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Impaired Red Blood Cell Deformability after Transfusion of Stored Allogeneic Blood but Not Autologous Salvaged Blood in Cardiac Surgery Patients

Salaria, Osman N. MD*; Barodka, Viachaslau M. MD*; Hogue, Charles W. MD*; Berkowitz, Dan E. MD*†; Ness, Paul M. MD; Wasey, Jack O. MD*; Frank, Steven M. MD*

doi: 10.1213/ANE.0000000000000227
Cardiovascular Anesthesiology: Research Report

BACKGROUND: Both cardiopulmonary bypass (CPB) and red blood cell (RBC) storage are associated with detrimental changes in RBC structure and function that may adversely affect tissue oxygen delivery. We tested the hypothesis that in cardiac surgery patients, RBC deformability and aggregation are minimally affected by CPB with autologous salvaged blood alone but are negatively affected by the addition of stored allogeneic blood.

METHODS: In this prospective cohort study, 32 patients undergoing cardiac surgery with CPB were divided into 3 groups by transfusion status: autologous salvaged RBCs alone (Auto; n = 12), autologous salvaged RBCs + minimal (<5 units) stored allogeneic RBCs (Auto+Allo min; n = 10), and autologous salvaged RBCs + moderate (≥5 units) stored allogeneic RBCs (Auto+Allo mod; n = 10). Ektacytometry was used to measure RBC elongation index (deformability) and critical shear stress (aggregation) before, during, and for 3 days after surgery.

RESULTS: In the Auto group, RBC elongation index did not change significantly from the preoperative baseline. In the Auto+Allo min group, mean elongation index decreased from 32.31 ± 0.02 (baseline) to 30.47 ± 0.02 (nadir on postoperative day 1) (P = 0.003, representing a 6% change). In the Auto+Allo mod group, mean elongation index decreased from 32.7 ± 0.02 (baseline) to 28.14 ± 0.01 (nadir on postoperative day 1) (P = 0.0001, representing a 14% change). Deformability then dose-dependently recovered toward baseline over the first 3 postoperative days. Changes in aggregation were unrelated to transfusion (no difference among groups). For the 3 groups combined, mean critical shear stress decreased from 359 ± 174 mPa to 170 ± 141 mPa (P = 0.01, representing a 54% change), with the nadir at the end of surgery and returned to baseline by postoperative day 1.

CONCLUSIONS: In cardiac surgery patients, transfusion with stored allogeneic RBCs, but not autologous salvaged RBCs, is associated with a decrease in RBC cell membrane deformability that is dose-dependent and may persist beyond 3 postoperative days. These findings suggest that autologous salvaged RBCs may be of higher quality than stored RBCs, since the latter are subject to the so-called storage lesions.

Published ahead of print May 7, 2014

From the Departments of *Anesthesiology/Critical Care Medicine, Biomedical Engineering, and Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.

Accepted for publication January 21, 2014.

Published ahead of print May 7, 2014

Funding: Support was provided from institutional and/or departmental sources and the National Institutes of Health R01 HL105296-03 (to D.E.B.), R01 HL092259-01 (to C.W.H.), and the New York Community Trust (to S.M.F.).

Conflicts of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address correspondence to Steven M. Frank, MD, Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, 1800 Zayed–Room 6208, Baltimore, Maryland 21287. Address e-mail to

© 2014 International Anesthesia Research Society