Introduction
Microcirculatory alterations during sepsis impair tissue oxygenation, which may be further worsened by anemia. Blood transfusions proved not to restore O2 delivery during sepsis [1]. The impact of storage lesions and/or leukocyte-derived mediators in red blood cell (RBC) units has not yet been clarified [2]. We compared the effects of leukoreduced (LR) versus nonLR packed RBCs on microcirculation and tissue oxygenation during sepsis.
Methods
A prospective randomized study. Twenty patients with either sepsis, severe sepsis or septic shock requiring RBC transfusion randomly received nonLR (Group 1, n = 10) or LR (Group 2, n = 10) fresh RBCs (<10 days old). Before and 1 hour after transfusion, microvascular density and flow were assessed with sidestream dark-field imaging sublingually. Thenar tissue O2 saturation (StO2) was measured using near-infrared spectroscopy and a vascular occlusion test was performed.
Results
The De Backer score (P = 0.02), total vessel density (P = 0.08), perfused vessel density (P = 0.04), proportion of perfused vessels (P = 0.01), and microvascular flow index (P = 0.04, Figure 1) increased only in Group 2. The StO2 upslope (Figure 2) during reperfusion increased in both groups (P < 0.05). In Group 1 the baseline StO2 and StO2 downslope during ischemia increased, probably reflecting a lower O2 consumption.
Conclusion
Unlike nonLR RBCs, the transfusion of fresh LR RBCs seems to improve microvascular perfusion and might help to restore tissue oxygenation during sepsis.
Blood transfusion and microvascular flow.
Blood transfusion and microvascular reactivity.
References
Marik PE, et al.: JAMA. 1993, 269: 3024-3029. 10.1001/jama.1993.03500230106037
Sparrow RL: Blood Transfus. 2010, 8(Suppl 3):s26-s30.
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Donati, A., Damiani, E., Domizi, R. et al. Microcirculation and blood transfusions during sepsis: leukoreduced (LR) versus non-LR red blood cells. Crit Care 17 (Suppl 2), P369 (2013). https://doi.org/10.1186/cc12307
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DOI: https://doi.org/10.1186/cc12307