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Critical Care
Published in: Critical Care 1/2014

Open Access 01-02-2014 | Research

Microcirculatory effects of the transfusion of leukodepleted or non-leukodepleted red blood cells in patients with sepsis: a pilot study

Authors: Abele Donati, Elisa Damiani, Michele Maria Luchetti, Roberta Domizi, Claudia Scorcella, Andrea Carsetti, Vincenzo Gabbanelli, Paola Carletti, Rosella Bencivenga, Hans Vink, Erica Adrario, Michael Piagnerelli, Armando Gabrielli, Paolo Pelaia, Can Ince

Published in: Critical Care | Issue 1/2014

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Abstract

Introduction

Microvascular alterations impair tissue oxygenation during sepsis. A red blood cell (RBC) transfusion increases oxygen (O2) delivery but rarely improves tissue O2 uptake in patients with sepsis. Possible causes include RBC alterations due to prolonged storage or residual leukocyte-derived inflammatory mediators. The aim of this study was to compare the effects of two types of transfused RBCs on microcirculation in patients with sepsis.

Methods

In a prospective randomized trial, 20 patients with sepsis were divided into two separate groups and received either non-leukodepleted (n = 10) or leukodepleted (n = 10) RBC transfusions. Microvascular density and perfusion were assessed with sidestream dark field (SDF) imaging sublingually, before and 1 hour after transfusions. Thenar tissue O2 saturation (StO2) and tissue hemoglobin index (THI) were determined with near-infrared spectroscopy, and a vascular occlusion test was performed. The microcirculatory perfused boundary region was assessed in SDF images as an index of glycocalyx damage, and glycocalyx compounds (syndecan-1, hyaluronan, and heparan sulfate) were measured in the serum.

Results

No differences were observed in microvascular parameters at baseline and after transfusion between the groups, except for the proportion of perfused vessels (PPV) and blood flow velocity, which were higher after transfusion in the leukodepleted group. Microvascular flow index in small vessels (MFI) and blood flow velocity exhibited different responses to transfusion between the two groups (P = 0.03 and P = 0.04, respectively), with a positive effect of leukodepleted RBCs. When within-group changes were examined, microcirculatory improvement was observed only in patients who received leukodepleted RBC transfusion as suggested by the increase in De Backer score (P = 0.02), perfused vessel density (P = 0.04), PPV (P = 0.01), and MFI (P = 0.04). Blood flow velocity decreased in the non-leukodepleted group (P = 0.03). THI and StO2 upslope increased in both groups. StO2 and StO2 downslope increased in patients who received non-leukodepleted RBC transfusions. Syndecan-1 increased after the transfusion of non-leukodepleted RBCs (P = 0.03).

Conclusions

This study does not show a clear superiority of leukodepleted over non-leukodepleted RBC transfusions on microvascular perfusion in patients with sepsis, although it suggests a more favorable effect of leukodepleted RBCs on microcirculatory convective flow. Further studies are needed to confirm these findings.

Trial registration

ClinicalTrials.gov, NCT01584999
Appendix
Available only for authorised users
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Metadata
Title
Microcirculatory effects of the transfusion of leukodepleted or non-leukodepleted red blood cells in patients with sepsis: a pilot study
Authors
Abele Donati
Elisa Damiani
Michele Maria Luchetti
Roberta Domizi
Claudia Scorcella
Andrea Carsetti
Vincenzo Gabbanelli
Paola Carletti
Rosella Bencivenga
Hans Vink
Erica Adrario
Michael Piagnerelli
Armando Gabrielli
Paolo Pelaia
Can Ince
Publication date
01-02-2014
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2014
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc13730

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