Kasiemobi E Pulliam1, Bernadin Joseph2, Mackenzie C Morris3, Rosalie A Veile4, Rebecca M Schuster5, Amy T Makley6, Timothy A Pritts7, Michael D Goodman8. 1. Section of General Surgery, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, OH 45267-0558, United States of America. Electronic address: pulliaki@ucmail.uc.edu. 2. Section of General Surgery, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, OH 45267-0558, United States of America. Electronic address: josephbn@ucmail.uc.edu. 3. Section of General Surgery, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, OH 45267-0558, United States of America. Electronic address: morri2m8@ucmail.uc.edu. 4. Section of General Surgery, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, OH 45267-0558, United States of America. Electronic address: veilere@ucmail.uc.edu. 5. Section of General Surgery, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, OH 45267-0558, United States of America. Electronic address: schustrm@ucmail.uc.edu. 6. Section of General Surgery, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, OH 45267-0558, United States of America. Electronic address: makleyat@ucmail.uc.edu. 7. Section of General Surgery, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, OH 45267-0558, United States of America. Electronic address: prittsta@ucmail.uc.edu. 8. Section of General Surgery, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, OH 45267-0558, United States of America. Electronic address: goodmamd@ucmail.uc.edu.
Abstract
BACKGROUND: Packed red blood cell (pRBC) units administered during resuscitation from hemorrhagic shock are of varied storage ages. We have previously shown that RBC-derived microparticles' impact on thrombogenesis. However, the impact of storage age on pRBC coagulability is unknown. Therefore, we sought to investigate the effect of storage age on innate coagulability and aggregability of stored pRBCs. METHODS: pRBCs prepared from male C57BL/6J mice were stored in Additive Solution-3 according to our standardized murine blood banking protocols for 14 days. Rotational thromboelastometry (ROTEM) was used to assess the innate coagulation status of fresh and 14-day old pRBCs. Viscoelastic coagulation parameters of clotting time (CT), clot formation time (CFT), alpha angle, and maximum clot firmness (MCF) were analyzed to determine coagulability. Plasma was added to the fresh pRBCs and 15-day old pRBCs to determine if the storage-associated coagulopathy was reversible with plasma. Statistical analyses were conducted with a Student's t-test. RESULTS: Fifteen-day old pRBCs demonstrated a significant reduction in MCF (10.3 vs. 24.4 mm, P-value <0.001) and alpha angle (6.0 vs. 27.2 degrees, P-value <0.001) as well as significant prolongation of CFT and CT (1126.5 vs. 571.4 s, P-value <0.001) compared to fresh pRBCs. FFP addition to 15-day old and fresh pRBCs, demonstrated a significant reduction in MCF and persistent prolongation of CFT. This suggests that pRBCs lost coagulability as they aged and this deficit was not completely corrected by plasma administration. CONCLUSIONS: Storage duration may be an important factor in coagulation potential of pRBCs. Transfusion with older pRBCs may contribute to coagulopathy in massively transfused patients.
BACKGROUND: Packed red blood cell (pRBC) units administered during resuscitation from hemorrhagic shock are of varied storage ages. We have previously shown that RBC-derived microparticles' impact on thrombogenesis. However, the impact of storage age on pRBC coagulability is unknown. Therefore, we sought to investigate the effect of storage age on innate coagulability and aggregability of stored pRBCs. METHODS: pRBCs prepared from male C57BL/6J mice were stored in Additive Solution-3 according to our standardized murine blood banking protocols for 14 days. Rotational thromboelastometry (ROTEM) was used to assess the innate coagulation status of fresh and 14-day old pRBCs. Viscoelastic coagulation parameters of clotting time (CT), clot formation time (CFT), alpha angle, and maximum clot firmness (MCF) were analyzed to determine coagulability. Plasma was added to the fresh pRBCs and 15-day old pRBCs to determine if the storage-associated coagulopathy was reversible with plasma. Statistical analyses were conducted with a Student's t-test. RESULTS: Fifteen-day old pRBCs demonstrated a significant reduction in MCF (10.3 vs. 24.4 mm, P-value <0.001) and alpha angle (6.0 vs. 27.2 degrees, P-value <0.001) as well as significant prolongation of CFT and CT (1126.5 vs. 571.4 s, P-value <0.001) compared to fresh pRBCs. FFP addition to 15-day old and fresh pRBCs, demonstrated a significant reduction in MCF and persistent prolongation of CFT. This suggests that pRBCs lost coagulability as they aged and this deficit was not completely corrected by plasma administration. CONCLUSIONS: Storage duration may be an important factor in coagulation potential of pRBCs. Transfusion with older pRBCs may contribute to coagulopathy in massively transfused patients.
Authors: Emily F Midura; Peter L Jernigan; Joshua W Kuethe; Lou Ann Friend; Rosalie Veile; Amy T Makley; Charles C Caldwell; Michael D Goodman Journal: J Surg Res Date: 2015-03-05 Impact factor: 2.192
Authors: Blessing T Oyeniyi; Erin E Fox; Michelle Scerbo; Jeffrey S Tomasek; Charles E Wade; John B Holcomb Journal: Injury Date: 2016-11-03 Impact factor: 2.586
Authors: Karim Brohi; Mitchell J Cohen; Michael T Ganter; Michael A Matthay; Robert C Mackersie; Jean-François Pittet Journal: Ann Surg Date: 2007-05 Impact factor: 12.969
Authors: Amy T Makley; Michael D Goodman; Lou Ann W Friend; Jay A Johannigman; Warren C Dorlac; Alex B Lentsch; Timothy A Pritts Journal: Shock Date: 2010-07 Impact factor: 3.454
Authors: Nena Matijevic; Yao-Wei W Wang; Charles E Wade; John B Holcomb; Bryan A Cotton; Martin A Schreiber; Peter Muskat; Erin E Fox; Deborah J Del Junco; Jessica C Cardenas; Mohammad H Rahbar; Mitchell Jay Cohen Journal: Thromb Res Date: 2014-07-22 Impact factor: 3.944