Aged versus fresh autologous platelet transfusion in a two‐hit healthy volunteer model of transfusion‐related acute lung injury. Issue 12 (27th October 2022)

• Record Type: Journal Article
• Authors: van Baarle, Floor L. F.; de Bruin, Sanne; Bulle, Esther B.; van Mourik, Niels; Lim, Endry H. T.; Tuip‐de Boer, Anita M.; Bongers, Annabel; de Wissel, Marit B.; van Bruggen, Robin; de Korte, Dirk; Vermeulen, Christie; Tan, Khik Wie; Jonkers, René E.; Bonta, Peter I.; Lutter, René; Dekker, Tamara; Dierdorp, Barbara S.; Peters, Anna L.; Biemond, Bart J.; Vlaar, Alexander P. J.
• Is Part Of: Transfusion. Volume 62:Issue 12(2022)
• Page Start: 2490
• Page End: 2501
• Publication Date: 2022-10-27
• Subjects: autologous blood transfusion -- bronchoalveolar lavage -- platelet activation -- platelet transfusion -- transfusion‐related acute lung injury; Hematology -- Periodicals; Blood -- Transfusion -- Periodicals; Blood Group Antigens -- Periodicals; Blood Preservation -- Periodicals; Blood Transfusion -- Periodicals; 615
• DOI: 10.1111/trf.17157
• Languages: English
• ISSNs: 0041-1132

Abstract

Abstract: Background: Transfusion‐related acute lung injury (TRALI) is a severe complication of blood transfusion that is thought of as a two‐hit event: first the underlying patient condition (e.g., sepsis), and then the transfusion. Transfusion factors include human leukocyte antigen antibodies or biologic response modifiers (BRMs) accumulating during storage. Preclinical studies show an increased TRALI risk with longer stored platelets, clinical studies are conflicting. We aim to discover whether longer platelet concentrate (PC) storage time increases TRALI risk in a controlled human experiment. Study Design and Methods: In a randomized controlled trial, 18 healthy male volunteers received a first hit of experimental endotoxemia (2 ng/kg lipopolysaccharide), and a second hit of fresh (2‐day old) or aged (7‐day old) autologous PC, or physiological saline. After 6 h, changes in TRALI pathways were determined using spirometry, chest X‐ray, and bronchoalveolar lavage (BAL). Results: All subjects reacted adequately to lipopolysaccharide infusion and satisfied SIRS criteria (increased pulse [>90/min] and temperature [>38°C]). There were no differences between the saline, fresh, and aged PC groups in BAL‐fluid protein (95 ± 33 μg/ml; 83 ± 21 μg/ml and 104 ± 29 μg/ml, respectively) and relative neutrophil count (1.5 ± 0.5%; 1.9 ± 0.8% and 1.3 ± 0.8%, respectively), nor in inflammatory BAL‐fluid BRMs (Interleukin‐6, CXCL8, TNFα, and myeloperoxidase), clinical respiratory parameters, and spirometry results. All chest X‐rays were normal. Conclusions: In a human endotoxemia model of autologous platelet transfusion, with an adequate first hit and platelet storage lesion, transfusion of 7‐day‐old PC does not increase pulmonary inflammation compared with 2‐day‐old PC.