Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery

Woźniak, M.J.; Sullo, Nikol; Qureshi, S.; Dott, W.; Cardigan, R.; Wiltshire, M.; Morris, T.; Nath, M.; Bittar, N.; Bhudia, S.K.; Kumar, T.; Goodall, A.H.; Murphy, G.J.

doi:10.1093/bja/aex083

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Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery

M.J. Woźniak, Nikol Sullo

, S. Qureshi, W. Dott, R. Cardigan, M. Wiltshire, T. Morris, M. Nath, N. Bittar, S.K. Bhudia, T. Kumar, A.H. Goodall, G.J. Murphy

British Journal of Anaesthesia, Volume: 118, Issue: 5, Pages: 689 - 698

Swansea University Author: Nikol Sullo

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DOI (Published version): 10.1093/bja/aex083

Abstract

BackgroundExperimental studies suggest that mechanical cell washing to remove pro-inflammatory components that accumulate in the supernatant of stored donor red blood cells (RBCs) might reduce inflammation and organ injury in transfused patients.MethodsCardiac surgery patients at increased risk of l...

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Published in:	British Journal of Anaesthesia
ISSN:	0007-0912
Published:	Elsevier BV 2017
Online Access:	Check full text
URI:	https://cronfa.swan.ac.uk/Record/cronfa70514

