Objectives: Children undergoing cardiac surgery with cardiopulmonary bypass are susceptible to additional inflammatory and immunogenic insults from blood transfusions. We hypothesize that washing red blood cells and platelets transfused to these patients will reduce postoperative transfusion-related immune modulation and inflammation.
Design: Prospective, randomized, controlled clinical trial.
Setting: University hospital pediatric cardiac intensive care unit.
Patients: Children from birth to 17 yrs undergoing cardiac surgery with cardiopulmonary bypass.
Interventions: Children were randomized to an unwashed or washed red blood cells and platelet transfusion protocol for their surgery and postoperative care. All blood was leuko-reduced, irradiated, and ABO identical. Plasma was obtained for laboratory analysis preoperatively, immediately, and 6 and 12 hrs after cardiopulmonary bypass. Primary outcome was the 12-hr postcardiopulmonary bypass interleukin-6-to-interleukin-10 ratio. Secondary measures were interleukin levels, C-reactive protein, and clinical outcomes.
Measurements and Main Results: One hundred sixty-two subjects were studied, 81 per group. Thirty-four subjects (17 per group) did not receive any blood transfusions. Storage duration of blood products was similar between groups. Among transfused subjects, the 12-hr interleukin ratio was significantly lower in the washed group (3.8 vs. 4.8; p = .04) secondary to lower interleukin-6 levels (after cardiopulmonary bypass: 65 vs.100 pg/mL, p = .06; 6 hrs: 89 vs.152 pg/mL, p = .02; 12 hrs: 84 vs.122 pg/mL, p = .09). Postoperative C-reactive protein was lower in subjects receiving washed blood (38 vs. 43 mg/L; p = .03). There was a numerical, but not statistically significant, decrease in total blood product transfusions (203 vs. 260) and mortality (2 vs. 6 deaths) in the washed group compared to the unwashed group.
Conclusions: Washed blood transfusions in cardiac surgery reduced inflammatory biomarkers, number of transfusions, donor exposures, and were associated with a nonsignificant trend toward reduced mortality. A larger study powered to test for clinical outcomes is needed to determine whether these laboratory findings are clinically significant.
From the Departments of Pediatrics (JMC, KSP, ED, EN, JSR), Pathology and Laboratory Medicine (KFH, SLS, NB), Cardiac Surgery (GMA, MS, FG), Environmental Medicine (RP), and Anesthesiology (DS, ME); University of Rochester, Rochester, NY; Department of Pediatrics (NBL), St. Christopher’s Hospital for Children, Philadelphia, PA.
*See also p. 357.
Supported, in part, by a Strong Children’s Research Development award from the URMC-Department of Pediatrics (J.M.C.), and from the National Institute of Environmental Health Sciences/National Institute of Health (ES01247) and the National Heart Lung and Blood Institute/National Institute of Health (HL100051, HL095467) (R.P.). These funding sources did not have any role in the study design, collection, analysis, and/or in the decision to submit the manuscript for publication. There are no relationships with industry.
Dr. Blumberg has served as a consultant to and is a research grant recipient from manufacturers of leuko-reduction filters (Pall Biomedical, Fenwall) and cell washing devices (Caridian). Caridian provided a small proportion of the cell washing sets for patients in the washed arm of the study. The remaining authors have not disclosed any potential conflicts of interest.
For information regarding this article, E-mail: Jill_Cholette@urmc.rochester.edu