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Exposure of Stored Packed Erythrocytes to Nitric Oxide Prevents
Transfusion-associated Pulmonary Hypertension
#MMPMID27517645
Muenster S
; Beloiartsev A
; Yu B
; Du E
; Abidi S
; Dao M
; Fabry G
; Graw JA
; Wepler M
; Malhotra R
; Fernandez BO
; Feelisch M
; Bloch KD
; Bloch DB
; Zapol WM
Anesthesiology
2016[Nov]; 125
(5
): 952-963
PMID27517645
show ga
BACKGROUND: Transfusion of packed erythrocytes stored for a long duration is
associated with increased pulmonary arterial pressure and vascular resistance.
Prolonged storage decreases erythrocyte deformability, and older erythrocytes are
rapidly removed from the circulation after transfusion. The authors studied
whether treating stored packed ovine erythrocytes with NO before transfusion
could prevent pulmonary vasoconstriction, enhance erythrocyte deformability, and
prolong erythrocyte survival after transfusion. METHODS: Ovine leukoreduced
packed erythrocytes were treated before transfusion with either NO gas or a
short-lived NO donor. Sheep were transfused with autologous packed erythrocytes,
which were stored at 4°C for either 2 ("fresh blood") or 40 days ("stored
blood"). Pulmonary and systemic hemodynamic parameters were monitored before,
during, and after transfusion. Transfused erythrocytes were labeled with biotin
to measure their circulating lifespan. Erythrocyte deformability was assessed
before and after NO treatment using a microfluidic device. RESULTS: NO treatment
improved the deformability of stored erythrocytes and increased the number of
stored erythrocytes circulating at 1 and 24?h after transfusion. NO treatment
prevented transfusion-associated pulmonary hypertension (mean pulmonary arterial
pressure at 30?min of 21?±?1 vs. 15?±?1 mmHg in control and NO-treated packed
erythrocytes, P < 0.0001). Washing stored packed erythrocytes before transfusion
did not prevent pulmonary hypertension. CONCLUSIONS: NO treatment of stored
packed erythrocytes before transfusion oxidizes cell-free oxyhemoglobin to
methemoglobin, prevents subsequent NO scavenging in the pulmonary vasculature,
and limits pulmonary hypertension. NO treatment increases erythrocyte
deformability and erythrocyte survival after transfusion. NO treatment might
provide a promising therapeutic approach to prevent pulmonary hypertension and
extend erythrocyte survival.
|*Nitric Oxide
[MESH]
|Animals
[MESH]
|Disease Models, Animal
[MESH]
|Erythrocyte Transfusion/*methods
[MESH]
|Erythrocytes/*drug effects
[MESH]
|Hypertension, Pulmonary/*prevention & control
[MESH]
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