Comparison of transfusion with DCLHb or pRBCs for treatment of intraoperative anemia in sheep

2002 ◽  
Vol 92 (1) ◽  
pp. 343-353 ◽  
Author(s):  
Luiz A. Vane ◽  
J. Sean Funston ◽  
Robert Kirschner ◽  
Don Harper ◽  
Donald J. Deyo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Blood Cells ◽  
Volume Expansion ◽  
Filling Pressure ◽  
Arterial Oxygen ◽  
Control Group ◽  
Hemodynamic Effects ◽  
Total Blood ◽  
Arterial Oxygen Content ◽  
Packed Red Blood Cells

Isoflurane-anesthetized sheep were transfused with packed red blood cells (pRBCs) or diaspirin cross-linked hemoglobin (DCLHb) for treatment of intraoperative hemorrhage. A rapid 15-min hemorrhage with lactated Ringer (LR) infusion maintained filling pressure at baseline and reduced blood hemoglobin (Hb) to ∼5 g/dl. Sheep received 2 g/kg Hb, DCLHb ( n = 6), or pRBCs ( n = 7); control group received LR alone ( n = 6). After 2 h, anesthesia was discontinued; sheep were monitored in the animal intensive care unit for 48 h. DCLHb expanded blood volume more, but increased total blood Hb less, than pRBCs. Lower Hb and increased methemoglobin resulted in lower arterial oxygen content compared with the pRBCs. DCLHb caused pulmonary hypertension (from 13 to 30 mmHg) and elevated filling pressure (from 6 to 15 mmHg). Cardiac outputs (CO) were similar for all groups during anesthesia; however, during recovery CO increased only in the LR and packed pRBCs groups. DCLHb may limit the reflex ability to increase CO after volume expansion. Hemodynamic effects of DCLHb may be exaggerated when infused after large-volume LR.

Fetal sheep endocrine responses to sustained hypoxemic stress after chronic fetal placental embolization

1997 ◽  
Vol 272 (5) ◽  
pp. E817-E823 ◽  
Author(s):  
R. Gagnon ◽  
J. Murotsuki ◽  
J. R. Challis ◽  
L. Fraher ◽  
B. S. Richardson
Keyword(s):  
Blood Flow ◽  
Oxygen Content ◽  
Regional Distribution ◽  
Arterial Oxygen ◽  
Control Group ◽  
Fetal Sheep ◽  
Arterial Oxygen Content ◽  
Placental Blood ◽  
Chronic Hypoxemia ◽  
Placental Blood Flow

The purpose of this study was to determine the endocrine and circulatory responses of the ovine fetus, near term, to sustained hypoxemic stress superimposed on chronic hypoxemia. Fetal sheep were chronically embolized (n = 7) for 10 days between 0.84 and 0.91 of gestation via the descending aorta until arterial oxygen content was decreased by approximately 30%. Control animals (n = 8) received saline only. On experimental day 10, both groups were embolized over a 6-h period until fetal arterial pH decreased to approximately 7.00. Regional distribution of lower body blood flows was measured on day 10, before and at the end of acute embolization. On day 10, the chronically embolized group had lower arterial oxygen content (P < 0.05), Po2 (P < 0.01), and placental blood flow (P < 0.05) than controls and higher prostaglandin E2 (PGE2) and norepinephrine plasma concentrations (both P < 0.05). In response to a superimposed sustained hypoxemic stress, there was a twofold greater increase in PGE2 in the chronically embolized group than in the control group (P < 0.05). However, the increase in fetal plasma cortisol in response to superimposed hypoxemic stress was similar in both groups, despite significantly lower adrenocorticotropic hormone and adrenal cortex blood flow responses in the chronically hypoxemic group (both P < 0.05). We conclude that PGE2 response to a sustained superimposed reduction in placental blood flow, leading to metabolic acidosis, is enhanced under conditions of chronic hypoxemia and may play an important role for the maintenance of the fetal cortisol response to an episode of superimposed acute stress.

