Key result
In vitro red blood cell transfusion increased residual platelet aggregation with ADP 5 µM (65.7% vs 57.7%; P=0.03) and P-selectin expression in blood from healthy volunteers.
Why the study?
The mechanisms leading to recurrent ischaemic events or mortality after red blood cell transfusion in anaemic ACS patients are poorly understood.
Does in vitro red blood cell transfusion increase platelet activation and aggregation in blood from healthy volunteers?
Does in vitro red blood cell transfusion increase platelet activation and aggregation in blood from healthy volunteers?
In vitro red blood cell transfusion increases platelet activation and aggregation, suggesting a potential mechanism for recurrent ischemic events after transfusion in ACS patients.
Answers are grounded in this paper and cite their sources.
May indicate prothrombotic transfusion effects in volunteers; hypothesis-generating and should not alter practice pending patient studies.
AIMS: The underlying mechanisms leading to recurrent ischaemic events or mortality after red blood cell (RBC) transfusion in anaemic acute coronary syndrome patients are poorly understood. The aim of this paper is to determine whether RBC transfusion increases platelet activation and aggregation. METHODS AND RESULTS: In vitro transfusions (n = 45) were performed by the addition of RBCs obtained from transfusion packs to fresh whole blood provided by healthy volunteers. Residual platelet aggregation (RPA) and maximal platelet aggregation (MPA) were assessed before and after in vitro transfusion using light transmission aggregometry performed with four different agonists. Flow cytometry was used for the measurement of P-selectin expression and vasodilatator-stimulated phosphoprotein (VASP) platelet reactivity index (PRI). To control for the effect of haemoconcentration, the same experiments were repeated after hematocrit adjustment using volunteer's platelet poor plasma. Transfusion increased platelet aggregation as measured by RPA with ADP 5 µM (57.7 ± 25 vs. 65.7 ± 24%; P = 0.03) or Collagen 2 µg/mL (59.4 ± 28 vs. 69.7 ± 24%; P = 0.03). There were no significant differences with Arachidonic Acid 1.25 mM or Epinephrine 20 µM and results were similar when MPA was considered. Platelet activation was also increased by transfusion as confirmed by an elevation of P-selectin expression induced by 20 µM ADP (12.2 ± 18 vs. 23.9 ± 18%; P = 0.002) or 50 µM ADP (15.4 ± 18.6 vs.26.8 ± 21.2%; P = 0.004) and an increase in VASP PRI (77.8 ± 6 vs. 81.9 ± 3%; P = 0.03). These effects were all independent of hematocrit. CONCLUSION: Red blood cell transfusion increases platelet activation and aggregation in vitro in healthy volunteers. This effect might be mediated through the P2Y(12) activation pathway.
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Silvain et al. (2010) studied Healthy volunteers (n=45). In vitro red blood cell transfusion vs. Before transfusion (baseline) was evaluated on Residual platelet aggregation (RPA) with ADP 5 µM (p=0.03). In vitro red blood cell transfusion increased residual platelet aggregation with ADP 5 µM (65.7% vs 57.7%; P=0.03) and P-selectin expression in blood from healthy volunteers.
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