Transfusion practices and novel blood products: Pre-clinical and clinical studies

This thesis includes several aspects of the current transfusion research field. Clinical transfusion practice was assessed in two surveys among physicians working in the ICU and in a small prospective cohort study. The surveys showed that red blood cells (RBCs) were relatively restrictively transfused, whilst platelet and plasma transfusion practice were more heterogenous and more liberal. Unfortunately, surveys only give insights in how physicians believe patients should be transfused. Therefore, we also performed a small prospective study to show how patients are actually transfused. This small study acts as a pilot study for a large international prospective study on transfusion practices.
In a pre-clinical randomized controlled trial in twenty healthy volunteers, the effect of an alkaline chloride-free additive solution of RBCs was assessed on post transfusion recovery and metabolic restoration. This study showed that RBCs stored in an alkaline chloride-free additive solution did not have a better post transfusion recovery (PTR) despite a better metabolic state in these RBCs. Furthermore, RBCs that were recovered from the circulation, showed reversal of the metabolic storage lesion after transfusion. Finally, we validated a novel method to label platelets with biotin as an alternative for radiolabelled platelets. While the procedural steps resulted in a small increase of platelet activation, the biotin label itself did not affect the quality of platelets. This method can be used in order to assess the PTR of platelets and to isolate platelets from the recipient’s circulation after transfusion.