Cardiac limitation to maximal oxygen transport and changes in components after jogging across the US

1975 ◽  
Vol 39 (6) ◽  
pp. 958-964 ◽  
Author(s):  
R. A. Bruce ◽  
F. Kusumi ◽  
B. H. Culver ◽  
J. Butler
Keyword(s):  
Stroke Volume ◽  
Oxygen Transport ◽  
Cell Mass ◽  
Young Male ◽  
The United States ◽  
Systemic Arterial Pressure ◽  
Arterial Oxygen ◽  
Total Blood ◽  
Male Adult ◽  
Arterial Oxygen Content

Observations were made before and 3–5 days after prolonged endurance jogging an average of 42 miles/day, 6 days/wk for 2.5 mo by a young male adult who voluntarily initiated a run across the United States. Both arterial PO2 and lactic acid increased. In each instance, the first limitation in circulatory delivery of oxygen was a plateau in stroke volume and cardiac output. Afterward, pulse deficit and systemic arterial pressure fell with exercise and heart rate accelerated. Although there was no change in oxygen transport (Q X CAO2), a reduction in stroke volume was exactly balanced by a rise in arterial oxygen content. Vital capacity, residual volume, and total lung capacity and diffusion capacity for carbon monoxide, hematocrit, and red cell mass increased, while plasma volume diminished and heart size and total blood volume were unchanged.

Physiological effects of hypervolemic polycythemia in newborn dogs

1982 ◽  
Vol 53 (4) ◽  
pp. 865-872 ◽  
Author(s):  
M. H. LeBlanc ◽  
U. R. Kotagal ◽  
L. I. Kleinman
Keyword(s):  
Cold Stress ◽  
Blood Cells ◽  
Control Group ◽  
Physiological Effects ◽  
O2 Consumption ◽  
Peripheral Vascular ◽  
Newborn Animal ◽  
Packed Red Blood Cells ◽  
O2 Transport ◽  
And Control

The effect of hypervolemic polycythemia (Hct 62–77) on O2 transport and O2 consumption (Vo2) was studied in 16 unanesthetized newborn dogs (age 3–10 days). A control group of 10 newborn dogs (3–10 days old) was made hypervolemic but not polycythemic in an otherwise identical experiment. Hypervolemia was attained by infusing 33 ml/kg of either packed red blood cells (polycythemia) or whole blood (controls). In the polycythemic group as a result of the transfusion, cardiac output (CO) decreased by 50% (P less than 0.001), peripheral vascular resistance (PVR) increased by 170% (P less than 0.001), but O2 transport did not change significantly, and Vo2 decreased only slightly by 13% (P less than 0.01). In the 10 control animals there were no significant changes in CO, PVR, O2 transport, or Vo2 as a result of the transfusion. Blood lactate increased only slightly in experimental (35%, P less than 0.04) and control animals (23%, NS). The ability of the animals to increase their O2 transport and Vo2 was tested by measuring the changes induced by cold stress. Cold stress produced a 20% increase in Vo2 (P less than 0.05) in both the polycythemic and the control animals. Thus in spite of a decreased CO in the nonstressed state the polycythemic animals were still able to increase O2 transport and Vo2 in response to cold stress. These results suggest that the newborn animal is capable of regulating CO to maintain O2 transport appropriate to uptake under conditions of hypervolemic, polycythemic hyperviscosity, and environmental cold stress.

Central circulation during exercise after venesection and reinfusion of red blood cells

1976 ◽  
Vol 40 (3) ◽  
pp. 379-383 ◽  
Author(s):  
B. Ekblom ◽  
G. Wilson ◽  
P. O. Astrand
Keyword(s):  
Red Blood Cells ◽  
Blood Cells ◽  
Maximal Exercise ◽  
Arterial Oxygen ◽  
Vo2 Max ◽  
Arterial Oxygen Content ◽  
Acute Change ◽  
Hb Concentration ◽  
Different Levels ◽  
Central Circulation

To study central circulation at different levels of hemoglobin (Hb) concentration, five subjects performed submaximal and maximal exercise in three different situations: 1) control, 2) after venesection of 800 ml of whole blood, and 3) after reinfusion of the red blood cells about 30–35 days after venesection. Maximal oxygen uptake (VO2 max) decreased from 4.27 l-min-1) at control to 4.03 l-min-1 after venesection (P less than 0.05) and increased to 4.61 l-min-1 after reinfusion (P less than 0.05). Maximal values on cardiac output (Q), heart rate (HR), and stroke volume (SV) were the same in the three situations. Thus, there was no compensatory increase in Qmax due to the lowered arterial oxygen content (Cao2) after venesection. An increase of the Cao2 (Hb concentration) and a lowering of the Cvo2 contributed equally to the increased VO2 max after reinfusion. At a given submaximal VO2, HR and blood lactates were increased at lowered Hb concentration and decreased at increased Hb concentration over control levels. Correlation coefficient for the change in Q in relation to the acute change in Hb concentration at a given submaximal VO2 was -0.49 (P less than 0.05).

