Effect of Blood Transfusion On Serum Haptoglobin.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3138-3138
Author(s):  
Shilpi Gupta ◽  
Fadi Nakhl ◽  
Kera Weiserbs ◽  
Frank J. Forte
Keyword(s):  
Conflicts Of Interest ◽  
Acute Phase Reactant ◽  
Normal Serum ◽  
Free Hemoglobin ◽  
Packed Red Blood Cells ◽  
Serum Haptoglobin ◽  
Haptoglobin Level ◽  
Larger Sample ◽  
Multiple Units ◽  
Stored Blood

Abstract Abstract 3138 Poster Board III-75 Introduction Haptoglobin, an alpha2 globulin, is an acute phase reactant, which functions to bind the globin portion of free hemoglobin in the blood. The half-life of serum haptoglobin is approximately five days, but in the presence of free hemoglobin, the hemoglobin-haptoglobin complex is rapidly cleared from the system causing a decrease in the measured serum haptoglobin (normal levels 36-195mg/dl). The measurement of serum haptoglobin is used as one of the laboratory markers for the diagnosis of hemolytic anemia. Since stored blood contains a variable amount of free hemoglobin, transfusion of this blood may affect haptoglobin levels and thereby negate the usefulness of haptoglobin measurement when hemolysis is suspected in recently transfused patients. Patients and methods Twenty-0ne patients, who were being transfused with more than one unit of packed red blood cells (PRBC), for non-hemolytic indications, were enrolled in the study and their serum haptoglobin levels were recorded before, immediately after, 24 hours after and 48 hours after PRBC transfusion. Observations and results A total of twenty-one patients were enrolled in the study and these patients received a total of forty-seven units of PRBC. The most common indication for transfusion was anemia secondary to blood loss. Eighteen patients received two units, one patient received three units, and two patients received four units of PRBC. Four patients received PRBC's that were more than 30 days old. When blood less than 30 days old was transfused there was a decrease to below normal in the haptoglobin level of only one patient, and this patient had a low normal serum haptoglobin level prior to transfusion. However, in four patients who received blood that was more than 30 days old, two (fifty percent) had a decrease in serum haptoglobin levels to below normal. Conclusion Serum haptoglobin can be used in the diagnosis of hemolysis in patients receiving multiple units of PRBC transfusions when the age of the transfused blood is less than thirty days. However, when PRBC's more than thirty days old are transfused measurement of serum haptoglobin might not prove to be a reliable indicator of hemolysis. Further studies with larger sample sizes are needed to confirm our findings. Disclosures No relevant conflicts of interest to declare.

scholarly journals Clinical Usefulness of Haptoglobin Levels to Evaluate Hemolysis in Recently Transfused Patients

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Shilpi Gupta ◽  
Kathleen Ahern ◽  
Fadi Nakhl ◽  
Frank Forte
Keyword(s):  
Blood Cells ◽  
Repeated Measures ◽  
Free Hemoglobin ◽  
Laboratory Marker ◽  
Packed Red Blood Cells ◽  
Serum Haptoglobin ◽  
Significant Difference ◽  
Time Periods ◽  
Multiple Units ◽  
Stored Blood

Introduction.Haptoglobin binds the globin portion of free hemoglobin. Serum haptoglobin measurement is used as a laboratory marker for the diagnosis of hemolytic anemia. Since stored blood contains free hemoglobin, transfusion may affect haptoglobin levels.Study Objectives.The aim of the study was to evaluate whether serum haptoglobin could be measured to assess hemolysis in recently transfused patients.Patients and Methods.Twenty-one patients, receiving more than one unit of packed red blood cells (PRBCs) for presumed nonhemolytic indications, were enrolled. Serum haptoglobin levels were recorded before, immediately after, and 24 and 48 hours after transfusion.Observations and Results.Analysis of variance with a repeated measures was used to examine the serum haptoglobin levels at different time periods and no significant difference was found (P=.28).Conclusion.The results suggest that serum haptoglobin can be used in the diagnosis of hemolysis in patients receiving multiple units of PRBC.

scholarly journals Studies on the Serum Haptoglobin Level in Hemoglobinemia and Its Influence on Renal Excretion of Hemoglobin

