TRANSFUSION OF THE INJURED PATIENT: PROCEED WITH CAUTION

Transfusion of the injured patient with packed red blood cells (PRBCs) is a dynamic process requiring vigilance during the acute resuscitative and recovery phases postinjury. Although adverse events have been reported in 2% to 10% of injured patients, the advent of new detection techniques for viral pathogens has markedly decreased the risk of infectious transmission. However, transfusions are strongly associated with immunosuppression in the host, which may occur days after the initial injury and may lead to bacterial infections. Conversely, early transfusion of stored PRBCs, >6 units in the first 12 h postinjury, contributes to an early state of hyperinflammation that is a strong, independent predictor of multiple organ failure (MOF) in those patients with intermediate injury severity scores. The roles of prestorage leukoreduction are also reviewed with respect to the promotion of both immunosuppression and hyperinflammation. We further summarize studies with hemoglobin substitutes, whose use may obviate many of the untoward events of transfusion and promise to lead to better outcomes for injured patients.

[1]  S. Sauerland,et al.  Immunologic Alterations Associated with High Blood Transfusion Volume After Multiple Injury: Effects on Plasmatic Cytokine and Cytokine Receptor Concentrations , 2003, Shock.

[2]  C. Cocanour,et al.  Abdominal compartment syndrome: the cause or effect of postinjury multiple organ failure. , 2003, Shock.

[3]  D. Coyle,et al.  Clinical outcomes following institution of the Canadian universal leukoreduction program for red blood cell transfusions. , 2003, JAMA.

[4]  A. Paterson,et al.  Lysophosphatidylcholines prime the NADPH oxidase and stimulate multiple neutrophil functions through changes in cytosolic calcium , 2003, Journal of leukocyte biology.

[5]  C. Silliman,et al.  Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic factors. , 2003, Blood.

[6]  C. Smith,et al.  A two-insult in vitro model of PMN-mediated pulmonary endothelial damage: requirements for adherence and chemokine release. , 2002, American journal of physiology. Cell physiology.

[7]  J. Minei,et al.  Allogeneic blood transfusion increases the risk of postoperative bacterial infection: a meta-analysis. , 2002, The Journal of trauma.

[8]  C. Silliman,et al.  Physiological levels of interleukin‐18 stimulate multiple neutrophil functions through p38 MAP kinase activation , 2002, Journal of leukocyte biology.

[9]  S. Stramer,et al.  Current prevalence and incidence of infectious disease markers and estimated window‐period risk in the American Red Cross blood donor population , 2002, Transfusion.

[10]  E. Moore,et al.  Increased rate of infection associated with transfusion of old blood after severe injury. , 2002, Archives of surgery.

[11]  E. Jacobs.  Clinical Update: Hemopure® - A Room Temperature Stable Hemoglobin Oxygen Carrier , 2001, AINS. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmertztherapie.

[12]  K. Landsteiner.  [Agglutination phenomena of normal human blood]. , 2001, Wiener klinische Wochenschrift.

[13]  P. Huygens,et al.  Arginase release from red blood cells: possible link in transfusion induced immune suppression? , 2001, Shock.

[14]  E. Moore,et al.  Blood transfusion and the two-insult model of post-injury multiple organ failure. , 2001, Shock.

[15]  D. Cheng.  Safety and efficacy of o-raffinose cross-linked human hemoglobin (Hemolink) in cardiac surgery. , 2001, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[16]  E. Moore,et al.  Plasma from aged stored red blood cells delays neutrophil apoptosis and primes for cytotoxicity: abrogation by poststorage washing but not prestorage leukoreduction. , 2001, The Journal of trauma.

[17]  F. Moore,et al.  POST‐INJURY MULTIPLE ORGAN FAILURE: THE ROLE OF THE GUT , 2001, Shock.

[18]  E. Moore,et al.  Age of transfused blood is an independent risk factor for postinjury multiple organ failure. , 1999, American journal of surgery.

[19]  D. Gens,et al.  Diaspirin Cross-Linked Hemoglobin (DCLHb) in the Treatment of Severe Traumatic Hemorrhagic Shock: A Randomized Controlled Efficacy Trial , 1999 .

[20]  J. Szalai,et al.  Infection in hospitalized trauma patients: incidence, risk factors, and complications. , 1999, The Journal of trauma.

[21]  S. Wilson,et al.  Improved survival following massive transfusion in patients who have undergone trauma. , 1999, Archives of surgery.

[22]  C. Silliman,et al.  Transfusion-related acute lung injury. , 2005, Blood.