Mirasol™ Pathogen Reduction of Packed Red Blood Cells (PRBCs) and Apheresis Platelet (Aplt) Concentrates Decreases Neutrophil Priming Activity Generated during Storage.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2893-2893
Author(s):  
Daniel R. Ambruso ◽  
Gail Thurman ◽  
Susanne Marschner ◽  
Ray Goodrich
Keyword(s):  
Blood Cells ◽  
Blood Donation ◽  
Uv Light ◽  
White Blood Cells ◽  
Biologically Active ◽  
Control Group ◽  
Superoxide Anion Production ◽  
Packed Red Blood Cells ◽  
Pathogen Reduction ◽  
Priming Activity

Abstract Introduction: During storage of cell containing components including PRBCs and Aplts, biologically active compounds such as lysophosphatidylcholine and other lipids are generated. Identified by their ability to enhance the fMLP stimulated respiratory burst in neutrophils, these biologic response modifiers (BRMs) have been implicated in the pathogenesis of transfusion related acute lung injury (TRALI). The Mirasol pathogen reduction system is a process that uses riboflavin and UV light to modify nucleic acids, reduce infectious pathogen load and inactivate white blood cells in blood components. An additional effect of the Mirasol in PRBCs and Aplts is a decrease in priming activity accumulated during storage. Methods: PRBCs were produced by standard technique from whole blood donation. PRBCs were treated with Mirasol (8) and stored; untreated, washed and stored in AS-3 additive solution (2); or produced untreated and stored in AS-3 (6). For platelets collected on Trima, one set of products was treated with Mirasol procedure on day 0. Another set was exposed to 25Gy of gamma irradiation. The control group was untreated and stored under standard conditions. Samples were removed on day 0 and 43 (PRBCs) and day 0, 5, 7 (Aplts); cells removed from residual supernatant/plasma by centrifugation and frozen at -70°C. Samples (10% by volume) were assayed to measure the ability to enhance the fMLP stimulated superoxide anion production (O2−) by peripheral blood neutrophils. O2− was measured as SOD inhibitable cytochrome c reduction and expressed as a ratio of the response to plasma followed by fMLP compared to fMLP alone. Priming by platelet activating factor (PAF) was a positive control. Priming is defined as >1.5 fold increase in O2− over the results for fMLP alone. Results: Samples from Mirasol treated PRBCs show no enhancement of fMLP stimulated O2− production either at day 0 or after 43 days of storage (Top figure). Washed controls exhibit a similar pattern. Unwashed controls demonstrate a small amount of priming on day 0 which further increased on day 43. For Aplts (Bottom figure), day 0 samples exhibited minimal priming. For Mirasol treated products, no changes were seen on days 5 and 7. In contrast, both gamma irradiated and untreated Aplts showed an increase comparable to that seen with PAF. Conclusion: Treatment of PRBCs and Aplts with Mirasol reduced the generation of priming activity normally developed during storage, possibly representing a decrease in production of BRMs including priming lipids. Mirasol treatment of cell containing components may reduce one class of etiologic agents associated with TRALI and may be a potential approach to reduce risk for this adverse event of transfusion. Figure Figure

Clinical Predictability of Intraventricular Hemorrhage in Preterm Infants

PEDIATRICS ◽  
1980 ◽  
Vol 65 (1) ◽  
pp. 30-34
Author(s):  
Anthony Lazzara ◽  
Peter Ahmann ◽  
Francine Dykes ◽  
Alfred W. Brann ◽  
James Schwartz
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Preterm Infants ◽  
Blood Cells ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Clinical Signs ◽  
Packed Red Blood Cells

Ninety-eight infants of less than 35 weeks' gestation, consecutively admitted to a regional neonatal intensive care unit, were followed prior to computerized tomography (CT) scan for clinical signs of subependymal and/or intraventricular hemorrhage. The presence or absence of intracerebral hemorrhage was confirmed by CT scan in all patients, and the severity of hemorrhage was quantitated as mild, moderate, or marked. Thirty-seven out of 98 infants (38%) demonstrated intracerebral hemorrhage on CT scan; 20 of 37 (54%) were predicted clinically. Clinical predictability was related to severity of hemorrhage as quantitated by CT scan. Clinical signs that were found helpful in predicting subependymal and/ or intraventricular hemorrhage were fall in hematocrit, failure of rise in hematocrit with transfusion of packed red blood cells, tight fontanel, decrease in spontaneous activity, decreased tone, abnormal eye signs, and seizures.