Blood ◽  
1957 ◽  
Vol 12 (6) ◽  
pp. 493-506 ◽  
Author(s):  
CARL-BERTIL LAURELL ◽  
MARGARETA NYMAN
Keyword(s):  
Intravenous Injection ◽  
Threshold Value ◽  
Free Hemoglobin ◽  
Electrophoretic Method ◽  
Serum Haptoglobin ◽  
Hemoglobin Binding ◽  
Constant Rate ◽  
Haptoglobin Level ◽  
Binding Power

Abstract A short survey is given of the literature on haptoglobin, the hemoglobin-binding serum protein, its properties and biologic variations. The principles of an electrophoretic method for quantitative determination of the serum haptoglobin are described. Electrophoretic studies showed that haptoglobin has a high affinity for hemoglobin at physiologic pH and that every haptoglobin molecule can bind at least 2 hemoglobin molecules. Observations made following the intravenous injection of hemoglobin showed: that hemoglobin administered intravenously is bound by the haptoglobin; that free hemoglobin is not demonstrable until more hemoglobin has been injected than can be bound by the haptoglobin; that the complex hemoglobin-haptoglobin is eliminated from the plasma after intravascular hemolysis or intravenous administration of hemoglobin without being excreted in the urine; that the hemoglobin-haptoglobin complex is removed from the plasma at a constant rate during the major part of the elimination period; that the haptoglobin level will fall to nil within 24 hours, if the amount of hemoglobin injected is sufficient to bind all the haptoglobin available. During the following days the rate of formation of haptoglobin can be studied. From the data available it can be concluded that hemoglobinuria cannot appear until the amount of hemoglobin administered intravenously or the amount liberated intravascularly exceeds the binding power of the haptoglobin and the reabsorption capacity of the tubules. The variation observed by earlier authors in the so-called renal threshold for hemoglobin on intravenous injection of hemoglobin can be explained among other things by the variation in the haptoglobin content in one and the same subject, i.e., if the haptoglobin level is low, the threshold value will also be low, and vice versa.

Footstrike is the major cause of hemolysis during running

2003 ◽  
Vol 94 (1) ◽  
pp. 38-42 ◽  
Author(s):  
R. D. Telford ◽  
G. J. Sly ◽  
A. G. Hahn ◽  
R. B. Cunningham ◽  
C. Bryant ◽  
...  
Keyword(s):  
Oxygen Uptake ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Random Order ◽  
Peak Oxygen Uptake ◽  
Red Cell ◽  
Free Hemoglobin ◽  
Serum Haptoglobin ◽  
Total Hemoglobin ◽  
Exercise Induced

There is a wide body of literature reporting red cell hemolysis as occurring after various forms of exercise. Whereas the trauma associated with footstrike is thought to be the major cause of hemolysis after running, its significance compared with hemolysis that results from other circulatory stresses on the red blood cell has not been thoroughly addressed. To investigate the significance of footstrike, we measured the degree of hemolysis after 1 h of running. To control for the potential effects of oxidative and circulatory stresses on the red blood cell, the same subjects cycled for 1 h at equivalent oxygen uptake. Our subjects were 10 male triathletes, who each completed two separate 1-h sessions of running and cycling at 75% peak oxygen uptake, which were performed in random order 1 wk apart. Plasma free hemoglobin and serum haptoglobin concentrations were measured as indicators of hemolysis. We also measured methemoglobin as a percentage of total hemoglobin immediately postexercise as an indicator of red cell oxidative stress. Plasma free hemoglobin increased after both running ( P < 0.01) and cycling ( P < 0.01), but the increase was fourfold greater after running ( P < 0.01). This was reflected by a significant fall in haptoglobin 1 h after the running trials, whereas no significant changes occurred after cycling at any sample point. Methemoglobin increased twofold after both running and cycling ( P < 0.01), with no significant differences between modes of exercise. The present data indicate that, whereas general circulatory trauma to the red blood cells associated with 1 h of exercise at 75% maximal oxygen uptake may result in some exercise-induced hemolysis, footstrike is the major contributor to hemolysis during running.