[23]  E. Moore,et al.  Resuscitation with a blood substitute abrogates pathologic postinjury neutrophil cytotoxic function. , 1999, The Journal of trauma.

[24]  M. Blajchman,et al.  Transfusion‐associated immunomodulation and universal white cell reduction: are we putting the cart before the horse? , 1999, Transfusion.

[25]  E. Moore,et al.  Resuscitation of the injured patient with polymerized stroma-free hemoglobin does not produce systemic or pulmonary hypertension. , 1998, American journal of surgery.

[26]  E. Moore,et al.  The first randomized trial of human polymerized hemoglobin as a blood substitute in acute trauma and emergent surgery. , 1998, Journal of the American College of Surgeons.

[27]  E. Faist,et al.  SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS), MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS), MULTIPLE ORGAN FAILURE (MOF): ARE WE WINNING THE BATTLE? , 1998, Shock.

[28]  N. Voelkel,et al.  Plasma and lipids from stored packed red blood cells cause acute lung injury in an animal model. , 1998, The Journal of clinical investigation.

[29]  A. Gulati,et al.  MODULATION OF RESUSCITATIVE EFFECT OF DIASPIRIN CROSS‐LINKED HEMOGLOBIN BY L‐NAME IN RATS , 1998, Shock.

[30]  J. Hermans,et al.  Beneficial effects of leukocyte depletion of transfused blood on postoperative complications in patients undergoing cardiac surgery: a randomized clinical trial. , 1998, Circulation.

[31]  M. Nucci,et al.  The search for blood substitutes. , 1998, Scientific American.

[32]  A. Gulati,et al.  DOSE‐DEPENDENT EFFECT OF DIASPIRIN CROSS‐LINKED HEMOGLOBIN ON REGIONAL BLOOD CIRCULATION OF SEVERELY HEMORRHAGED RATS , 1998, Shock.

[33]  M. Tweeddale,et al.  Association of mortality with age of blood transfused in septic ICU patients , 1997, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[34]  E. Moore,et al.  Clinical utility of human polymerized hemoglobin as a blood substitute after acute trauma and urgent surgery. , 1997, The Journal of trauma.

[35]  M. Remberger,et al.  Generation of cytokines in red cell concentrates during storage is prevented by prestorage white cell reduction , 1997, Transfusion.

[36]  A. Paterson,et al.  The association of biologically active lipids with the development of transfusion‐related acute lung injury: a retrospective study , 1997, Transfusion.

[37]  A. Sauaia,et al.  Blood Transfusion: An Independent Risk Factor for Postinjury Multiple Organ Failure , 1997 .

[38]  F. Moore,et al.  REDUCED PAF‐ACETYLHYDROLASE ACTIVITY IS ASSOCIATED WITH POSTINJURY MULTIPLE ORGAN FAILURE , 1997, Shock.

[39]  H. Nielsen,et al.  Time‐dependent, spontaneous release of white cell‐ and platelet‐derived bioactive substances from stored human blood , 1996, Transfusion.

[40]  N. Qvist,et al.  Randomised comparison of leucocyte-depleted versus buffy-coat-poor blood transfusion and complications after colorectal surgery , 1996, The Lancet.

[41]  N. Blumberg,et al.  Immunomodulation by blood transfusion: an evolving scientific and clinical challenge. , 1996, The American journal of medicine.

[42]  S. Kleinman,et al.  The Risk of Transfusion-Transmitted Viral Infections , 1996 .

[43]  A. Sauaia,et al.  Early Risk Factors for Postinjury Multiple Organ Failure , 1996, World Journal of Surgery.

[44]  E. Moore,et al.  Neutrophil priming and activation in the pathogenesis of postinjury multiple organ failure. , 1996, New horizons.

[45]  G. Regel,et al.  Pattern of Organ Failure following Severe Trauma , 1996, World Journal of Surgery.

[46]  M. Soop,et al.  Cytokines in stored red blood cell concentrates: promoters of systemic inflammation and simulators of acute transfusion reactions? , 1996, Acta anaesthesiologica Scandinavica.

[47]  C. Cayten,et al.  Early Predictors of Sepsis in the Motor-Vehicle Crash Trauma Victim , 1996, Prehospital and Disaster Medicine.

[48]  C. Silliman,et al.  Analysis of the priming activity of lipids generated during routine storage of platelet concentrates , 1996, Transfusion.

[49]  K. Burhop,et al.  THE EFFECTS OF DIASPIRIN CROSS‐LINKED HEMOGLOBIN IN SEPSIS , 1996, Shock.