Mechanisms of coronary vasoconstriction induced by high arterial oxygen tension

1997 ◽  
Vol 272 (1) ◽  
pp. H67-H75 ◽  
Author(s):  
S. Mouren ◽  
R. Souktani ◽  
M. Beaussier ◽  
L. Abdenour ◽  
M. Arthaud ◽  
...  
Keyword(s):  
Red Blood Cells ◽  
Oxygen Tension ◽  
Blood Cells ◽  
Arterial Oxygen Tension ◽  
Hemoglobin Concentration ◽  
Nordihydroguaiaretic Acid ◽  
Arterial Oxygen ◽  
Coronary Vasoconstriction ◽  
Arterial Oxygen Content ◽  
Arterial Blood

In isolated rabbit hearts perfused with suspension of red blood cells, we investigated the role of the endothelium and of several substances in the coronary vasoconstriction induced by a high arterial blood oxygen tension (PaO2). Red blood cells in Krebs-Henseleit buffer were oxygenated to obtain control and high-PaO2 perfusates. Arterial oxygen content was kept constant in both perfusates by reducing hemoglobin concentration in the high-PaO2 perfusate. Coronary blood flow was kept constant so that oxygen supply would not vary with the rise in PaO2. Increases in perfusion pressure therefore reflected increased coronary resistance. The high PaO2-induced coronary vasoconstriction was not affected by administration of indomethacin, nordihydroguaiaretic acid, NG-nitro-L-arginine, or superoxide dismutase and catalase but was abolished after endothelium damage or by cromakalim. These results demonstrate that 1) the endothelium contributes to the high PaO2-induced coronary vasoconstriction; 2) this effect is independent of cyclooxygenase or lipoxygenase products, nitric oxide, or free radicals; and 3) the closure of ATP-sensitive K+ channels mediates this vasoconstriction.

scholarly journals Does the Age of Packed Red Blood Cells, Donor Sex or Sex Mismatch Affect the Sublingual Microcirculation in Critically Ill Intensive Care Unit Patients? — A Secondary Interpretation of a Retrospective Analysis

2021 ◽  
Author(s):  
Demian Knobel ◽  
Jonas Scheuzger ◽  
Andreas Buser ◽  
Alexa Hollinger ◽  
Caroline E. Gebhard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Red Blood Cells ◽  
Sofa Score ◽  
Blood Cells ◽  
Flow Index ◽  
Packed Red Blood Cells ◽  
Microcirculatory Flow ◽  
The Impact

Abstract BackgroundIn vitro studies have thoroughly documented the impact of storage lesions in packed red blood cells (pRBC) on erythrocyte oxygen carrying capacity due to older age of blood products. While studies have examined the effect of pRBC age on patient outcome, only few data exist on the microcirculation, their primary site of action.MethodsIn this secondary analysis, we examined the relationship between the age of pRBC and changes of microcirculatory flow (MCF) in 54 patients. Data from the Basel Bedside assessment Microcirculation Transfusion Limit study (Ba2MiTraL), investigating the effects of one pRBC on the sublingual MCF provided the basis of this study. ResultsMean change from pre-to post-transfusion proportion of perfused vessels (∆PPV) was +8.8% (IQR: -0.5 – 22.5), 5.5% (IQR: 0.1–10.1), and +4.7% (IQR: -2.1 – 6.5) after transfusion of fresh (≤ 14 days old), medium (15 to 34 days old), and old (≥ 35 days old) pRBC, respectively. Values for the microcirculatory flow index (MFI) were +0.22 (IQR: -0.1 – 0.6), +0.22 (IQR: 0.0 – 0.3), and +0.06 (IQR: -0.1 – 0.3) for the fresh, medium, and old pRBC age groups, respectively.Lower ∆PPV and transfusion of older blood were correlated with a higher Sequential Organ Failure Assessment (SOFA) score of patients upon admission to the intensive care unit (ICU) (p=0.01). However, regression models showed no overall significant correlation between pRBC age and ∆PPV (p=0.2). No correlation between donor’s sex or a mismatch between donor and recipient sex was found.ConclusionWe detected no significant correlation between age of pRBC and change in MCF between pre- and post-transfusion among all investigated patients. However, in patients with a higher SOFA score upon ICU admission, there might be a negative effect on the proportion of perfused microcirculatory vessels after transfusion of older blood.

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