| The effect of blood transfusion on pulmonary permeability in cardiac surgery patients: a prospective multicenter cohort study. | |
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MedLine Citation:
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PMID: 21745211 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: There is an association between blood transfusion and pulmonary complications in cardiac surgery. Mediators of increased pulmonary vascular leakage after transfusion are unknown. We hypothesized that factors may include antibodies or bioactive lipids, which have been implicated in transfusion-related acute lung injury. STUDY DESIGN AND METHODS: We performed a prospective cohort study in two university hospital intensive care units in the Netherlands. Pulmonary vascular permeability was measured in cardiac surgery patients after receiving no, restrictive (one or two transfusions), or multiple (five or more transfusions) transfusions (n = 20 per group). The pulmonary leak index (PLI), using (67) Ga-labeled transferrin, was determined within 3 hours postoperatively. Blood products were screened for bioactive lipid accumulation and the presence of antibodies. RESULTS: The PLI was elevated in all groups after cardiac surgery. Transfused patients had a higher PLI compared to nontransfused patients (33 × 10(-3) ± 20 × 10(-3) vs. 23 × 10(-3) ± 11 × 10(-3) /min, p < 0.01). The amount of red blood cell (RBC) products, but not of fresh-frozen plasma or platelets, was associated with an increase in PLI (β, 1.6 [0.2-3.0]). Concerning causative factors in the blood product, neither the level of bioactive lipids nor the presence of antibodies was associated with an increase in PLI. Patient factors such as surgery risk and time on cardiopulmonary bypass did not influence the risk of pulmonary leakage after blood transfusion. CONCLUSIONS: Transfusion in cardiothoracic surgery patients is associated with an increase in pulmonary capillary permeability, an effect that was dose dependent for RBC products. The level of bioactive lipids or the presence of HLA or HNA antibodies in the transfused products were not associated with increased pulmonary capillary permeability. |
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Authors:
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Alexander P J Vlaar; Alex D Cornet; Jorrit J Hofstra; Leendert Porcelijn; Albertus Beishuizen; Willem Kulik; Margreeth B Vroom; Marcus J Schultz; A B Johan Groeneveld; Nicole P Juffermans |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-7-11 |
Journal Detail:
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Title: Transfusion Volume: - ISSN: 1537-2995 ISO Abbreviation: - Publication Date: 2011 Jul |
Date Detail:
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Created Date: 2011-7-12 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0417360 Medline TA: Transfusion Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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© 2011 American Association of Blood Banks. |
Affiliation:
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From the Department of Intensive Care Medicine, the Department of Internal Medicine, the Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), and the Laboratory of Genetic Metabolic Diseases, Academic Medical Center; Sanquin Diagnostic Services, Sanquin Region North West; and the Department of Intensive Care Medicine and the Institute for Cardiovascular Research Vrije Universiteit (ICAR-VU), VU Medical Center Amsterdam, Amsterdam, the Netherlands. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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