HAEMATOLOGICAL AND BIOCHEMICAL EFFECTS OF TRANSFUSION OF STORED BLOOD IN TRANSFUSION-DEPENDENT THALASSEMIA PATIENTS
Abstract
Background: Thalassemia is a genetic disease in which there is an imbalance in the synthesis of globin polypeptide chains. The current study aimed to determine the haematological and biochemical effects of transfusion of seven days stored blood in transfusion-dependent thalassemia patients. Methods: A quasi-experimental study was conducted between January and July 2021 at Muhammad College of Medicine, Peshawar. A total of 20 transfusion-dependent thalassemia patients were selected. The impact of transfusion of 7-days old blood on haemoglobin levels, serum LDH, serum electrolytes, serum-free haemoglobin, serum bilirubin, serum-free iron, serum ferritin, and C-reactive protein were measured. Variations in pre-transfusion and post-transfusion samples were determined using paired-samples t-test, and p<0.05 was considered significant. Results: There was a non-significant difference in increase of haemoglobin levels (p=0.543) after transfusion of fresh and stored blood. Similarly, RBC counts, MCV, MCH, MCHC showed a slightly lower increase as compared to fresh blood. No differences were seen in platelet count between the two groups. However, the rise in white cells was significantly higher after transfusion of 7-days stored blood as compared to fresh blood (p=0.002). A non-significant increase in post-transfusion LDH (p=0.13), direct bilirubin (p=0.76) and indirect bilirubin (p=0.45) was seen. No differences in creatinine, glucose, and uric acid variations were found. Levels of C-reactive protein showed a significantly higher raise when 7-days stored blood was transfused in comparison with fresh blood (p=0.012). Conclusion: At least seven days stored blood can be safely transfused to transfusion-dependent thalassemia patients.
References
World Health Organization. The 2016 global status report on blood safety and availability. World Health Organization. 2017. Available from: https://apps.who.int/iris/ handle/10665/254987.
Rogers MAM, Greene MT, Davis JA, Ratz D, Kuhn LE, Saint S, et al. Longitudinal Study of Transfusion Utilization in Hospitalized Veterans. J Clin Outcomes Manag 2017;24(9):404–11.
Shah FT, Sayani F, Trompeter S, Drasar E, Piga A. Challenges of blood transfusions in Beta-thalassemia. Blood Rev 2019;37:100588.
Yoshida T, Prudent M, D'alessandro A. Red blood cell storage lesion: causes and potential clinical consequences. Blood Transfus 2019;17(1):27–52.
Remy KE, Sun J, Wang D, Welsh J, Solomon SB, Klein HG, et al. Transfusion of recently donated (fresh) red blood cells (RBCs) does not improve survival in comparison with current practice, while safety of the oldest stored units is yet to be established: a meta-analysis. Vox Sang 2016;111(1):43–54.
Rapido F, Brittenham GM, Bandyopadhyay S, La Carpia F, L'Acqua C, McMahon DJ, et al. Prolonged red cell storage before transfusion increases extravascular hemolysis. J Clin Invest. 2017;127(1):375–82.
Spitalnik SL. Stored red blood cell transfusions: iron, inflammation, immunity, and infection. Transfusion. 2014;54(10):2365–71.
De Santo LS, Romano G, Mango E, Iorio F, Savarese L, Numis F, et al. Age and blood transfusion: relationship and prognostic implications in cardiac surgery. J Thorac Dis 2017;9(10):3719–27.
García-Roa M, del Carmen Vicente-Ayuso M, Bobes AM, Pedraza AC, González-Fernández A, Martín MP, et al. Red blood cell storage time and transfusion: current practice, concerns and future perspectives. Blood Transfus 2017;15(3):222–31.
Hamizah L, Susanah S, Rakhmilla LE. Clinical Manifestations Of Children With Thalassemia Major: Clinical Course One Year Later. Asian J Biol Med Sci 2017;3(1).
Shah A, Brunskill SJ, Desborough MJ, Doree C, Trivella M, Stanworth SJ. Transfusion of red blood cells stored for shorter versus longer duration for all conditions. Cochrane Database Syst Rev 2018;12(12):CD010801.
