PMID- 21314930
OWN - NLM
STAT- MEDLINE
DCOM- 20111207
LR  - 20231104
IS  - 1466-609X (Electronic)
IS  - 1364-8535 (Print)
IS  - 1364-8535 (Linking)
VI  - 15
IP  - 1
DP  - 2011
TI  - Blood transfusion during cardiac surgery is associated with inflammation and 
      coagulation in the lung: a case control study.
PG  - R59
LID - 10.1186/cc10032 [doi]
AB  - INTRODUCTION: Blood transfusion is associated with increased morbidity and 
      mortality in cardiac surgery patients, but cause-and-effect relations remain 
      unknown. We hypothesized that blood transfusion is associated with changes in 
      pulmonary and systemic inflammation and coagulation occurring in patients who do 
      not meet the clinical diagnosis of transfusion-related acute lung injury (TRALI). 
      METHODS: We performed a case control study in a mixed medical-surgical intensive 
      care unit of a university hospital in the Netherlands. Cardiac surgery patients 
      (n = 45) were grouped as follows: those who received no transfusion, those who 
      received a restrictive transfusion (one two units of blood) or those who received 
      multiple transfusions (at least five units of blood). Nondirected bronchoalveolar 
      lavage fluid (BALF) and blood were obtained within 3 hours postoperatively. 
      Normal distributed data were analyzed using analysis of variance and Dunnett's 
      post hoc test. Nonparametric data were analyzed using the Kruskal-Wallis and 
      Mann-Whitney U tests. RESULTS: Restrictive transfusion increased BALF levels of 
      interleukin (IL)-1beta and D-dimer compared to nontransfused controls (P < 0.05 for 
      all), and IL-1beta levels were further enhanced by multiple transfusions (P < 0.01). 
      BALF levels of IL-8, tumor necrosis factor alpha (TNFalpha) and thrombin-antithrombin 
      complex (TATc) were increased after multiple transfusions (P < 0.01, P < 0.001 
      and P < 0.01, respectively) compared to nontransfused controls, but not after 
      restrictive transfusions. Restrictive transfusions were associated with increased 
      pulmonary levels of plasminogen activator inhibitor 1 compared to nontransfused 
      controls with a further increase after multiple transfusions (P < 0.001). 
      Concomitantly, levels of plasminogen activator activity (PAA%) were lower (P < 
      0.001), indicating impaired fibrinolysis. In the systemic compartment, 
      transfusion was associated with a significant increase in levels of TNFalpha, TATc 
      and PAA% (P < 0.05). CONCLUSIONS: Transfusion during cardiac surgery is 
      associated with activation of inflammation and coagulation in the pulmonary 
      compartment of patients who do not meet TRALI criteria, an effect that was partly 
      dose-dependent, suggesting transfusion as a mediator of acute lung injury. These 
      pulmonary changes were accompanied by systemic derangement of coagulation.
FAU - Tuinman, Pieter R
AU  - Tuinman PR
AD  - Department of Intensive Care Medicine and Laboratory of Experimental Intensive 
      Care and Anesthesiology, Academic Medical Center, Meibergdreef 9, Amsterdam 
      NL-1105 AZ, The Netherlands. p.r.tuinman@amc.uva.nl
FAU - Vlaar, Alexander P
AU  - Vlaar AP
FAU - Cornet, Alexander D
AU  - Cornet AD
FAU - Hofstra, Jorrit J
AU  - Hofstra JJ
FAU - Levi, Marcel
AU  - Levi M
FAU - Meijers, Joost C M
AU  - Meijers JC
FAU - Beishuizen, Albertus
AU  - Beishuizen A
FAU - Schultz, Marcus J
AU  - Schultz MJ
FAU - Groeneveld, Ab Johan
AU  - Groeneveld AJ
FAU - Juffermans, Nicole P
AU  - Juffermans NP
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20110211
PL  - England
TA  - Crit Care
JT  - Critical care (London, England)
JID - 9801902
SB  - IM
CIN - Crit Care. 2011;15(2):152. PMID: 21542872
MH  - Acute Lung Injury/blood
MH  - Aged
MH  - *Blood Coagulation
MH  - *Cardiac Surgical Procedures
MH  - Case-Control Studies
MH  - Female
MH  - Humans
MH  - Inflammation/blood/*etiology
MH  - Intraoperative Care/*adverse effects
MH  - Lung Diseases/blood/*etiology
MH  - Male
MH  - Middle Aged
MH  - *Transfusion Reaction
MH  - Treatment Outcome
PMC - PMC3221992
EDAT- 2011/02/15 06:00
MHDA- 2011/12/13 00:00
PMCR- 2011/02/11
CRDT- 2011/02/15 06:00
PHST- 2010/12/02 00:00 [received]
PHST- 2011/01/18 00:00 [revised]
PHST- 2011/02/11 00:00 [accepted]
PHST- 2011/02/15 06:00 [entrez]
PHST- 2011/02/15 06:00 [pubmed]
PHST- 2011/12/13 00:00 [medline]
PHST- 2011/02/11 00:00 [pmc-release]
AID - cc10032 [pii]
AID - 10.1186/cc10032 [doi]
PST - ppublish
SO  - Crit Care. 2011;15(1):R59. doi: 10.1186/cc10032. Epub 2011 Feb 11.