Blood Utilization at Regional Hospitals

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S151-S151
Author(s):  
Ryan Demkowicz ◽  
Josephine Dermawan ◽  
Sindu Shetty ◽  
Richard Scarborough ◽  
Haiyan Lu ◽  
...  
Keyword(s):  
Decision Process ◽  
Blood Cells ◽  
Chart Review ◽  
Blood Product ◽  
Transfusion Medicine ◽  
Screening Criteria ◽  
Packed Red Blood Cells ◽  
Blood Utilization ◽  
Regional Hospitals ◽  
Multiple Units

Abstract Introduction Transfusion medicine is unique to lab medicine. While it still involves testing and reporting of results, it is one of the few areas where the laboratory is providing treatment. The risk of providing a blood product must be weighed against the benefit before the decision is made to transfuse a patient. Our study looked at blood utilization at our regional hospitals to assess if there were areas where we need to improve this decision process. Methods Chart reviews were performed for patients who received packed red blood cells (RBCs) in the regional hospitals over a 2-month period. Using the AABB and Choosing Wisely recommendations, we created two screening criteria: hemoglobin (Hb) >8 g/dL or greater than 1 unit RBC ordered when Hb is >6 g/dL to screen for outliers among RBC orders. A more in-depth chart review including information on clinical diagnosis, indications, bleeding status, and blood loss during surgery was performed on cases that met these criteria. Using this information, a decision was made on the appropriateness of the transfusion. Results In total, 1,592 RBC units were screened at eight regional hospitals. Sixty-eight (4%) were flagged as inappropriate, 57 (83.8%) due to multiple units, and 11 (16.2%) for an Hb >8 g/dL. The percentage of inappropriate transfusions at a hospital ranged from 5.2% to 13.6%. However, all hospitals except one were under 5.5%. Discussion In general, regional physicians are transfusing RBCs appropriately. When a unit is ordered inappropriately, it is most likely due to ordering multiple units upfront. To further improve blood utilization, these data were presented to hospital administration and a new alert in the EMR was created. A repeat study will be performed to see if the alerts and awareness of these data has had an effect on blood utilization.

Genetic factors associated with serum haptoglobin level in a Japanese population

2014 ◽  
Vol 433 ◽  
pp. 54-57 ◽  
Author(s):  
Mikiko Soejima ◽  
Noriaki Sagata ◽  
Nobukazu Komatsu ◽  
Tetsuro Sasada ◽  
Atsushi Kawaguchi ◽  
...  
Keyword(s):  
Japanese Population ◽  
Genetic Factors ◽  
Factors Associated ◽  
Serum Haptoglobin ◽  
Haptoglobin Level

Release of Procoagulant and Proinflammatory Cell-Derived Microparticles (MP) During Blood Storage: Effects of Storage Time, Leukoreduction, and Residual Platelets,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3373-3373
Author(s):  
Wenche Jy ◽  
Sherry Shariatmadar ◽  
Marco Ricci ◽  
Orlando Gomez-Marin ◽  
Carlos Bidot ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Storage Time ◽  
Time Course ◽  
Conflicts Of Interest ◽  
Annexin V ◽  
Bioactive Substances ◽  
Platelet Counts ◽  
The Impact ◽  
Stored Blood ◽  
Over Time

