Aged versus fresh autologous platelet transfusion in a two‐hit healthy volunteer model of transfusion‐related acute lung injury
Floor L. F. van Baarle, Sanne de Bruin, Esther Bulle, Niels van Mourik, Endry H. T. Lim, Anita M. Tuip‐de Boer, Annabel Bongers, Marit B. de Wissel, Robin van Bruggen, Dirk de Korte, Christie Vermeulen, Khik Wie Tan, René E. Jonkers, Peter I. Bonta, René Lutter, Tamara Dekker, Barbara Dierdorp, Anna L. Peters, Bart J. Biemond, Alexander P. J. Vlaar
Abstract
Abstract Background Transfusion‐related acute lung injury (TRALI) is a severe complication of blood transfusion that is thought of as a two‐hit event: first the underlying patient condition (e.g., sepsis), and then the transfusion. Transfusion factors include human leukocyte antigen antibodies or biologic response modifiers (BRMs) accumulating during storage. Preclinical studies show an increased TRALI risk with longer stored platelets, clinical studies are conflicting. We aim to discover whether longer platelet concentrate (PC) storage time increases TRALI risk in a controlled human experiment. Study Design and Methods In a randomized controlled trial, 18 healthy male volunteers received a first hit of experimental endotoxemia (2 ng/kg lipopolysaccharide), and a second hit of fresh (2‐day old) or aged (7‐day old) autologous PC, or physiological saline. After 6 h, changes in TRALI pathways were determined using spirometry, chest X‐ray, and bronchoalveolar lavage (BAL). Results All subjects reacted adequately to lipopolysaccharide infusion and satisfied SIRS criteria (increased pulse [>90/min] and temperature [>38°C]). There were no differences between the saline, fresh, and aged PC groups in BAL‐fluid protein (95 ± 33 μg/ml; 83 ± 21 μg/ml and 104 ± 29 μg/ml, respectively) and relative neutrophil count (1.5 ± 0.5%; 1.9 ± 0.8% and 1.3 ± 0.8%, respectively), nor in inflammatory BAL‐fluid BRMs (Interleukin‐6, CXCL8, TNFα and myeloperoxidase), clinical respiratory parameters, and spirometry results. All chest X‐rays were normal. Conclusions In a human endotoxemia model of autologous platelet transfusion, with an adequate first hit and platelet storage lesion, transfusion of 7‐day‐old PC does not increase pulmonary inflammation compared with 2‐day‐old PC.