[50]  H. Allgayer,et al.  MODULATION OF IMMUNE RESPONSE BY BLOOD TRANSFUSION: EVIDENCE FOR A DIFFERENTIAL EFFECT OF ALLOGENEIC AND AUTOLOGOUS BLOOD IN COLORECTAL CANCER SURGERY , 1995, Shock.

[51]  W. Uhl,et al.  A multicenter study of phospholipase A2 in patients in intensive care units. , 1995, Journal of the American College of Surgeons.

[52]  C. Silliman,et al.  Partial characterization of lipids that develop during the routine storage of blood and prime the neutrophil NADPH oxidase. , 1994, The Journal of laboratory and clinical medicine.

[53]  J. Kelton,et al.  The role of the plasma from platelet concentrates in transfusion reactions. , 1994, The New England journal of medicine.

[54]  R. Roumen,et al.  Serum lipofuscin as a prognostic indicator of adult respiratory distress syndrome and multiple organ failure , 1994, The British journal of surgery.

[55]  R. Nichols,et al.  Risk of infection, infecting flora and treatment considerations in penetrating abdominal trauma , 1994, Surgery, gynecology & obstetrics.

[56]  T. Wobbes,et al.  Randomised controlled trial comparing transfusion of leucocyte-depleted or buffy-coat-depleted blood in surgery for colorectal cancer , 1994, The Lancet.

[57]  J. Ogden,et al.  The Development of Hemoglobin Solutions as Red Cell Substitutes , 1994, International anesthesiology clinics.

[58]  E. Snyder,et al.  Cytokine generation in stored platelet concentrates , 1994, Transfusion.

[59]  E. Moore,et al.  Postinjury multiple organ failure: role of extrathoracic injury and sepsis in adult respiratory distress syndrome. , 1993, New horizons.

[60]  R. Goris,et al.  Scoring systems and blood lactate concentrations in relation to the development of adult respiratory distress syndrome and multiple organ failure in severely traumatized patients. , 1993, The Journal of trauma.

[61]  J. Hess,et al.  Systemic and pulmonary hypertension after resuscitation with cell-free hemoglobin. , 1993, Journal of applied physiology.

[62]  M. Peetermans,et al.  Increased tumor necrosis factor alpha (TNF alpha), interleukin 1, and interleukin 6 (IL‐6) levels in the plasma of stored platelet concentrates: relationship between TNF alpha and IL‐6 levels and febrile transfusion reactions , 1993, Transfusion.

[63]  S. M. Hamilton.  The use of blood in resuscitation of the trauma patient. , 1993, Canadian journal of surgery. Journal canadien de chirurgie.

[64]  C. Cayten,et al.  Blood transfusion increases the risk of infection after trauma. , 1993, Archives of surgery.

[65]  Morgan As.  Risk factors for infection in the trauma patient. , 1992 .

[66]  T. Edna,et al.  Association between blood transfusion and infection in injured patients. , 1992, The Journal of trauma.

[67]  P. Christiansen,et al.  Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery , 1992, The British journal of surgery.

[68]  G. Leparc,et al.  Infection after injury: association with blood transfusion. , 1992, The American surgeon.

[69]  J. Macarthur,et al.  Hypothermia and acidosis worsen coagulopathy in the patient requiring massive transfusion. , 1991, American journal of surgery.

[70]  E. Moore,et al.  Incommensurate oxygen consumption in response to maximal oxygen availability predicts postinjury multiple organ failure. , 1991, The Journal of trauma.

[71]  J. Waymack,et al.  The effect of transfusions on the incidence of bacterial infection. , 1990, Military Medicine.

[72]  G. Andreu,et al.  Prevention of HLA immunization with leukocyte-poor packed red cells and platelet concentrates obtained by filtration. , 1988, Blood.

[73]  A. Ledgerwood,et al.  The effect of hemorrhagic shock on the clotting cascade in injured patients. , 1988, The Journal of trauma.

[74]  D. Heimbach,et al.  Clotting factor levels and the risk of diffuse microvascular bleeding in the massively transfused patient , 1987, British journal of haematology.

[75]  R. Wilson,et al.  Outcome of massive transfusion exceeding two blood volumes in trauma and emergency surgery. , 1987, The Journal of trauma.

[76]  G. Luna,et al.  Nonoperative observation therapy for splenic injuries: a safe therapeutic option? , 1987, American journal of surgery.

[77]  M. Malangoni,et al.  The risk of infection after colon injury. , 1986, Surgery.

