Autologous Transfusion of Stored Red Blood Cells Increases Pulmonary Artery Pressure

作者：Berra Lorenzo^*; Pinciroli Riccardo; Stowell Christopher P; Wang Lin; Yu Binlan; Femandez Bernadette O; Feelisch Martin; Mietto Cristina; Hod Eldad A; Chipman Daniel; Scherrer Cro**ie Marie Ile; Bloch Kenneth D; Zapol Warren M

来源：American Journal of Respiratory and Critical Care Medicine, 2014, 190(7): 800-807.

DOI：10.1164/rccm.201405-0850OC

• hemoglobins
• pulmonary hypertension
• nitric oxide
• endothelium
• echocardiography

Rationale: Transfusion of erythrocytes stored for prolonged periods is associated with increased mortality. Erythrocytes undergo hemolysis during storage and after transfusion. Plasma hemoglobin scavenges endogenous nitric oxide leading to systemic and pulmonary vasoconstriction. %26lt;br%26gt;Objectives: We hypothesized that transfusion of autologous blood stored for 40 days would increase the pulmonary artery pressure in volunteers with endothelial dysimpaired endothelial production of nitric oxide). We also tested whether breathing nitric oxide before and during transfusion could prevent the increase of pulmonary artery pressure. %26lt;br%26gt;Methods: Fourteen obese adults with endothelial dysfunction were enrolled in a randomized crossover study of transfusing autologous, leukoreduced blood stored for either 3 or 40 days. Volunteers were transfused with 3-day blood, 40-day blood, and 40-day blood while breathing 80 ppm nitric oxide. %26lt;br%26gt;Measurements and Main Results: The age of volunteers was 41 +/- 4 years (mean +/- SEM), and their body mass index was 33.4 +/- 1.3 kg/m(2). Plasma hemoglobin concentrations increased after transfusion with 40-day and 40-day plus nitric oxide blood but not after transfusing 3-day blood. Mean pulmonary artery pressure, estimated by transthoracic echocardiography, increased after transfusing 40-day blood (18 +/- 2 to 23 +/- 2 mm Hg; P %26lt; 0.05) but did not change after transfusing 3-day blood (17 +/- 2 to 18 +/- 2 mm Hg; P = 0.5). Breathing nitric oxide decreased pulmonary artery pressure in volunteers transfused with 40-day blood (17 +/- 2 to 12 +/- 1 mm Hg; P %26lt; 0.05). %26lt;br%26gt;Conclusions: Transfusion of autologous leukoreduced blood stored for 40 days was associated with increased plasma hemoglobin levels and increased pulmonary artery pressure. Breathing nitric oxide prevents the increase of pulmonary artery pressure produced by transfusing stored blood.

• 出版日期2014-10-1