Abstract Abstract 3373 Introduction Several studies have indicated that transfusion with older blood carries more risk of adverse reactions than transfusion with younger blood, but this remains controversial. It is not clear why older blood may carry increased risks, or what the “safe age” of stored blood is. It is known that multiple bioactive substances are generated from blood during storage, and one or more of these substances may be involved in transfusion-related complications. Among them, MP are a recognized marker of the storage lesion, and their involvement in transfusion-related complications has been postulated. However, questions such as MP species, quantity, biological activity, and factors affecting their release are not well elucidated. The purpose of this study was to quantify MP species and their activity in stored RBC as a function of storage time, and to evaluate the impact of leukoreduction and residual platelets on MP release. Methods (I) MP generation and functional activity Thirty-four bags of packed RBC (16 non-leukoreduced, 18 leukoreduced) of known blood types (A+, B+, AB+, O+) were obtained from the blood bank within 2–4 days of drawing, and then stored at 4°C. Time of receipt was defined as day 0. At days 0, 10, 20, 30, and 40, 40 mL samples were centrifuged at 1000xg for 20 min to remove cells. The supernatants were then assayed for: (1) subtypes of MP by flow cytometry comprising (a) red cell MP (RMP) assessed by CD235a, (b) leukocyte MP (LMP) by CD45, (c) platelet MP (PMP) by CD41, (d) endothelial MP (EMP) by CD144, and (e) generic MP by Ulex Europaeus (Ulex) or Annexin V (AnV); (2) MP-mediated thrombin generation assay (TGA); (3) MP-mediated inflammatory activity by CD 11b expression in neutrophils following incubation with MP. (II) Reconstitution of increasing platelet counts in leukoreduced RBC. To investigate the effect of residual platelets on RMP generation, we mixed a constant amount of RBC with increasing amounts of type-matched platelets (0 to 250,000/μL f.c.) in standard storage bags and measured time-dependent MP release. Results (A) Time-course of MP generation (i) Non-leukoreduced. RMP, PMP and LMP all increased with time, but with different patterns. RMP increased little to day 10 but then rose exponentially, and by day 40 they were 4–6 fold higher than at day 0. PMP counts rose steadily from day 0 and peaked at day 20, being 2–3 fold higher than at day 0. LMP showed no significant change until day 20 when they started to increase, and then increased sharply after day 30, and by day 40 were 1.5–2 fold higher than at day 0. Levels of PMP (days 0 to 20) and RMP (days 20 to 40) correlated with increasing MP-mediated procoagulant and inflammatory markers. (ii) Leukoreduced. Pre-storage leukoreduction decreased RMP generation by 20–40%, completely suppressed PMP and LMP generation, and reduced total MP-mediated procoagulant and inflammatory markers by 40–60%. CBC showed that leukoreduction not only removed >99% WBC but also reduced residual platelets by >95% (from 90 ±30 ×103/μL to 3.5 ±1.3 ×103/μL). This suggests that residual leukocytes and platelets potentiate RMP generation. (B) Effects of residual platelets on RMP generation. To further study the effects of platelets on RMP generation, we mixed known counts of platelets with leukoreduced RBC, and then evaluated RMP generation over time. We found that RMP levels released were proportional to the platelet counts, as were the procoagulant and inflammatory markers. These results show that platelets in stored RBC play a key role in RMP generation. Conclusion Multiple MP types (PMP, LMP, RMP) are released during storage, and their levels increase over time but their patterns of change are different. Procoagulant and inflammatory markers increase in parallel with PMP and RMP. Our data support the hypothesis that age of stored blood could be important in transfusion-related complications, via MP production. Leukoreduction sharply reduces MP generation and procoagulant and inflammatory markers, suggesting that known benefits of leukoreduction may be attributable to reduced MP production. The finding that residual platelets in stored RBC can potentiate RMP generation suggests that minimizing platelets in non-leukoreduced packed cells could reduce the risk of transfusion-related complications. (Supported by NIH grant 1R01HL098031). Disclosures: No relevant conflicts of interest to declare.

Advanced Age As a Risk Factor for Folate-Induced Cobalamin (Cbl) Deficiency

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5268-5268
Author(s):  
Lawrence R. Solomon
Keyword(s):  
Conflicts Of Interest ◽  
Geometric Mean ◽  
High Serum ◽  
Normal Serum ◽  
Advanced Age ◽  
Serum Folate ◽  
Older Individuals ◽  
Ambulatory Care Setting ◽  
Normal Range ◽  
Cognitive Changes

Abstract 5268 Folate therapy can induce or exacerbate neuro-cognitive changes in patients with clinically significant Cbl deficiency. High serum folate (sFol) values in subjects with low Cbl levels have also been associated with increases in the Cbl-dependent metabolite, methylmalonic acid (MMA) as well as with hematologic, neuro-cognitive and fetal abnormalities, raising concerns about the use of both folate supplements and folate-fortified grains. However, in a more recent study of young adults, MMA values were unaffected by high sFol values. Significantly, advanced age is also linked to increased MMA values even when Cbl values are normal. Thus, a retrospective study was performed of 91 non-diabetic subjects with normal renal function and low-normal Cbl values (201–300 pg/ml) who were evaluated for Cbl deficiency in an ambulatory care setting over a 10 year period to determine if age is a significant determinant of the metabolic interaction of sFol and Cbl when Cbl levels are within the normal reference range. In older individuals (≥60 yrs) with low-normal serum Cbl values, the geometric mean MMA value was significantly higher (401 nmol/l; n=11) when sFol values were elevated (>20 ng/ml) than when sFol values were normal (298 nmol/l; n=35)(p<0.025). In contrast, in younger subjects, mean MMA values were similar in both high and normal sFol groups (302 nmol/l; n=15 vs 270 nmol/l; n=30)(p=0.52). There was no correlation between MMA and sFol when sFol values were within the normal range in either age group (r≤0.07). Finally, when sFol levels were elevated, Cbl therapy significantly decreased MMA values in 8 of 9 younger subjects (89%) and in all 7 older individuals (100%) studied. It is concluded that: 1) MMA values are increased when sFol levels are elevated and Cbl values are low-normal but this effect is age-dependent; 2) the effect of sFol on MMA is not progressive but occurs only at sFol values above the normal range; and 3) Cbl therapy decreases MMA values in almost all subjects regardless of pretreatment sFol values. Since these findings may have clinical significance, caution in the use of folate supplements is advised. Disclosures: No relevant conflicts of interest to declare.

