Metabolic impact of red blood cell exchange with rejuvenated red blood cells in sickle cell patients.

Journal Article (Journal Article)

BACKGROUND: Red blood cell exchange (RCE) transfusions are a mainstay in the treatment of sickle cell anemia (SCA), and allow a temporary restoration of physiological parameters with respect to erythrocyte oxygen carrying capacity and systems metabolism. Recently, we noted that 1) RCE significantly impacts recipients' metabolism in SCA; 2) fresh and end-of-storage red blood cell (RBC) units differently impact systems of metabolism in healthy autologous recipients; and 3) phosphate/inosine/pyruvate/adenine (PIPA) solution reverses the metabolic age of stored RBCs. Therefore, we hypothesized that RCE with PIPA-treated RBC units could further increase the metabolic benefits of RCE in SCA patients. STUDY DESIGN AND METHODS: Circulating plasma and erythrocytes were collected from patients with SCA before and after RCE, with either conventional or PIPA-treated RBC units, prior to metabolomics analyses. RESULTS: Consistent with prior work, RCE significantly decreased circulating levels of markers of systemic hypoxemia (lactate, succinate) and decreased plasma levels of acyl-carnitines and amino acids. However, PIPA-treated exchanges were superior to untreated RCEs, with a higher energy state and an increased capacity to activate the pentose phosphate pathway and glutamine metabolism. In addition, RBCs and plasma from recipients of PIPA-treated RBC units resulted in significantly decreased levels of post-transfusion plasticizers, though at the expense of higher circulating levels of oxidized purines (hypoxanthine, xanthine, and the antioxidant urate). CONCLUSION: Transfusion of PIPA-treated RBCs further increases the metabolic benefits of RCE to patients with SCA, significantly reducing the levels of post-transfusion plasticizers.

Full Text

Duke Authors

Cited Authors

  • Gehrke, S; Shah, N; Gamboni, F; Kamyszek, R; Srinivasan, AJ; Gray, A; Landrigan, M; Welsby, I; D'Alessandro, A

Published Date

  • October 2019

Published In

Volume / Issue

  • 59 / 10

Start / End Page

  • 3102 - 3112

PubMed ID

  • 31385330

Pubmed Central ID

  • PMC6785363

Electronic International Standard Serial Number (EISSN)

  • 1537-2995

Digital Object Identifier (DOI)

  • 10.1111/trf.15467


  • eng

Conference Location

  • United States