TY - JOUR
T1 - The effect of plasma transfusion in an experimental two-hit animal model of transfusion-associated circulatory overload with heart failure
AU - Bulle, Esther B.
AU - Klanderman, Robert B.
AU - de Wissel, Marit B.
AU - Roelofs, Joris J. T. H.
AU - Veelo, Denise P.
AU - van den Brom, Charissa E.
AU - Kapur, Rick
AU - Vlaar, Alexander P. J.
N1 - Funding Information: is research was funded by a Landsteiner Foundation for Blood Research (LSBR) fellowship grant to A.P.J. Vlaar, number 1931F. From the Landsteiner Foundation for Blood Transfusion Research, Haarlem, the Netherlands. e funding body was in no way involved in the study design, collection, analysis and the interpretation of data, nor in writing the manuscript. Publisher Copyright: © 2023 Edizioni SIMTI. All rights reserved.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - BACKGROUND: Transfusion-associated circulatory overload (TACO) is a leading cause of transfusion-related morbidity and mortality. TACO follows a two-hit pathophysiology, where comorbidities like cardiac or renal failure act as the first hit followed by blood transfusion as a second hit. Observational studies suggest that plasma transfusion is more likely to cause TACO than other blood products. We conducted a randomized animal study to gather evidence that plasma transfusion can induce TACO. MATERIAL AND METHODS: As a first hit a large myocardial infarction was created in male Wistar rats. Then animals were randomized to receive 4 units of solvent/ detergent-treated pooled plasma (SDP), fresh frozen plasma (FFP), a colloid control (albumin 5%) or a crystalloid fluid control (Ringer's lactate) (n=10 per group). The primary outcome was the difference between pre- and post-transfusion left-ventricular end diastolic pressure (ΔLVEDP). Secondary outcomes were markers for acute lung injury; lung wet/dry weight ratio, PaO2/FiO2 ratio and pulmonary histological assessment. RESULTS: Pre-transfusion characteristics were similar between groups. ΔLVEDP increased significantly after transfusion with SDP (7.7 mmHg; 4.5-10.5) and albumin (13.0 mmHg; 6.5-15.2), but not after FFP (7.9 mmHg, 1.1; 11.3) compared to infusion with Ringer's lactate (0.6 mmHg; 0.4-2.2), p=0.007, p=0.0005 and p=0.14 respectively. There were no significant differences in ΔLVEDP between groups receiving SDP, FFP or albumin. There was no increase in acute lung injury in any group compared to other groups. DISCUSSION: Circulatory overload, measured as ΔLVEDP, was induced after transfusion of SDP or albumin, but not after infusion of Ringer's lactate. These results show that the effect of plasma transfusion on ΔLVEDP differs from fluid overload induced by crystalloid infusion. Colloid osmotic pressure may be an important component in the development of TACO and should be a target for future research.
AB - BACKGROUND: Transfusion-associated circulatory overload (TACO) is a leading cause of transfusion-related morbidity and mortality. TACO follows a two-hit pathophysiology, where comorbidities like cardiac or renal failure act as the first hit followed by blood transfusion as a second hit. Observational studies suggest that plasma transfusion is more likely to cause TACO than other blood products. We conducted a randomized animal study to gather evidence that plasma transfusion can induce TACO. MATERIAL AND METHODS: As a first hit a large myocardial infarction was created in male Wistar rats. Then animals were randomized to receive 4 units of solvent/ detergent-treated pooled plasma (SDP), fresh frozen plasma (FFP), a colloid control (albumin 5%) or a crystalloid fluid control (Ringer's lactate) (n=10 per group). The primary outcome was the difference between pre- and post-transfusion left-ventricular end diastolic pressure (ΔLVEDP). Secondary outcomes were markers for acute lung injury; lung wet/dry weight ratio, PaO2/FiO2 ratio and pulmonary histological assessment. RESULTS: Pre-transfusion characteristics were similar between groups. ΔLVEDP increased significantly after transfusion with SDP (7.7 mmHg; 4.5-10.5) and albumin (13.0 mmHg; 6.5-15.2), but not after FFP (7.9 mmHg, 1.1; 11.3) compared to infusion with Ringer's lactate (0.6 mmHg; 0.4-2.2), p=0.007, p=0.0005 and p=0.14 respectively. There were no significant differences in ΔLVEDP between groups receiving SDP, FFP or albumin. There was no increase in acute lung injury in any group compared to other groups. DISCUSSION: Circulatory overload, measured as ΔLVEDP, was induced after transfusion of SDP or albumin, but not after infusion of Ringer's lactate. These results show that the effect of plasma transfusion on ΔLVEDP differs from fluid overload induced by crystalloid infusion. Colloid osmotic pressure may be an important component in the development of TACO and should be a target for future research.
KW - animal models
KW - plasma
KW - pulmonary edema
KW - transfusion reaction
KW - transfusion-associated circulatory overload
UR - http://www.scopus.com/inward/record.url?scp=85159550979&partnerID=8YFLogxK
U2 - https://doi.org/10.2450/2022.0141-22
DO - https://doi.org/10.2450/2022.0141-22
M3 - Article
C2 - 36346876
SN - 1723-2007
VL - 21
SP - 218
EP - 226
JO - Blood transfusion
JF - Blood transfusion
IS - 3
ER -