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Published on: April 10, 2013
Changes in gene expression following trauma are related to the age of transfused packed red blood cells
Hew D T Torrance1, Mark E Vivian, Karim Brohi
1From the Adult Critical Care Unit (H.D.T.T., M.E.V., J.R.P., R.M.P., C.J.H., M.J.O.), Royal London Hospital, Barts Health NHS Trust; Centre for Trauma Sciences (H.DT.T., K.B.), Blizard Institute, and Centre for Translational Medicine and Therapeutics (H.D.T.T., M.E.V., J.R.P., R.M.P., H.C.O., C.J.H., M.J.O.), William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
Insights
Older stored red blood cells (RBCs) are linked to immune suppression in trauma patients. This study found that longer storage durations correlate with specific inflammatory gene expression changes, suggesting increased immunosuppression.
Area of Science:
- Immunology
- Transfusion Medicine
- Trauma Research
Background:
- Packed red blood cell (PRBC) transfusion is linked to increased nosocomial infections and mortality.
- Storage duration of PRBCs may impact patient outcomes.
- Investigating the relationship between PRBC age and inflammatory gene expression in trauma patients is crucial.
Purpose of the Study:
- To explore the association between the age of transfused PRBCs and inflammatory gene expression patterns.
- To determine if PRBC storage duration influences immune response in severely injured trauma patients.
Main Methods:
- Severely injured trauma patients receiving PRBCs within 24 hours of injury were studied.
- Blood samples were collected at baseline, 24, and 72 hours post-trauma.
- Quantitative PCR was used to measure inflammatory gene expression, with PRBC age as a key variable.
Main Results:
- Older PRBCs correlated with decreased expression of IL-12, IL-23, and RORγt within 24 hours.
- Extended storage of PRBCs was associated with reduced IL-12 expression over 72 hours.
- A rise in transforming growth factor β expression was observed with older PRBCs over 72 hours, independent of other factors.
Conclusions:
- Increased PRBC storage duration is associated with gene expression patterns indicative of heightened immunosuppression.
- These findings suggest that PRBC age may play a role in modulating the immune response post-trauma.
Background:
Transfusion of packed red blood cells (PRBCs) is associated with an increased incidence of nosocomial infections and an increased risk of death. The duration of storage before transfusion may influence these outcomes. Here, we explore the association between the age of transfused PRBCs and specific patterns of inflammatory gene expression in severely injured trauma patients.
Methods:
Severely injured trauma patients requiring intensive care unit treatment and receiving transfusion of PRBCs within 24 hours of the injury were recruited. Blood samples were obtained within 2 hours of the trauma, at 24 hours, and at 72 hours. Messenger RNA was extracted from whole blood, and gene expression was quantified using quantitative polymerase chain reaction. The median age of the units of PRBCs transfused to each patient was recorded. The primary outcome measure was the change in candidate gene expression over the initial 72 hours.
Results:
Sixty-four patients were studied. Fifty-three patients (83%) were male, and the median age was 40.5 years (interquartile range [IQR], 31-59). Median Injury Severity Score (ISS) was 31.5 (IQR, 23-43), and 55 patients (86%) experienced a blunt injury. Forty-one patients (64%) developed a nosocomial infection, and 15 patients (23%) died before hospital discharge. Each patient received a median of 5 U of PRBCs (IQR, 4-9.8 U) during the first 24 hours of hospital admission. The median age of the units of PRBCs transfused in each patient was 20 days (IQR, 17-22 days). Older blood was associated with greater decreases in interleukin 12 (IL-12), IL-23, and RORγt (all p's < 0.05) gene expression over the initial 24 hours, greater decreases in IL-12 gene expression over 72 hours, and a rise in transforming growth factor β gene expression over the first 72 hours. A multivariate analysis confirmed the independence of these associations.
Conclusion:
Increasing the duration of storage of PRBCs before transfusion is associated with a pattern of gene expression consistent with more severe immunosuppression.
Level Of Evidence:
Epidemiologic study, level III.
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