Hemoglobinuria Is a Risk Factor For Kidney Disease Progression In Sickle Cell Anemia

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 996-996
Author(s):  
Santosh L. Saraf ◽  
Xu Zhang ◽  
Tamir Kanias ◽  
James P. Lash ◽  
Robert E. Molokie ◽  
...  
Keyword(s):  
Steady State ◽  
Kidney Disease ◽  
Kidney Function ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Conflicts Of Interest ◽  
Red Blood Cell Transfusion ◽  
Free Hemoglobin ◽  
Arterial Blood

Abstract Chronic kidney disease (CKD) is a frequent complication of sickle cell anemia (SCA) and is a predictor of early mortality. To determine the predictors of deteriorating kidney function in SCA, we followed 164 patients treated at the University of Illinois at Chicago for a median of 32 months (range 3-88 months). Steady-state estimated glomerular filtration (eGFR), albuminuria, and hemoglobinuria assessments were obtained at baseline and during the follow-up period. Steady-state was defined as greater than four weeks from a vaso-occlusive pain episode or a red blood cell transfusion. Hemoglobinuria was defined as positive for blood on dipstick and < 2 red blood cells on microscopy. Fifty-six (34%) of the patients had hemoglobinuria at baseline. We confirmed in a subset of 43 patients that dipstick positive hemoglobinuria (n=17) was associated with higher urine cell-free hemoglobin concentrations determined by ELISA than dipstick negative urine (n=26) (23.1 vs. 11.5 ng/mL, p<0.0001) (Figure 1). Age and mean arterial blood pressures were similar in patients with hemoglobinuria at baseline compared to those without but markers of hemolysis were higher (LDH, indirect bilirubin, AST, and reticulocyte percentage; p<0.0001). Sixty-one percent (95%CI: 48-73%) of patients with hemoglobinuria at baseline had hemoglobinuria at most recent follow up compared to 9% (95%CI: 5-18%) of patients without hemoglobinuria at baseline (p<0.0001). The proportion of patients with CKD progression defined by a 50% reduction in eGFR calculated by the CKD-EPI formula or requirement for hemodialysis or kidney transplant was higher in patients with baseline hemoglobinuria (13%, 7/56) versus without hemoglobinuria (1%, 1/108) (HR 14, 95%CI: 2-113; logrank p=0.001) (Figure 2). Progression of albuminuria category from normoalbuminuria (albuminuria < 30mg/g creatinine) to either microalbuminuria (albuminuria = 30-300 mg/g creatinine) or macroalbuminuria (albuminuria > 300mg/g creatinine) or microalbuminuria to macroalbuminuria was also higher in patients with baseline hemoglobinuria (42%, 11/26) versus without hemoglobinuria (13%, 9/67) (HR 3.1, 95%CI: 1.3-7.7; logrank p=0.004) (Figure 3). In conclusion, hemoglobinuria determined by urinalysis at steady-state is a valid assessment of increased urine cell-free hemoglobin concentration and is fairly consistent on repeat testing at steady-state visits. The presence of hemoglobinuria is significantly associated with a greater risk for progression of CKD and albuminuria. Our findings are consistent with the possibility that cell-free hemoglobin contributes to the progression of kidney disease in SCA. Further research including measures to decrease cell-free hemoglobin exposure to preserve kidney function are warranted.Figure 1Figure 1. Figure 2Figure 2. Figure 3Figure 3. Disclosures: No relevant conflicts of interest to declare.

