The effects of non-leukoreduced red blood cell transfusions on microcirculation in mixed surgical patients

Background: The impact of the storage process on oxygen-carrying properties of red blood cells and the efficacy of red blood cell (RBC) transfusions concerning tissue oxygenation remain an issue of debate in transfusion medicine. Storage time and leukocyte content probably interact since longer storage duration is thought to cause greater accumulation of leukocyte-derived cytokines and red blood cell injury. Objectives: The aim of this study was to investigate the effects of storage and the efficacy of fresh (stored for less than 1 week) versus aged (stored for more than 3 weeks) non-leukoreduced RBC transfusions on sublingual microvascular density and flow in mixed surgical patients. Methods: Eighteen surgical patients were included in this study. Patients were randomly assigned into two groups receiving fresh (Group A) and aged (Group B) RBC transfusions. Sublingual microcirculatory functional capillary density (FCD) and microvascular flow index (MFI) were assessed using orthogonal polarization spectral COPS) imaging. Measurements and collection of blood samples were performed after induction of general anesthesia, before RBC transfusion and 30 min after the RBC transfusion ended. Results: In both groups RBC transfusions caused an increase in hemoglobin concentration (p < 0.001). RBC transfusions increased FCD in Group A (p < 0.001), while FCD remained unaffected in Group B. Changes in MFI following RBC transfusion in both groups remained unaltered. Conclusions: Fresh non-leukoreduced RBC transfusions but not RBCs stored for more than 3 weeks, were effective in improving microciruculatory perfusion by elevating the number of perfused microvessels in mixed surgical patients. (C) 2013 Elsevier Ltd. All rights reserved.