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Transfusion of Anaerobically or Conventionally Stored Blood After Hemorrhagic Shock

Williams, Alexander T.*; Jani, Vivek P.*; Nemkov, Travis; Lucas, Alfredo*; Yoshida, Tatsuro; Dunham, Andrew; Alessandro, Angelo D’; Cabrales, Pedro*

doi: 10.1097/SHK.0000000000001386
Basic Science Aspects (Animal Subjects): PDF Only

Background: Resuscitation from hemorrhagic shock (HS) by blood transfusion restores oxygen (O2) delivery and provides hemodynamic stability. Current regulations allow red blood cells (RBCs) to be stored and used for up to 42 days. During storage, RBCs undergo many structural and functional changes. These storage lesions have been associated with adverse events and increased mortality after transfusion, increasing the need for improved RBC storage protocols. This study evaluates the efficacy of anaerobically stored RBCs to resuscitate rats from severe HS compared with conventionally stored RBCs.

Methods and results: Rat RBCs were stored under anaerobic, anaerobic/hypercapnic, or conventional conditions for a period of 3 weeks. Hemorrhage was induced by controlled bleeding, shock was maintained for 30 min, and RBCs were transfused to restore and maintain blood pressure near the prhemorrhage level. All storage conditions met current regulatory 24-h posttransfusion recovery requirements. Transfusion of anaerobically stored RBCs required significantly less RBC volume to restore and maintain hemodynamics. Anaerobic or anaerobic/hypercapnic RBCs restored hemodynamics better than conventionally stored RBCs. Resuscitation with conventionally stored RBCs impaired indices of left ventricular cardiac function, increased hypoxic tissue staining and inflammatory markers, and affected organ function compared with anaerobically stored RBCs.

Conclusions: Resuscitation from HS via transfusion of anaerobically stored RBCs recovered cardiac function, restored hemodynamic stability, and improved outcomes.

*Department of Bioengineering, University of California, San Diego, La Jolla, California

Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Aurora, Colorado

Hemanext, Lexington, Massachusetts

Address reprint requests to Pedro Cabrales, 9500 Gilman Dr., PFBH 182, La Jolla, CA 92093. E-mail:

Received 13 March, 2019

Revised 1 April, 2019

Accepted 15 May, 2019

Authors’ contributions: ATW and PC designed the experimental studies; ATW performed experiments and acquired data. ATW, VPJ, and AL analyzed data. TN and ADA acquired and analyzed metabolomics data. TY and AD generated technology for ex vivo oxygen-controlled preservation of RBCs and provided reagents. ATW, VPJ, ADA, and PC wrote the manuscript.

Reagents were provided by Hemanext for completion of the study. Hemanext did not participate in implementation of the study. Additional funding was provided by NIH grants from the Heart Lung and Blood Institute, T32-HL105373, R01-HL126945, and R01 HL138116.

The authors would like to disclose that TY and AD are a part of Hemanext. ADA is a consultant for Hemanext.

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© 2019 by the Shock Society