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Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e31822f173c
Cardiac Intensive Care

Washing red blood cells and platelets transfused in cardiac surgery reduces postoperative inflammation and number of transfusions: Results of a prospective, randomized, controlled clinical trial*

Cholette, Jill M. MD; Henrichs, Kelly F. MT(ASCP); Alfieris, George M. MD; Powers, Karen S. MD; Phipps, Richard PhD; Spinelli, Sherry L. PhD; Swartz, Michael PhD; Gensini, Francisco MD; Daugherty, L. Eugene MD; Nazarian, Emily MD; Rubenstein, Jeffrey S. MD, MBA; Sweeney, Dawn MD; Eaton, Michael MD; Lerner, Norma B. MD, MPH; Blumberg, Neil MD

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Abstract

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.

©2012The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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