Delivery of oxygen-carrying capacity via transfusion of ECs (also known as packed RBCs) is a valuable support mechanism in the management of critically ill humans and other animals. Despite the well-documented benefits of transfusion, administration of ECs carries the potential for a variety of adverse events, some of which are a consequence of the duration of storage of the cells.1
During storage, erythrocytes undergo various changes that are generally referred to as RBC storage lesions.2 Storage-related effects may impact cell membranes, leading to the generation of microparticles.3 Microparticles are small (generally < 1 μm in diameter), cytosol-containing vesicles surrounded by a membrane bilayer. Microparticles may develop under normal physiologic conditions from platelets and a variety of cells, including erythrocytes, endothelial cells, and leukocytes. Erythrocyte-derived microparticles are formed only in very low numbers in vivo under normal physiologic conditions,4 but marked generation of microparticles from all hematologic cell types during storage of human ECs has been reported.3,5–7
Microparticles are involved in several processes,5 including inflammation,8 angiogenesis,9 hemostasis,8 thrombosis,10 infection,11 and endothelial function.12 The presence of PPLs such as phosphatidylserine on the surface of microparticles allows binding of coagulation factors13 and is necessary for normal thrombin production.8 Microparticles derived from stored human ECs are able to support thrombin generation in vitro.14
Leukoreduction (removal of leukocytes by a specially charged filter) has the potential to decrease microparticle formation in stored ECs through elimination of many of the cell types from which they are formed during the storage period, as well as through reduction of proinflammatory mediators that are generated by leukocytes and platelets. The objectives of the study reported here were to evaluate canine ECs for the presence of PPL, determine whether PPL concentration changes during the course of storage of ECs, and ascertain whether prestorage leukoreduction reduces the development of PPL.
The Pall Corp donated the leukoreduction filter bags, Jerry Fina of Charter Medical donated the sampling ports, and Paul Riley of Diagnostica Stago donated the STA Procoag-PPL kits.
Presented in part at the International Veterinary Emergency and Critical Care Symposium, San Antonio, Tex, September 2012.
The authors thank Jessica Garrett for technical assistance.
Terumo Transfusion Products, Somerset, NJ.
Leukotrap WB System, Pall Corp, East Hills, NY.
Adsol, Baxter Healthcare, Deerfield, Ill.
Optisol, Terumo Transfusion Products, Somerset, NJ.
STA Procoag-PPL, Diagnostica Stago, Asnieres, France.
STart4 coagulometer, Diagnostica Stago, Asnieres, France.
Owren-Koller buffer, Diagnostica Stago, Asnieres, France.
Avanti Polar Lipids, Alabaster, Ala.
Thrombinoscope BV, Maasstraat, The Netherlands.
PPP-Low Reagent, Thrombinoscope BV, Maasstraat, The Netherlands.
FluCa, Thrombinoscope BV, Maasstraat, The Netherlands.
Thrombin Calibrator, Thrombinoscope BV, Maasstraat, The Netherlands.
Citrated human pooled normal plasma, George King Biomedical, Overland Park, Kan.
Sigma Stat, version 2.03, SPSS Inc, Chicago, Ill.
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