Blood stored for long may be less safe for patients with massive blood loss and shock as it may have adverse effects on them, researchers, including one of Indian origin, suggest.
The researchers found that for patients who have massive bleeding and receive many transfusion units, older blood was associated with dysfunction in blood flow, increased injury and inflammation in critical end organs, and lung infection.
The link between older stored red blood cell transfusions and subsequent bacterial pneumonia is free heme — a breakdown product from degraded red blood cells, the researchers said.
Heme is part of the oxygen-binding hemoglobin pigment that gives blood cells their red colour and carries oxygen through the body from the lungs.
Free heme is known to induce inflammatory injury to major organs in diseases like sickle cell or sepsis. During storage and upon transfusion, stored red blood cells lyse open, releasing free heme.
“An adverse role for heme suggests that finding ways to limit heme exposure or prevent heme toxicity may improve safety of stored red blood cell transfusions,” said co-author of the study Rakesh Patel, Professor at the University of Alabama at Birmingham.
For the study, published in the journal PLOS Medicine, mice were resuscitated after trauma and hemorrhage, using either fresh or two-week-old stored blood.
Two days later, they were challenged by instilling the lungs with the bacteria Pseudomonas aeruginosa. A two-week storage of mouse blood approximates storage of human red blood cells for 42 days.
Compared to fresh blood, resuscitation with the stored blood significantly increased bacterial lung injury, as shown by higher mortality, and increases in fluid accumulation and bacterial numbers in the lungs.
Free heme acts, in part, by activating the toll-like receptor 4, the researcher said.
The researchers also found that transfusion with stored blood induced release of the inflammation mediator HMGB1, part of the body’s immune response.