TY - JOUR
T1 - Effect of red blood cell transfusion on inflammation, endothelial cell activation and coagulation in the critically ill
AU - van Manen, Lisa
AU - van Hezel, Maike E.
AU - Boshuizen, Margit
AU - Straat, Marleen
AU - de Man, Angelique M. E.
AU - Dekimpe, Charlotte
AU - Vanhoorelbeke, Karen
AU - van Bruggen, Robin
AU - Juffermans, Nicole P.
N1 - Publisher Copyright: © 2021 The Authors. Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2022/1
Y1 - 2022/1
N2 - Background and Objectives: Red blood cell (RBC) transfusion is a frequently applied intervention in an intensive care unit. However, transfusion is associated with adverse outcomes including organ failure and thrombo-embolic events. Mechanisms of these effects are not known but may be related to activation of the endothelium or of the coagulation or inflammatory system. We hypothesized that a RBC transfusion in the critically ill would result in further activation of these systems. Materials and Methods: In 74 non-bleeding critically ill patients receiving one RBC unit, markers of inflammation, endothelial cell activation and coagulation were measured before transfusion, at 1 h after transfusion and 24 h after transfusion. The impact of disease severity of the recipient on these changes was assessed by comparing septic and non-septic patients (according to sepsis-3 definition) and by correlation of biomarkers with the sequential organ failure assessment (SOFA) score. Results: Levels of von Willebrand Factor (vWF), soluble ICAM-1, soluble thrombomodulin, fibrinogen and d-dimer were already high at baseline, whereas ADAMTS13 levels were low. VWF levels increased significantly 24 h after RBC transfusion (median 478% (338–597) vs. 526% (395–623), p = 0.009). The other biomarkers did not change significantly. Post transfusion change was not dependent on the presence of sepsis and was not correlated with SOFA score. Conclusion: RBC transfusion in critically ill patients was associated with an increase in circulating vWF levels, suggesting a further increase in activation of the endothelium, a finding that was independent of the presence of sepsis or organ injury level.
AB - Background and Objectives: Red blood cell (RBC) transfusion is a frequently applied intervention in an intensive care unit. However, transfusion is associated with adverse outcomes including organ failure and thrombo-embolic events. Mechanisms of these effects are not known but may be related to activation of the endothelium or of the coagulation or inflammatory system. We hypothesized that a RBC transfusion in the critically ill would result in further activation of these systems. Materials and Methods: In 74 non-bleeding critically ill patients receiving one RBC unit, markers of inflammation, endothelial cell activation and coagulation were measured before transfusion, at 1 h after transfusion and 24 h after transfusion. The impact of disease severity of the recipient on these changes was assessed by comparing septic and non-septic patients (according to sepsis-3 definition) and by correlation of biomarkers with the sequential organ failure assessment (SOFA) score. Results: Levels of von Willebrand Factor (vWF), soluble ICAM-1, soluble thrombomodulin, fibrinogen and d-dimer were already high at baseline, whereas ADAMTS13 levels were low. VWF levels increased significantly 24 h after RBC transfusion (median 478% (338–597) vs. 526% (395–623), p = 0.009). The other biomarkers did not change significantly. Post transfusion change was not dependent on the presence of sepsis and was not correlated with SOFA score. Conclusion: RBC transfusion in critically ill patients was associated with an increase in circulating vWF levels, suggesting a further increase in activation of the endothelium, a finding that was independent of the presence of sepsis or organ injury level.
KW - RBC transfusion
KW - coagulation
KW - critically ill patients
KW - endothelial activation
KW - inflammation
UR - http://www.scopus.com/inward/record.url?scp=85109003847&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/vox.13125
DO - https://doi.org/10.1111/vox.13125
M3 - Article
C2 - 34196412
SN - 0042-9007
VL - 117
SP - 64
EP - 70
JO - Vox sanguinis
JF - Vox sanguinis
IS - 1
ER -