LIANA S.

CERVANTES SEPTEMBER 19, 2018

BSN-III RELATED READING
MEDICAL-SURGICAL WARD
OSPITAL NG PALAWAN

BLOOD STORED LONGER MAY BE LESS SAFE FOR

PATIENTS WITH MASSIVE BLOOD LOSS AND
SHOCK
March 10, 2018 University of Alabama at Birmingham

Human blood from donors can be stored for use up to 42 days, and it is a mainstay
therapy in transfusion medicine. However, recent studies looking back at patient
records have shown that transfusion with older, stored blood is associated with
adverse effects.

For severely injured patients who have massive bleeding and receive many
transfusion units, older blood was associated with dysfunction in blood flow,
increased injury and inflammation in critical end organs, and lung infection.

In a collaborative study using a mouse model, University of Alabama at Birmingham

researchers from the departments of Anesthesiology and Perioperative Medicine,
Biostatistics, Emergency Medicine, Pathology, and Surgery have found mechanistic
links between older stored red blood cell transfusions and subsequent bacterial
pneumonia.
LIANA S. CERVANTES SEPTEMBER 19, 2018
BSN-III RELATED READING
MEDICAL-SURGICAL WARD
OSPITAL NG PALAWAN

This may reveal new approaches to improve safety of stored red blood cell
transfusions.

The key player is free heme, a breakdown product from degraded red blood cells.
Heme is part of the oxygen-binding hemoglobin pigment that gives blood cells their
red color and carries oxygen through the body from the lungs. While in the red blood
cell, heme is relatively safe; but once outside the confines of the red cells, free heme
is toxic and can cause tissue injury. During storage and upon transfusion, stored red
blood cells lyse open, releasing free heme.

An adverse role for heme suggests that finding ways to limit heme exposure or
prevent heme toxicity may improve safety of stored red blood cell transfusions, say
UAB researchers Rakesh Patel, Ph.D., and Jean-Francois Pittet, M.D.

Patel is a professor of pathology and director of the Center for Free Radical Biology,
and Pittet is a professor of anesthesiology and perioperative medicine at the UAB
School of Medicine.

In a study led by Patel and Pittet and published in the journal PLOS Medicine, mice
were resuscitated after trauma and hemorrhage, using either fresh or two-week-old
stored blood. Two days later, they were challenged by instilling the lungs with the
bacteria Pseudomonas aeruginosa. A two-week storage of mouse blood
approximates storage of human red blood cells for 42 days.

Compared to fresh blood, resuscitation with the stored blood significantly increased
bacterial lung injury, as shown by higher mortality, and increases in fluid
accumulation and bacterial numbers in the lungs.

A connection between free heme and infection susceptibility and severity was shown
two ways. First, Pseudomonas aeruginosa-induced mortality was completely
prevented by the addition of hemopexin, a scavenging protein in humans that
removes free heme from the blood.

Second, adding an inhibitor of a cell surface receptor called toll-like receptor 4, or

genetically removing that receptor from mice, also prevented the bacteria-induced
mortality. Free heme—which is known to induce inflammatory injury to major organs
in diseases like sickle cell or sepsis—acts, in part, by activating the toll-like receptor
4.

The researchers also found that transfusion with stored blood induced release of the
inflammation mediator HMGB1, part of the body's immune response.

In tissue culture experiments, Patel, Pittet and colleagues found that addition of free
heme increased permeability in a sheet of endothelial cells, and free heme inhibited
macrophages from ingesting Pseudomonas aeruginosa. Macrophages are immune
cells that remove infection by ingesting and destroying bacteria.
LIANA S. CERVANTES SEPTEMBER 19, 2018
BSN-III RELATED READING
MEDICAL-SURGICAL WARD
OSPITAL NG PALAWAN

Finally, in a 16-month study, the researchers found that human trauma-hemorrhage

patients who received large amounts of transfused blood were also receiving
amounts of free heme sufficient to overwhelm the normal amounts of hemopexin
found in a person's blood.

"We recognize that many challenges and questions remain and view our data as
hypothesis-generating," Patel, Pittet and colleagues said. "Clinically, our findings
underscore the need to establish whether the storage age of transfused
red blood cells correlates with increasing levels of free heme after transfusion, and
whether low ratios of hemopexin to free heme will identify patients at greater risk for
adverse outcomes after massive transfusions."

https://m.medicalxpress.com/news/2018-03-blood-longer-safe-patients-massive.html

II. SUMMARY OF RELATED READING

For severely injured patients who have massive bleeding and receive many transfusion units,
older blood was associated with dysfunction in blood flow, increased injury and
inflammation in critical end organs, and lung infection. The researchers have found
mechanistic links between older stored red blood cell transfusions and subsequent bacterial
pneumonia. The key player is free heme, a breakdown product from degraded red blood
cells. Heme is part of the oxygen-binding hemoglobin pigment that gives blood cells their
red color and carries oxygen through the body from the lungs. Free heme, which is known to
induce inflammatory injury to major organs in diseases like sickle cell or sepsis, acts, in part,
by activating the toll-like receptor. The researchers also found that transfusion with stored
blood induced release of the inflammation mediator HMGB1, part of the body’s immune
response.

III. REACTION/CRITICS
Blood transfusion has been an essential part of every medical and surgical
procedure at every hospital. Blood has saved so much lives for many years now and
it still does and always will especially during emergency situations. it is a miracle
body fluid that gives life to every human being on earth. For that, blood donations
have been widely promoted. Governments and private sectors have been so eager
to collect more blood and store for future needs. However, if blood storage and
transfusions has given us so much benefits, the article above states that a study was
conducted and result showed that long timed-stored blood can affect the quality of
the blood itself and can even cause certain microorganism to grow and enter a
patient body who had massive blood loss and just had blood transfusion. I, as a
nursing student, find this study as an additional insight for me and I think this study
could lead to more studies about how to improve blood storage in the future without
even affecting its quality.
LIANA S. CERVANTES SEPTEMBER 19, 2018
BSN-III RELATED READING
MEDICAL-SURGICAL WARD
OSPITAL NG PALAWAN

IV. LEARNING INSIGHTS

After reading the article I have learned that there is still so much room for
improvement in the field of nursing and science. I definitely thought ,before, that we
already have the perfect solution on how to manage blood loss by inventing the
process of storing and transfusing of blood however finding out about the study
conducted, I had realized that fresh things always are the best not just for foods but
also applies to blood, however it is still so little chances of getting fresh bloods
nowadays especially in this present busy world wherein people are always too
occupied by other things.

VI. RECOMMENDATIONS/SUGGESTIONS
This study shows me new insights regarding blood transfusions to patients with
massive blood loss. I think this article is a good tool for gaining more realizations and
ideas in regards to blood and BT, for the nursing students, this article will help us
understand how blood works, its components and other matters that is involve in BT.
It also will prepare the nurses for any future cases that might encounter along the
way. Having new ideas and knowledge will give the nursing students better
advantages.