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Participants were randomized to receive either mechanically washed allogenic RBCs or standard care RBCs. The primary outcome was serum interleukin-8 measured at baseline and at four postsurgery time points. A mechanism substudy evaluated the effects of washing on stored RBCs in vitro and on markers of platelet, leucocyte, and endothelial activation in trial subjects.ResultsSixty adult cardiac surgery patients at three UK cardiac centres were enrolled between September 2013 and March 2015. Subjects received a median of 3.5 (interquartile range 2–5.5) RBC units, stored for a mean of 21 (sd 5.2) days, within 48 h of surgery. Mechanical washing reduced concentrations of RBC-derived microvesicles but increased cell-free haemoglobin concentrations in RBC supernatant relative to standard care RBC supernatant. There was no difference between groups with respect to perioperative serum interleukin-8 values [adjusted mean difference 0.239 (95% confidence intervals −0.231, 0.709), P=0.318] or concentrations of plasma RBC microvesicles, platelet and leucocyte activation, plasma cell-free haemoglobin, endothelial activation, or biomarkers of heart, lung, or kidney injury.ConclusionsThese results do not support a hypothesis that allogenic red blood cell washing has clinical benefits in cardiac surgery.</abstract><type>Journal Article</type><journal>British Journal of Anaesthesia</journal><volume>118</volume><journalNumber>5</journalNumber><paginationStart>689</paginationStart><paginationEnd>698</paginationEnd><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0007-0912</issnPrint><issnElectronic/><keywords>Cardiovascular surgery; inflammation; transfusion</keywords><publishedDay>1</publishedDay><publishedMonth>5</publishedMonth><publishedYear>2017</publishedYear><publishedDate>2017-05-01</publishedDate><doi>10.1093/bja/aex083</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>National Institute for Health Research Programme Grant for Applied Research (RP-PG-0407-10384 for The REDWASH trial); British Heart Foundation (RG/13/6/29947, CH/12/1/29419, and PG/11/95/29173 to G.J.M., M.W., W.D., T.K. and N.S.); Leicester Cardiovascular Biomedical Research Unit (G.J.M., M.W., W.D., T.K. and N.S.).</funders><projectreference/><lastEdited>2025-10-09T15:48:15.0148585</lastEdited><Created>2025-09-25T14:50:21.8021454</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Biomedical Science</level></path><authors><author><firstname>M.J.</firstname><surname>Woźniak</surname><order>1</order></author><author><firstname>Nikol</firstname><surname>Sullo</surname><orcid>0000-0002-9885-5474</orcid><order>2</order></author><author><firstname>S.</firstname><surname>Qureshi</surname><order>3</order></author><author><firstname>W.</firstname><surname>Dott</surname><order>4</order></author><author><firstname>R.</firstname><surname>Cardigan</surname><order>5</order></author><author><firstname>M.</firstname><surname>Wiltshire</surname><order>6</order></author><author><firstname>T.</firstname><surname>Morris</surname><order>7</order></author><author><firstname>M.</firstname><surname>Nath</surname><order>8</order></author><author><firstname>N.</firstname><surname>Bittar</surname><order>9</order></author><author><firstname>S.K.</firstname><surname>Bhudia</surname><order>10</order></author><author><firstname>T.</firstname><surname>Kumar</surname><order>11</order></author><author><firstname>A.H.</firstname><surname>Goodall</surname><order>12</order></author><author><firstname>G.J.</firstname><surname>Murphy</surname><order>13</order></author></authors><documents><document><filename>70514__35290__be5abcfba7534c69ae2c4c3fdeb77cf4.pdf</filename><originalFilename>70514.VoR.pdf</originalFilename><uploaded>2025-10-09T15:43:13.4656124</uploaded><type>Output</type><contentLength>562641</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>Copyright: The Author 2017. 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spelling	2025-10-09T15:48:15.0148585 v2 70514 2025-09-25 Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery a2c2be54c418e779fd6a010486e1c730 0000-0002-9885-5474 Nikol Sullo Nikol Sullo true false 2025-09-25 MEDS BackgroundExperimental studies suggest that mechanical cell washing to remove pro-inflammatory components that accumulate in the supernatant of stored donor red blood cells (RBCs) might reduce inflammation and organ injury in transfused patients.MethodsCardiac surgery patients at increased risk of large-volume RBC transfusion were eligible. Participants were randomized to receive either mechanically washed allogenic RBCs or standard care RBCs. The primary outcome was serum interleukin-8 measured at baseline and at four postsurgery time points. A mechanism substudy evaluated the effects of washing on stored RBCs in vitro and on markers of platelet, leucocyte, and endothelial activation in trial subjects.ResultsSixty adult cardiac surgery patients at three UK cardiac centres were enrolled between September 2013 and March 2015. Subjects received a median of 3.5 (interquartile range 2–5.5) RBC units, stored for a mean of 21 (sd 5.2) days, within 48 h of surgery. Mechanical washing reduced concentrations of RBC-derived microvesicles but increased cell-free haemoglobin concentrations in RBC supernatant relative to standard care RBC supernatant. There was no difference between groups with respect to perioperative serum interleukin-8 values [adjusted mean difference 0.239 (95% confidence intervals −0.231, 0.709), P=0.318] or concentrations of plasma RBC microvesicles, platelet and leucocyte activation, plasma cell-free haemoglobin, endothelial activation, or biomarkers of heart, lung, or kidney injury.ConclusionsThese results do not support a hypothesis that allogenic red blood cell washing has clinical benefits in cardiac surgery. Journal Article British Journal of Anaesthesia 118 5 689 698 Elsevier BV 0007-0912 Cardiovascular surgery; inflammation; transfusion 1 5 2017 2017-05-01 10.1093/bja/aex083 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee National Institute for Health Research Programme Grant for Applied Research (RP-PG-0407-10384 for The REDWASH trial); British Heart Foundation (RG/13/6/29947, CH/12/1/29419, and PG/11/95/29173 to G.J.M., M.W., W.D., T.K. and N.S.); Leicester Cardiovascular Biomedical Research Unit (G.J.M., M.W., W.D., T.K. and N.S.). 2025-10-09T15:48:15.0148585 2025-09-25T14:50:21.8021454 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Biomedical Science M.J. Woźniak 1 Nikol Sullo 0000-0002-9885-5474 2 S. Qureshi 3 W. Dott 4 R. Cardigan 5 M. Wiltshire 6 T. Morris 7 M. Nath 8 N. Bittar 9 S.K. Bhudia 10 T. Kumar 11 A.H. Goodall 12 G.J. Murphy 13 70514__35290__be5abcfba7534c69ae2c4c3fdeb77cf4.pdf 70514.VoR.pdf 2025-10-09T15:43:13.4656124 Output 562641 application/pdf Version of Record true Copyright: The Author 2017. This is an Open Access article distributed under the terms of the Creative Commons Attribution License. true eng http://creativecommons.org/licenses/by/4.0/)
title	Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery
spellingShingle	Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery Nikol Sullo
title_short	Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery
title_full	Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery
title_fullStr	Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery
title_full_unstemmed	Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery
title_sort	Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery
author_id_str_mv	a2c2be54c418e779fd6a010486e1c730
author_id_fullname_str_mv	a2c2be54c418e779fd6a010486e1c730_***_Nikol Sullo
author	Nikol Sullo
author2	M.J. Woźniak Nikol Sullo S. Qureshi W. Dott R. Cardigan M. Wiltshire T. Morris M. Nath N. Bittar S.K. Bhudia T. Kumar A.H. Goodall G.J. Murphy
format	Journal article
container_title	British Journal of Anaesthesia
container_volume	118
container_issue	5
container_start_page	689
publishDate	2017
institution	Swansea University
issn	0007-0912
doi_str_mv	10.1093/bja/aex083
publisher	Elsevier BV
college_str	Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id	facultyofmedicinehealthandlifesciences
hierarchy_top_title	Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id	facultyofmedicinehealthandlifesciences
hierarchy_parent_title	Faculty of Medicine, Health and Life Sciences
department_str	Swansea University Medical School - Biomedical Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Biomedical Science
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description	BackgroundExperimental studies suggest that mechanical cell washing to remove pro-inflammatory components that accumulate in the supernatant of stored donor red blood cells (RBCs) might reduce inflammation and organ injury in transfused patients.MethodsCardiac surgery patients at increased risk of large-volume RBC transfusion were eligible. Participants were randomized to receive either mechanically washed allogenic RBCs or standard care RBCs. The primary outcome was serum interleukin-8 measured at baseline and at four postsurgery time points. A mechanism substudy evaluated the effects of washing on stored RBCs in vitro and on markers of platelet, leucocyte, and endothelial activation in trial subjects.ResultsSixty adult cardiac surgery patients at three UK cardiac centres were enrolled between September 2013 and March 2015. Subjects received a median of 3.5 (interquartile range 2–5.5) RBC units, stored for a mean of 21 (sd 5.2) days, within 48 h of surgery. Mechanical washing reduced concentrations of RBC-derived microvesicles but increased cell-free haemoglobin concentrations in RBC supernatant relative to standard care RBC supernatant. There was no difference between groups with respect to perioperative serum interleukin-8 values [adjusted mean difference 0.239 (95% confidence intervals −0.231, 0.709), P=0.318] or concentrations of plasma RBC microvesicles, platelet and leucocyte activation, plasma cell-free haemoglobin, endothelial activation, or biomarkers of heart, lung, or kidney injury.ConclusionsThese results do not support a hypothesis that allogenic red blood cell washing has clinical benefits in cardiac surgery.
published_date	2017-05-01T05:31:01Z
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score	11.444473

Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery

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