Autologous red blood cell transfusion does not result in a more profound increase in pulmonary capillary wedge pressure compared to saline in critically ill patients: A randomized crossover trial

Joachim J Bosboom, Robert B Klanderman, Lotte E Terwindt, Esther B Bulle, Marije Wijnberge, Susanne Eberl, Antoine H Driessen, Toon A Winkelman, Bart F Geerts, Denise P Veelo, Markus W Hollmann, Alexander P J Vlaar, Joachim J Bosboom, Robert B Klanderman, Lotte E Terwindt, Esther B Bulle, Marije Wijnberge, Susanne Eberl, Antoine H Driessen, Toon A Winkelman, Bart F Geerts, Denise P Veelo, Markus W Hollmann, Alexander P J Vlaar

Abstract

Background and objectives: Transfusion-associated circulatory overload (TACO) is a major cause of severe transfusion-related morbidity. Transfusion of red blood cells (RBCs) has been shown to induce hydrostatic pressure overload. It is unclear which product-specific factors contribute. We set out to determine the effect of autologous RBC transfusion versus saline on pulmonary capillary wedge pressure (PCWP) change.

Materials and methods: In a randomized crossover trial, patients who had undergone coronary bypass surgery were allocated to treatment post-operatively in the intensive care unit with either an initial 300 ml autologous RBC transfusion (salvaged during surgery) or 300 ml saline infusion first, followed by the other. Primary outcome was the difference in PCWP change. Secondary outcome measures were the difference in extra-vascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI).

Results: Change in PCWP was not higher after autologous RBC transfusion compared to saline (ΔPCWP 0.3 ± 0.4 vs. 0.1 ± 0.4 mmHg). ΔEVLWI and ΔPVPI were significantly decreased after autologous RBC transfusion compared to saline (ΔEVLWI -1.6 ± 0.6 vs. 0.2 ± 0.4, p = 0.02; ΔPVPI -0.3 ± 0.1 vs. 0.0 ± 0.1, p = 0.01). Haemodynamic variables and colloid osmotic pressure were not different for autologous RBC transfusion versus saline.

Conclusion: Transfusion of autologous RBCs did not result in a more profound increase in PCWP compared to saline. RBC transfusion resulted in a decrease of EVLWI and PVPI compared to saline. Our data suggest that transfusing autologous RBCs may lead to less pulmonary oedema compared to saline. Future studies with allogeneic RBCs are needed to investigate other factors that may mediate the increase of PCWP, resulting in TACO.

Keywords: autologous blood transfusion; volume overload.

Conflict of interest statement

Dr. Denise P. Veelo reported receipt of grants and consultancy fees from Edwards Lifesciences, and research grants from Philips and Hemologic. Dr. Markus W. Hollmann reported serving as executive section editor of pharmacology for Anaesthesia & Analgesia and as section editor of anaesthesiology for the Journal of Clinical Medicine and receipt of speakers fees from CSL Behring and Eurocept BV and consultancy fees from Eurocept BV. The other authors declare no conflict of interest.

© 2022 The Authors. Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion.

Figures

FIGURE 1
FIGURE 1
Flow‐chart. *Measurements were not possible due to re‐thoracotomy.