Haptoglobin Therapy Prevents Kidney Injury in Stored Blood Resuscitation of Murine Hemorrhagic Shock

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 761-761
Author(s):  
Jan A. Graw ◽  
Ivy A. Rosales ◽  
Yumin Liu ◽  
Venkata S. Sabbisetti ◽  
Frank E. Riley ◽  
...  
Keyword(s):  
Hemorrhagic Shock ◽  
Plasma Levels ◽  
Conflicts Of Interest ◽  
Kidney Injury ◽  
Control Group ◽  
Blood Storage ◽  
Circulating Blood Volume ◽  
Plasma Ngal ◽  
Free Heme ◽  
Stored Blood

Abstract Introduction: Extracellular hemoglobin (Hb) and free heme are major breakdown products of hemolyzing Red Blood Cells (RBC). Mammals have evolved scavenger systems to bind circulating Hb with haptoglobin (Hp) and free heme with hemopexin (Hx). During storage RBC undergo numerous morphological and biochemical changes. Transfusion of stored RBC (SRBC) increases plasma levels of heme and Hb. Increased plasma Hb levels are associated with kidney injury (KI). In prolonged hemorrhagic shock (HS) systemic hypotension and hypoperfusion impair kidney function. KI is an important complication of HS and is associated with a markedly increased mortality and morbidity rate. In this study we employed a murine model of 14-day blood storage mimicking 42-day human blood storage. We first determined that HS-induced KI is more severe in mice resuscitated with SRBC than in those transfused fresh RBC (FRBC). Then we studied whether treatment with either Hp or Hx during transfusion reduced KI after SRBC-resuscitation from HS. Methods: Leukoreduced, packed RBC obtained from WT C57BL6 mice were stored in CPDA-1 at 4°C for either <24 h (FRBC) or 2 weeks (SRBC). Anesthetized mice were bled approximately 50-60% of circulating blood volume over 10 min to maintain a constant mean arterial pressure of 35 mmHg and induce HS. After 120 min of HS, mice were resuscitated with either FRBC or SRBC. Sham operated mice that did not undergo hemorrhagic shock or resuscitation served as a control group. Furthermore, some mice receiving SRBC were given a co-infusion of 7.5 mg of either Hp, or Hx or albumin (Alb) during transfusion. The Alb treated group of mice served as a control for the treatment protein loading. After recovery from anesthesia, urine was collected for 24 h in a metabolic chamber. Urine creatinine, hemoglobin, and Kidney Injury Molecule-1 (KIM-1) were measured. At 48 h post HS the mice were sacrificed and plasma markers of liver and kidney injury were measured. Kidney injury was quantified by a kidney pathology scoring system. Results: After HS and resuscitation hemoglobinuria was detected in 24 h urine samples collected from mice resuscitated with SRBC (see Table). Urine KIM-1 levels were increased after HS and resuscitation with either FRBC or SRBC (FRBC differs vs. Sham, p<0.01; SRBC differs vs. Sham, p<0.05). Plasma NGAL-levels and the kidney tubular injury score were greater in SRBC-transfused mice than in Sham operated mice or FRBC-resuscitated mice (KI score: SRBC differs vs. Sham and FRBC, p<0.01). Hemoglobinuria was present in SRBC-resuscitated mice treated with Alb or Hx but not SRBC transfused mice treated with Hp. Plasma NGAL levels at 48 h after shock did not differ in mice resuscitated with SRBC+Hp or FRBC but were greater in mice resuscitated with SRBC+Alb and SRBC+Hx. Plasma Hb levels at 48 h after resuscitation were less than 33.1±6.4 mg/ml and did not differ from Sham levels between all groups, but plasma Hb levels were 7-fold increased to 231.7±25.7 mg/ml in mice transfused with SRBC+Hp (SRBC+Hp differs vs. all other groups; p<0.001). Plasma levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were greater after resuscitation with SRBC and with all three treatments than after resuscitation with FRBC. Conclusion: In comparison to resuscitation from HS with FRBC, resuscitation with SRBC produced hemoglobinuria and greater KI. Treatment with exogenous Hp during transfusion but not treatment with Hx or Alb reduced SRBC-induced hemoglobinuria and prevented kidney injury after HS and resuscitation with SRBC. Treatment with exogenous Hp may prevent KI associated with high plasma Hb concentrations such as after massive transfusion of stored blood, prolonged cardiopulmonary bypass or in acute exacerbations of hemolytic disease. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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