Linda R, Ninda D. Differences in changes of hemoglobin between 6-12 hours and 12-14 hours after transfusion. Indones J Clin Pathol Med Lab 2018;24(2):108–11.
Spadaro S, Taccone FS, Fogagnolo A, Franchi F, Scolletta S, Ragazzi R, et al. The effects of blood transfusion on red blood cell distribution width in critically ill patients: a pilot study. Transfusion 2018;58(8):1863–9.
Fischer D, Büssow J, Meybohm P, Weber CF, Zacharowski K, Urbschat A, et al. Microparticles from stored red blood cells enhance procoagulant and proinflammatory activity. Transfusion 2017;57(11):2701–11.
Remy KE, Hall MW, Cholette J, Juffermans NP, Nicol K, Doctor A, et al. Mechanisms of red blood cell transfusion‐related immunomodulation. Transfusion 2018;58(3):804–15.
Faraji‐Goodarzi M, Taee N, Bajelan A, Safdari M. Leukocytosis in patients with favism and association with blood transfusion. J Clin Lab Anal 2019;33(6):e22906.
Hirani R, Dean MM, Balogh ZJ, Lott NJ, Seggie J, Hsu JM, et al. Donor white blood cell survival and cytokine profiles following red blood cell transfusion in Australian major trauma patients. Mol Immunol 2018;103:229–34.
Muszynski JA, Spinella PC, Cholette JM, Acker JP, Hall MW, Juffermans NP, et al. Transfusion‐related immunomodulation: review of the literature and implications for pediatric critical illness. Transfusion 2017;57(1):195–206.
Straat M, Böing AN, Tuip-De Boer A, Nieuwland R, Juffermans NP. Extracellular vesicles from red blood cell products induce a strong pro-inflammatory host response, dependent on both numbers and storage duration. Transfus Med Hemother 2016;43(4):302–5.
Kapur R, Kim M, Rondina MT, Porcelijn L, Semple JW. Elevation of C-reactive protein levels in patients with transfusion-related acute lung injury. Oncotarget 2016;7(47):78048–54.
Trinchero A, Marchetti M, Giaccherini C, Tartari CJ, Russo L, Falanga A. Platelet haemostatic properties in β-thalassaemia: the effect of blood transfusion. Blood Transfus 2017;15(5):413–21.
Wiesen AR, Byrd JC, Hospenthal DR, Howard RS, Shorr AR, Glass KL, et al. Transient abnormalities in serum bilirubin and lactate dehydrogenase levels following red blood cell transfusions in adults. Am J Med 1998;104(2):144–7.
Al-Moshary M, Imtiaz N, Al-Mussaed E, Khan A, Ahmad S, Albqami S. Clinical and biochemical assessment of liver function test and its correlation with serum ferritin levels in transfusion-dependent thalassemia patients. Cureus 2020;12(4):e7574.
Kelly S, Rodeghier M, DeBaun MR. Automated exchange compared to manual and simple blood transfusion attenuates rise in ferritin level after 1 year of regular blood transfusion therapy in chronically transfused children with sickle cell disease. Transfusion 2020;60(11):2508–16.
Fianza PI, Rahmawati A, Widihastha SH, Afifah S, Ghozali M, Indrajaya A, et al. Iron Overload in Transfusion-Dependent Indonesian Thalassemic Patients. Anemia 2021;2021:5581831.
Fibach E, Rachmilewitz EA. Iron overload in hematological disorders. Presse Med 2017;46(12 Pt 2):e296–305.
Ballas SK, Zeidan AM, Duong VH, DeVeaux M, Heeney MM. The effect of iron chelation therapy on overall survival in sickle cell disease and β-thalassemia: A systematic review. Am J Hematol 2018;93(7):943–52.
Dignass A, Farrag K, Stein J. Limitations of serum ferritin in diagnosing iron deficiency in inflammatory conditions. Int J Chronic Dis 2018;2018:9394060.
Sadoom MQ, Ali BH. Evaluation of hepcidin hormone and some biochemical parameters in iraqi children patients with β-thalassaemia intermedia before and after blood transfusion. J Natural Sci Res 2018;8(10):22–9.
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