References

    1. Carson JL, Triulzi DJ, Ness PM. Indications for and adverse effects of red‐cell transfusion. N Engl J Med. 2017;377:1261–72.
    1. Delaney M, Wendel S, Bercovitz RS, Cid J, Cohn C, Dunbar NM, et al. Transfusion reactions: prevention, diagnosis, and treatment. Lancet. 2016;388:2825–36.
    1. Bosboom JJ, Klanderman RB, Zijp M, Hollmann MW, Veelo DP, Binnekade JM, et al. Incidence, risk factors, and outcome of transfusion‐associated circulatory overload in a mixed intensive care unit population: a nested case‐control study. Transfusion. 2017;58:498–506.
    1. Bosboom JJ, Klanderman RB, Migdady Y, Bolhuis B, Veelo DP, Geerts BF, et al. Transfusion‐associated circulatory overload: a clinical perspective. Transfus Med Rev. 2019;33:69–77.
    1. Andrzejewski C Jr, Casey MA, Popovsky MA. How we view and approach transfusion‐associated circulatory overload: pathogenesis, diagnosis, management, mitigation, and prevention. Transfusion. 2013;53:3037–47.
    1. Blumberg N, Heal JM, Gettings KF, Phipps RP, Masel D, Refaai MA, et al. An association between decreased cardiopulmonary complications (transfusion‐related acute lung injury and transfusion‐associated circulatory overload) and implementation of universal leukoreduction of blood transfusions. Transfusion. 2010;50:2738–44.
    1. Andrzejewski C Jr, Popovsky MA, Stec TC, Provencher J, O'Hearn L, Visintainer P, et al. Hemotherapy bedside biovigilance involving vital sign values and characteristics of patients with suspected transfusion reactions associated with fluid challenges: can some cases of transfusion‐associated circulatory overload have proinflammatory aspects? Transfusion. 2012;52:2310–20.
    1. Parmar N, Pendergrast J, Lieberman L, Lin Y, Callum J, Cserti‐Gazdewich C. The association of fever with transfusion‐associated circulatory overload. Vox Sang. 2017;112:70–8.
    1. Piccin A, Cronin M, Brady R, Sweeney J, Marcheselli L, Lawlor E. Transfusion‐associated circulatory overload in Ireland: a review of cases reported to the National Haemovigilance Office 2000 to 2010. Transfusion. 2015;55:1223–30.
    1. Menis M, Anderson SA, Forshee RA, McKean S, Johnson C, Holness L, et al. Transfusion‐associated circulatory overload (TACO) and potential risk factors among the inpatient US elderly as recorded in Medicare administrative databases during 2011. Vox Sang. 2014;106:144–52.
    1. Clifford L, Jia Q, Subramanian A, Yadav H, Schroeder DR, Kor DJ. Risk factors and clinical outcomes associated with perioperative transfusion‐associated circulatory overload. Anesthesiology. 2017;126:409–18.
    1. Nand N, Gupta SP, Gupta MS. Hemodynamic evaluation of blood transfusion in chronic severe anemia with special reference to speed of transfusion. Jpn Heart J. 1985;26:759–65.
    1. Gupta SP, Nand N, Gupta MS, Mohan JC. Haemodynamic changes following blood transfusion in cases of chronic severe anemia: increased safety with simultaneous furosemide administration. Angiology. 1983;34:699–704.
    1. Baron‐Stefaniak J, Leitner GC, Küntzel NKI, Meyer EL, Hiesmayr MJ, Ullrich R, et al. Transfusion of standard‐issue packed red blood cells induces pulmonary vasoconstriction in critically ill patients after cardiac surgery – a randomized, double‐blinded, clinical trial. PLoS One. 2019;14:e0213000.
    1. Berra L, Pinciroli R, Stowell CP, Wang L, Yu B, Fernandez BO, et al. Autologous transfusion of stored red blood cells increases pulmonary artery pressure. Am J Respir Crit Care Med. 2014;190:800–7.
    1. Vlaar AP, Cornet AD, Hofstra JJ, Porcelijn L, Beishuizen A, Kulik W, et al. The effect of blood transfusion on pulmonary permeability in cardiac surgery patients: a prospective multicenter cohort study. Transfusion. 2012;52:82–90.
    1. Murphy EL, Kwaan N, Looney MR, Gajic O, Hubmayr RD, Gropper MA, et al. Risk factors and outcomes in transfusion‐associated circulatory overload. Am J Med. 2013;126:e29–38.
    1. Roubinian NH, Hendrickson JE, Triulzi DJ, Gottschall JL, Michalkiewicz M, Chowdhury D, et al. Contemporary risk factors and outcomes of transfusion‐associated circulatory overload. Crit Care Med. 2018;46:577–85.
    1. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332.
    1. Whitener S, Konoske R, Mark JB. Pulmonary artery catheter. Best Pract Res Clin Anaesthesiol. 2014;28:323–35.
    1. Collins SR, Blank RS, Deatherage LS, Dull RO. Special article: the endothelial glycocalyx: emerging concepts in pulmonary edema and acute lung injury. Anesth Analg. 2013;117:664–74.
    1. Marik PE, Lemson J. Fluid responsiveness: an evolution of our understanding. Br J Anaesth. 2014;112:617–20.
    1. Wiersum‐Osselton JC, Whitaker B, Grey S, Land K, Perez G, Rajbhandary S, et al. Revised international surveillance case definition of transfusion‐associated circulatory overload: a classification agreement validation study. Lancet Haematol. 2019;6:e350–e8.
    1. Monnet X, Teboul JL. Transpulmonary thermodilution: advantages and limits. Crit Care. 2017;21:147.
    1. Senn S. Cross‐over trials in clinical research. Hoboken, NJ: John Wiley & Sons Ltd; 2002.
    1. Fujimoto N, Borlaug BA, Lewis GD, Hastings JL, Shafer KM, Bhella PS, et al. Hemodynamic responses to rapid saline loading: the impact of age, sex, and heart failure. Circulation. 2013;127:55–62.
    1. Tudor GE, Koch GG, Catellier D. 20 statistical methods for crossover designs in bioenvironmental and public health studies. Handbook of statistics. Amsterdam: Elsevier; 2000. p. 571–614.
    1. Cullison M, Mahon R, McGwin G, McCarron R, Browning R, Auker C. Blood transfusions, blood storage, and correlation with elevated pulmonary arterial pressures. Transfusion. 2019;59:1259–66.
    1. Fung YL, Tung JP, Foley SR, Simonova G, Thom O, Staib A, et al. Stored blood transfusion induces transient pulmonary arterial hypertension without impairing coagulation in an ovine model of nontraumatic haemorrhage. Vox Sang. 2013;105:150–8.
    1. Baskurt OK, Meiselman HJ. Blood rheology and hemodynamics. Semin Thromb Hemost. 2003;29:435–50.
    1. Cribbs SK, Martin GS. Fluid balance and colloid osmotic pressure in acute respiratory failure: optimizing therapy. Expert Rev Respir Med. 2009;3:651–62.
    1. Klanderman RB, Bosboom JJ, Korsten H, Zeiler T, Musson REA, Veelo DP, et al. Colloid osmotic pressure of contemporary and novel transfusion products. Vox Sang. 2020;115:664–75.

Source: PubMed

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