Plasma and lipids from stored platelets cause acute lung injury in an animal model
Article first published online: 16 APR 2003
Volume 43, Issue 5, pages 633–640, May 2003
How to Cite
Silliman, C. C., Bjornsen, A. J., Wyman, T. H., Kelher, M., Allard, J., Bieber, S. and Voelkel, N. F. (2003), Plasma and lipids from stored platelets cause acute lung injury in an animal model. Transfusion, 43: 633–640. doi: 10.1046/j.1537-2995.2003.00385.x
A-PLTs = apheresis PLTs; EBS = Earls buffered salt solution; D.0 = Day 0; D.5 = Day 5; IP = intraperitoneal; LPS = lipopolysaccharide (endotoxin); LTB4 = leukotriene B4; PA = pulmonary artery; WB-PLTs = whole-blood PLTs.
This work was supported by Bonfils Blood Center, a grant from the National Blood Foundation, and grant #HL59355-04 from NHLBI, NIH.
- Issue published online: 16 APR 2003
- Article first published online: 16 APR 2003
- Received for publication June 7, 2002; revision received October 10, 2002, and accepted December 2, 2002.
BACKGROUND : Transfusion of PLT concentrates may cause TRALI, a life-threatening reaction that has been linked to the infusion of anti-WBC immunoglobulins or older, stored PLTs that contain bioactive lipids. We hypothesize that lipids generated during storage of PLTs cause TRALI in a two-event animal model.
STUDY DESIGN AND METHODS : Plasma from both whole-blood PLTs (WB-PLTs) and apheresis PLTs (A-PLTs) was isolated on Day 0 (D.0) and Day 5 (D.5) of storage and heat-treated before use. Rats were pretreated with saline or 2 mg per kg endotoxin (LPS), anesthetized, and the lungs were ventilated, isolated, and perfused with saline or 5-percent PLT plasma. Pulmonary artery pressure, pulmonary edema, and leukotriene B 4 levels (perfusate) were measured.
RESULTS : Plasma from D.5, but not D.0, of the identical WB-PLT and A-PLT units caused injury in lungs from LPS-pretreated rats (LPS/D.5) evidenced by increases in pulmonary edema and leukotriene B 4 (p < 0.05). Lipid extracts and purified lipids from D.5 PLT plasma also elicited injury in lungs from LPS-pretreated rats (p < 0.05). Saline/D.5 plasma or lipids or LPS/D.0 did not cause pulmonary edema. Prestorage WBC reduction was ineffective in inhibiting TRALI.
CONCLUSION : PLT-induced TRALI may be the result of two events: 1) the clinical condition of the patient and 2) the infusion of lipids in stored PLTs.