Haemostatic function and biomarkers of endothelial damage before and after RBC transfusion in patients with haematologic disease

TY - JOUR

T1 - Haemostatic function and biomarkers of endothelial damage before and after RBC transfusion in patients with haematologic disease

AU - Larsen, A M

AU - Leinøe, E B

AU - Johansson, P I

AU - Birgens, H

AU - Ostrowski, S R

N1 - © 2015 International Society of Blood Transfusion.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Background and objectives: Transfusion of red blood cells (RBC) is beneficial for the patient but can also be harmful, as randomized trials have demonstrated increased infection rates, bleeding and mortality. The study aim was to investigate the response of the vascular system (the haemostatic function and the endothelium) to RBC transfusion. Materials and Methods: Blood was sampled from patients with various transfusion-dependent haematologic diseases before 1 and 24 h after RBC transfusion. Primary and secondary haemostasis was evaluated by whole-blood impedance aggregometry (Multiplate) and by thromboelastography (TEG). Samples were analysed by ELISA for biomarkers reflecting endothelial activation and damage (sICAM-1, syndecan-1, sThrombomodulin (sTM), sVE-Cadherin), platelet activation (sCD40L) and inflammation (hsCRP). Results: A total of 58 patients were enrolled in the study. Median age was 71 years. Compared to before transfusion, patients had slightly reduced coagulability 1 h after RBC transfusion, assessed by TEG. However, transfusion of older RBC products (>14 days) was associated with increased coagulability (all P < 0·05). The level of syndecan-1 increased slightly 24 h after transfusion (median 12·4 (IQR 9-23) vs. 13·2 (9-25) ng/ml, P < 0·01), indicating increased glycocalyx degradation. Conclusion: Overall, RBC transfusion was associated with reduced coagulability and endothelial glycocalyx degradation. Transfusion of older RBCs was however associated with increased coagulability. The changes observed were small to moderate and the clinical relevance of these findings should be investigated in larger studies.

AB - Background and objectives: Transfusion of red blood cells (RBC) is beneficial for the patient but can also be harmful, as randomized trials have demonstrated increased infection rates, bleeding and mortality. The study aim was to investigate the response of the vascular system (the haemostatic function and the endothelium) to RBC transfusion. Materials and Methods: Blood was sampled from patients with various transfusion-dependent haematologic diseases before 1 and 24 h after RBC transfusion. Primary and secondary haemostasis was evaluated by whole-blood impedance aggregometry (Multiplate) and by thromboelastography (TEG). Samples were analysed by ELISA for biomarkers reflecting endothelial activation and damage (sICAM-1, syndecan-1, sThrombomodulin (sTM), sVE-Cadherin), platelet activation (sCD40L) and inflammation (hsCRP). Results: A total of 58 patients were enrolled in the study. Median age was 71 years. Compared to before transfusion, patients had slightly reduced coagulability 1 h after RBC transfusion, assessed by TEG. However, transfusion of older RBC products (>14 days) was associated with increased coagulability (all P < 0·05). The level of syndecan-1 increased slightly 24 h after transfusion (median 12·4 (IQR 9-23) vs. 13·2 (9-25) ng/ml, P < 0·01), indicating increased glycocalyx degradation. Conclusion: Overall, RBC transfusion was associated with reduced coagulability and endothelial glycocalyx degradation. Transfusion of older RBCs was however associated with increased coagulability. The changes observed were small to moderate and the clinical relevance of these findings should be investigated in larger studies.

KW - Adult

KW - Aged

KW - Antigens, CD

KW - Biomarkers

KW - C-Reactive Protein

KW - CD40 Ligand

KW - Cadherins

KW - Enzyme-Linked Immunosorbent Assay

KW - Erythrocyte Transfusion

KW - Erythrocytes

KW - Female

KW - Hematologic Diseases

KW - Humans

KW - Intercellular Adhesion Molecule-1

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Syndecan-1

KW - Thrombelastography

KW - Thrombomodulin

U2 - 10.1111/vox.12249

DO - 10.1111/vox.12249

M3 - Journal article

C2 - 25754541

SN - 0042-9007

VL - 109

SP - 52

EP - 61

JO - Vox Sanguinis

JF - Vox Sanguinis

IS - 1

ER -