1-10 days, and 77 received RBCs stored 25-35 days. The median (interquartile range) cell-free hemoglobin was nearly 3 times higher in longer-storage RBCs (26.4 [15.5-43.4] μmol/L) than in shorter-storage RBCs (10.8 [7.8-18.6] μmol/L), P < .0001. Median (interquartile range) BNP 2 hours posttransfusion was 156 (59-650) pg/mL (shorter storage) versus 158 (59-425) pg/mL (longer storage), P = .76. BNP values 22 hours posttransfusion were 110 (46-337) pg/mL (shorter storage) versus 96 (49-310) pg/mL (longer storage), P = .76. Changes in BNP within individuals from pretransfusion to 2 hours (or 22 hours) posttransfusion were not significantly different between the study groups. BNP change following transfusion did not correlate with the concentration of cell-free hemoglobin in the RBC supernatant. Blood pressure, blood ureanitrogen, creatinine, and change in plasma hemoglobin were not significantly different in the 2 groups. CONCLUSION: In a randomized trial among children at risk for reduced NO bioavailability, we found that BNP, blood pressure, creatinine, and plasma hemoglobin were not higher in patients receiving RBCs stored for 25-35 versus 1-10 days.
Authors: Mark T Gladwin; Robyn J Barst; Oswaldo L Castro; Victor R Gordeuk; Cheryl A Hillery; Gregory J Kato; Daniel B Kim-Shapiro; Roberto Machado; Claudia R Morris; Martin H Steinberg; Elliott P Vichinsky Journal: Blood Date: 2010-08-05 Impact factor: 22.113
Authors: Chenell Donadee; Nicolaas J H Raat; Tamir Kanias; Jesús Tejero; Janet S Lee; Eric E Kelley; Xuejun Zhao; Chen Liu; Hannah Reynolds; Ivan Azarov; Sheila Frizzell; E Michael Meyer; Albert D Donnenberg; Lirong Qu; Darrel Triulzi; Daniel B Kim-Shapiro; Mark T Gladwin Journal: Circulation Date: 2011-07-11 Impact factor: 29.690
Authors: Marie E Steiner; Paul M Ness; Susan F Assmann; Darrell J Triulzi; Steven R Sloan; Meghan Delaney; Suzanne Granger; Elliott Bennett-Guerrero; Morris A Blajchman; Vincent Scavo; Jeffrey L Carson; Jerrold H Levy; Glenn Whitman; Pamela D'Andrea; Shelley Pulkrabek; Thomas L Ortel; Larissa Bornikova; Thomas Raife; Kathleen E Puca; Richard M Kaufman; Gregory A Nuttall; Pampee P Young; Samuel Youssef; Richard Engelman; Philip E Greilich; Ronald Miles; Cassandra D Josephson; Arthur Bracey; Rhonda Cooke; Jeffrey McCullough; Robert Hunsaker; Lynne Uhl; Janice G McFarland; Yara Park; Melissa M Cushing; Charles T Klodell; Ravindra Karanam; Pamela R Roberts; Cornelius Dyke; Eldad A Hod; Christopher P Stowell Journal: N Engl J Med Date: 2015-04-09 Impact factor: 91.245
Authors: Anita Hill; Russell P Rother; Xunde Wang; Sidney M Morris; Kerry Quinn-Senger; Richard Kelly; Stephen J Richards; Monica Bessler; Leonard Bell; Peter Hillmen; Mark T Gladwin Journal: Br J Haematol Date: 2010-03-08 Impact factor: 6.998
Authors: Roberto F Machado; Anastasia Anthi; Martin H Steinberg; Duane Bonds; Vandana Sachdev; Gregory J Kato; Angelo M Taveira-DaSilva; Samir K Ballas; William Blackwelder; Xiuli Xu; Lori Hunter; Bruce Barton; Myron Waclawiw; Oswaldo Castro; Mark T Gladwin Journal: JAMA Date: 2006-07-19 Impact factor: 56.272