Can volume-reduced plasma products prevent transfusion-associated circulatory overload in a two-hit animal model?

Autor: Bulle EB; Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Klanderman RB; Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., de Wissel MB; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Roelofs JJTH; Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Cardiovascular Sciences, Microcirculation, University of Amsterdam, Amsterdam, The Netherlands., Veelo DP; Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., van den Brom CE; Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam, The Netherlands., Kapur R; Sanquin Research, Department of Experimental Immunohematology, Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Vlaar APJ; Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Vox sanguinis [Vox Sang] 2023 Mar; Vol. 118 (3), pp. 185-192. Date of Electronic Publication: 2023 Jan 04.
DOI: 10.1111/vox.13395
Abstrakt: Background and Objectives: Transfusion-associated circulatory overload (TACO) is a pulmonary transfusion complication and a leading cause of transfusion-related morbidity and mortality. Volume overload and rising hydrostatic pressure as a consequence of transfusion are seen as the central pathway leading to TACO. A possible preventative measure for TACO could be the use of low-volume blood products like volume-reduced lyophilized plasma. We hypothesize that volume-reduced lyophilized plasma decreases circulatory overload leading to a reduced pulmonary capillary pressure and can therefore be an effective strategy to prevent TACO.
Materials and Methods: A validated two-hit animal model in rats with heart failure was used. Animals were randomized to receive 4 units of either solvent-detergent pooled plasma (SDP) as control, standard volume lyophilized plasma (LP-S) or hyperoncotic volume-reduced lyophilized plasma (LP-VR). The primary outcome was the difference between pre-transfusion and post-transfusion left ventricular end-diastolic pressure (ΔLVEDP). Secondary outcomes included markers for acute lung injury.
Results: LVEDP increased in all randomization groups following transfusion. The greatest elevation was seen in the group receiving LP-VR (+11.9 mmHg [5.9-15.6]), but there were no significant differences when compared to groups receiving either LP-S (+6.3 mmHg [2.9-13.4], p = 0.29) or SDP (+7.7 mmHg [4.5-10.5], p = 0.55). There were no significant differences in markers for acute lung injury, such as pulmonary wet/dry weight ratios, lung histopathology scores or PaO 2 /FiO 2 ratio between the three groups.
Conclusion: Transfusion with hyperoncotic volume-reduced plasma did not attenuate circulatory overload compared to standard volume plasma and was therefore not an effective preventative strategy for TACO in this rat model.
(© 2023 The Authors. Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion.)
Databáze: MEDLINE
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