BACKGROUND: Removal of cytokines, chemokines, and microvesicles from the supernatant of allogeneic erythrocytes may help mitigate adverse transfusion reactions. Blood bank-based washing procedures present logistical difficulties; therefore, we tested the hypothesis that on-demand bedside washing of allogeneic erythrocyte units is capable of removing soluble factors and is feasible in a clinical setting. METHODS: There were in vitro and prospective, observation cohort components to this a priori planned substudy evaluating bedside allogeneic erythrocyte washing, with a cell saver, during cardiac surgery. Laboratory data were collected from the first 75 washed units given to a subset of patients nested in the intervention arm of a parent clinical trial. Paired pre- and postwash samples from the blood unit bags were centrifuged. The supernatant was aspirated and frozen at -70°C, then batch-tested for cell-derived microvesicles, soluble CD40 ligand, chemokine ligand 5, and neutral lipids (all previously associated with transfusion reactions) and cell-free hemoglobin (possibly increased by washing). From the entire cohort randomized to the intervention arm of the trial, bedside washing was defined as feasible if at least 75% of prescribed units were washed per protocol. RESULTS: Paired data were available for 74 units. Washing reduced soluble CD40 ligand (median [interquartile range]; from 143 [1 to 338] ng/ml to zero), chemokine ligand 5 (from 1,314 [715 to 2,551] to 305 [179 to 488] ng/ml), and microvesicle numbers (from 6.90 [4.10 to 20.0] to 0.83 [0.33 to 2.80] × 106), while cell-free hemoglobin concentration increased from 72.6 (53.6 to 171.6) mg/dl to 210.5 (126.6 to 479.6) mg/dl (P < 0.0001 for each). There was no effect on neutral lipids. Bedside washing was determined as feasible for 80 of 81 patients (99%); overall, 293 of 314 (93%) units were washed per protocol. CONCLUSIONS: Bedside erythrocyte washing was clinically feasible and greatly reduced concentrations of soluble factors thought to be associated with transfusion-related adverse reactions, increasing concentrations of cell-free hemoglobin while maintaining acceptable (less than 0.8%) hemolysis.
BACKGROUND: Removal of cytokines, chemokines, and microvesicles from the supernatant of allogeneic erythrocytes may help mitigate adverse transfusion reactions. Blood bank-based washing procedures present logistical difficulties; therefore, we tested the hypothesis that on-demand bedside washing of allogeneic erythrocyte units is capable of removing soluble factors and is feasible in a clinical setting. METHODS: There were in vitro and prospective, observation cohort components to this a priori planned substudy evaluating bedside allogeneic erythrocyte washing, with a cell saver, during cardiac surgery. Laboratory data were collected from the first 75 washed units given to a subset of patients nested in the intervention arm of a parent clinical trial. Paired pre- and postwash samples from the blood unit bags were centrifuged. The supernatant was aspirated and frozen at -70°C, then batch-tested for cell-derived microvesicles, soluble CD40 ligand, chemokine ligand 5, and neutral lipids (all previously associated with transfusion reactions) and cell-free hemoglobin (possibly increased by washing). From the entire cohort randomized to the intervention arm of the trial, bedside washing was defined as feasible if at least 75% of prescribed units were washed per protocol. RESULTS: Paired data were available for 74 units. Washing reduced soluble CD40 ligand (median [interquartile range]; from 143 [1 to 338] ng/ml to zero), chemokine ligand 5 (from 1,314 [715 to 2,551] to 305 [179 to 488] ng/ml), and microvesicle numbers (from 6.90 [4.10 to 20.0] to 0.83 [0.33 to 2.80] × 106), while cell-free hemoglobin concentration increased from 72.6 (53.6 to 171.6) mg/dl to 210.5 (126.6 to 479.6) mg/dl (P < 0.0001 for each). There was no effect on neutral lipids. Bedside washing was determined as feasible for 80 of 81 patients (99%); overall, 293 of 314 (93%) units were washed per protocol. CONCLUSIONS: Bedside erythrocyte washing was clinically feasible and greatly reduced concentrations of soluble factors thought to be associated with transfusion-related adverse reactions, increasing concentrations of cell-free hemoglobin while maintaining acceptable (less than 0.8%) hemolysis.
Authors: Jill M Cholette; Kelly F Henrichs; George M Alfieris; Karen S Powers; Richard Phipps; Sherry L Spinelli; Michael Swartz; Francisco Gensini; L Eugene Daugherty; Emily Nazarian; Jeffrey S Rubenstein; Dawn Sweeney; Michael Eaton; Norma B Lerner; Neil Blumberg Journal: Pediatr Crit Care Med Date: 2012-05 Impact factor: 3.624
Authors: Melissa Alberts; Robert C Groom; Richard Walczak; Robert Kramer; Adrienne Karpiel; Jeanette Dieter; Lisa Sheth; Nathaniel H Greene; Edmund H Jooste Journal: J Extra Corpor Technol Date: 2017-06
Authors: K Maślanka; M Uhrynowska; P Łopacz; A Wróbel; G Smoleńska-Sym; K Guz; E Lachert; A Ostas; E Brojer Journal: Vox Sang Date: 2014-08-18 Impact factor: 2.144
Authors: Kieran P O'Dea; John R Porter; Nikhil Tirlapur; Umar Katbeh; Suveer Singh; Jonathan M Handy; Masao Takata Journal: PLoS One Date: 2016-12-09 Impact factor: 3.240
Authors: Matthew A Warner; Ian J Welsby; Phillip J Norris; Christopher C Silliman; Sarah Armour; Erica D Wittwer; Paula J Santrach; Laurie A Meade; Lavonne M Liedl; Chelsea M Nieuwenkamp; Brian Douthit; Camille M van Buskirk; Phillip J Schulte; Rickey E Carter; Daryl J Kor Journal: BMJ Open Date: 2017-08-18 Impact factor: 2.692
Authors: Majed A Refaai; Grace W Conley; Kelly F Henrichs; Hannah McRae; Amy E Schmidt; Richard P Phipps; Sherry L Spinelli; Debra Masel; Jill M Cholette; Anthony Pietropaoli; Michael P Eaton; Neil Blumberg Journal: Am J Clin Pathol Date: 2018-07-03 Impact factor: 2.493
Authors: Pearl Toy; Mark R Looney; Mark Popovsky; Miodrag Palfi; Gösta Berlin; Catherine E Chapman; Paula Bolton-Maggs; Michael A Matthay Journal: Ann Am Thorac Soc Date: 2022-05