Estimation of Achievable Oxygen Consumption Following Transfusion With Rejuvenated Red Blood Cells.

Published

Journal Article

Erythrocyte storage induces a nonphysiological increase in hemoglobin-oxygen affinity (quantified by low p50, the oxygen tension at 50% hemoglobin saturation), which can be restored through biochemical rejuvenation. The objective was to mathematically model the impact of transfusing up to 3 standard allogeneic units or rejuvenated units on oxygen delivery (DO2) and oxygen consumption (VO2). Oxygen dissociation curves were generated from additive solution-1 red blood cell (RBC) leukoreduced units (n = 7) before and after rejuvenation following manufacturer's instructions. Two of these units were used to prepare standard or rejuvenated donor RBC and added to samples of fresh whole blood. These admixtures were used to construct an in vitro transfusion model of postoperative anemia and determine a linear equation for calculating the sample p50, which was subsequently used to calculate DO2 and VO2 after simulated transfusions. Whole blood-packed red blood cell unit admixture p50s could be predicted from a linear model including the p50 of its components, the mass fraction of the transfused component, and interaction terms (R2 = .99, P < 0.001). Transfusion with standard units slightly, but significantly, increased projected DO2 compared with rejuvenated units (P = 0.03), but rejuvenated units markedly increased projected VO2 (P = 0.03). Standard units did not significantly change VO2 relative to pre-transfusion levels (P > 0.1). Using high-p50, rejuvenated RBC in simulated transfusions greatly improved projected VO2, indicating the potential for increased end-organ oxygen availability compared with standard transfusion. Patient capacity to increase cardiac output after cardiac surgery may be limited. Transfusing high-p50 RBC in this setting may improve the perioperative care of these patients.

Full Text

Duke Authors

Cited Authors

  • Srinivasan, AJ; Kausch, K; Inglut, C; Gray, A; Landrigan, M; Poisson, JL; Schroder, JN; Welsby, IJ

Published Date

  • June 2018

Published In

Volume / Issue

  • 30 / 2

Start / End Page

  • 134 - 141

PubMed ID

  • 29432891

Pubmed Central ID

  • 29432891

Electronic International Standard Serial Number (EISSN)

  • 1532-9488

International Standard Serial Number (ISSN)

  • 1043-0679

Digital Object Identifier (DOI)

  • 10.1053/j.semtcvs.2018.02.009

Language

  • eng