[78]  S. Moore,et al.  Diagnostic and pathogenetic considerations in transfusion‐related acute lung injury , 1985, Transfusion.

[79]  E. Mammen,et al.  Serial changes in primary hemostasis after massive transfusion. , 1985, Surgery.

[80]  D. Trunkey,et al.  Risk of infection after penetrating abdominal trauma. , 1984, The New England journal of medicine.

[81]  D. Goldfinger,et al.  Prevention of Adverse Reactions to Blood Transfusion by the Administration of Saline‐Washed Red Blood Cells , 1981, Transfusion.

[82]  Lucas Ce,et al.  Clinical significance of altered coagulation tests after massive transfusion for trauma. , 1981, The American surgeon.

[83]  T. Simon,et al.  Hemostasis in Massively Transfused Trauma Patients , 1979, Annals of surgery.

[84]  P. Terasaki,et al.  Improvement of kidney-graft survival with increased numbers of blood transfusions. , 1978, The New England journal of medicine.

[85]  A. Baue.  Multiple, progressive, or sequential systems failure. A syndrome of the 1970s. , 1975, Archives of surgery.

[86]  AL SNIECINSKIEl.  Prevention of Refractoriness and HLA-Alloimmunization Using Filtered Blood Products , 2005 .

[87]  E. Moore.  Blood substitutes: the future is now. , 2003, Journal of the American College of Surgeons.

[88]  E. Moore,et al.  Alteration of the postinjury hyperinflammatory response by means of resuscitation with a red cell substitute. , 2003, The Journal of trauma.

[89]  L. Pearce,et al.  The pharmacology of tissue oxygenation by biopure's hemoglobin-based oxygen carrier, Hemopure (HBOC-201). , 2003, Advances in experimental medicine and biology.

[90]  M. Ochsner,et al.  Post hoc mortality analysis of the efficacy trial of diaspirin cross-linked hemoglobin in the treatment of severe traumatic hemorrhagic shock. , 2002, The Journal of trauma.

[91]  M. Blajchman.  Incidence and significance of the bacterial contamination of blood components. , 2002, Developments in biologicals.

[92]  J. Freedman,et al.  Proceedings of a consensus conference: prevention of post-transfusion CMV in the era of universal leukoreduction. , 2001, Transfusion medicine reviews.

[93]  S. Kleinman,et al.  Leukocyte reduction of blood components: public policy and new technology. , 2000, Transfusion medicine reviews.

[94]  A. Baue,et al.  Multiple Organ Failure , 2000, Springer New York.

[95]  E. Moore,et al.  Stored red blood cells selectively activate human neutrophils to release IL-8 and secretory PLA2. , 2000, Shock.

[96]  E. Vamvakas,et al.  Prestorage versus poststorage white cell reduction for the prevention of the deleterious immunomodulatory effects of allogeneic blood transfusion. , 2000, Transfusion medicine reviews.

[97]  A. Sauaia,et al.  Multiple organ failure can be predicted as early as 12 hours after injury. , 1998, The Journal of trauma.

[98]  S. Kleinman,et al.  The risk of transfusion-transmitted viral infections. The Retrovirus Epidemiology Donor Study. , 1996, The New England journal of medicine.

[99]  M. Blajchman,et al.  Growth enhancement of established tumors by allogeneic blood transfusion in experimental animals and its amelioration by leukodepletion: the importance of the timing of the leukodepletion. , 1994, Blood.

[100]  N. Heddle,et al.  Biologic effects of leukocytes present in transfused cellular blood products. , 1994, Blood.

[101]  A. Sauaia,et al.  Early predictors of postinjury multiple organ failure. , 1994, Archives of surgery.

[102]  A. Morgan.  Risk factors for infection in the trauma patient. , 1992, Journal of the National Medical Association.

[103]  J. Morris,et al.  Massive transfusion: outcome in blunt trauma patients. , 1991, The Journal of trauma.

[104]  R. Dennis,et al.  Risk factors for multiorgan failure: a case-control study. , 1991, The Journal of trauma.

[105]  D. Heimbach,et al.  Prophylactic platelet administration during massive transfusion. A prospective, randomized, double-blind clinical study. , 1986, Annals of surgery.

[106]  E. Dellinger,et al.  Risk of infection following laparotomy for penetrating abdominal injury. , 1984, Archives of surgery.

[107]  M. Pečan,et al.  [Massive transfusion]. , 1982, Acta chirurgica Iugoslavica.

[108]  A. Ledgerwood,et al.  Clinical significance of altered coagulation tests after massive transfusion for trauma. , 1981, The American surgeon.