Plasma expander and blood storage effects on capillary perfusion in transfusion after hemorrhage

Authors

  • C. Makena Hightower,

    1. From the Department of Bioengineering, University of California at San Diego, La Jolla, California; the Department of Experimental Medicine, Faculty of Medicine, Universidad Nacional Autónoma de México, Hospital General de México, México D.F., Mexico; and the Department of Medicine, Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York.
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  • Beatriz Y. Salazar Vázquez,

    1. From the Department of Bioengineering, University of California at San Diego, La Jolla, California; the Department of Experimental Medicine, Faculty of Medicine, Universidad Nacional Autónoma de México, Hospital General de México, México D.F., Mexico; and the Department of Medicine, Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York.
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  • Pedro Cabrales,

    1. From the Department of Bioengineering, University of California at San Diego, La Jolla, California; the Department of Experimental Medicine, Faculty of Medicine, Universidad Nacional Autónoma de México, Hospital General de México, México D.F., Mexico; and the Department of Medicine, Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York.
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  • Amy G. Tsai,

    1. From the Department of Bioengineering, University of California at San Diego, La Jolla, California; the Department of Experimental Medicine, Faculty of Medicine, Universidad Nacional Autónoma de México, Hospital General de México, México D.F., Mexico; and the Department of Medicine, Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York.
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  • Seetharama A. Acharya,

    1. From the Department of Bioengineering, University of California at San Diego, La Jolla, California; the Department of Experimental Medicine, Faculty of Medicine, Universidad Nacional Autónoma de México, Hospital General de México, México D.F., Mexico; and the Department of Medicine, Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York.
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  • Marcos Intaglietta

    Corresponding author
    1. From the Department of Bioengineering, University of California at San Diego, La Jolla, California; the Department of Experimental Medicine, Faculty of Medicine, Universidad Nacional Autónoma de México, Hospital General de México, México D.F., Mexico; and the Department of Medicine, Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York.
      Marcos Intaglietta, PhD, Department of Bioengineering, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0412; e-mail: mintagli@ucsd.edu.
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  • This study was supported in part by the USPHS Bioengineering Research Partnership Grants R24-HL 064395 (MI), R01-HL 062354 (MI), T32-HL 007089 (CMH), R01-HL52684 (PC), and US Army Medical Research and Materiel Command Award W81XH1120012 (AGT).

Marcos Intaglietta, PhD, Department of Bioengineering, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0412; e-mail: mintagli@ucsd.edu.

Abstract

BACKGROUND: Treating hemorrhage with blood transfusions in subjects previously hemodiluted with different colloidal plasma expanders, using fresh autologous blood or blood that has been stored for 2 weeks, allows identifying the interaction between type of plasma expander and differences in blood storage.

STUDY DESIGN AND METHODS: Studies used the hamster window chamber model. Fresh autologous plasma, 130-kDa starch-based plasma expander (hydroxyethyl starch [HES]), or 4% polyethylene glycol–conjugated albumin (PEG-Alb) was used for 20% of blood volume (BV) hemodilution. Hemodilution was followed by a 55% by BV 40-minute hemorrhagic shock period, treated with transfusion of fresh or blood that was stored for 2 weeks. Outcome was evaluated 1 hour after blood transfusion in terms of microvascular and systemic variables.

RESULTS: Results were principally dependent on the type of colloidal solution used during hemodilution, 4% PEG-Alb yielding the best microvascular recovery evaluated in terms of the functional capillary density. This result was consistent whether fresh blood or stored blood was used in treating the subsequent shock period. Fresh blood results were significantly better in systemic and microvascular terms relative to stored blood. HES and fresh plasma hemodilution yielded less favorable results, a difference that was enhanced when fresh versus stored blood was compared in their efficacy of correcting the subsequent hemorrhage.

CONCLUSION: The type of plasma expander used for hemodilution influences the short-term outcome of subsequent volume resuscitation using blood transfusion, 4% PEG-Alb providing the most favorable outcome by comparison to HES or fresh plasma.

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