Washing older blood units before transfusion reduces plasma iron and improves outcomes in experimental canine pneumonia

Irene Corteś-Puch, Dong Wang, Junfeng Sun, Steven B. Solomon, Kenneth E. Remy, Melinda Fernandez, Jing Feng, Tamir Kanias, Landon Bellavia, Derek Sinchar, Andreas Perlegas, Michael A. Solomon, Walter E. Kelley, Mark A. Popovsky, Mark T. Gladwin, Daniel B. Kim-Shapiro, Harvey G. Klein, Charles Natanson

Research output: Contribution to journalArticlepeer-review

56 Scopus citations


In a randomized controlled blinded trial, 2-year-old purpose-bred beagles (n = 24), with Staphylococcus aureus pneumonia, were exchanged-transfused with either 7- or 42-day-old washed or unwashed canine universal donor blood (80 mL/kg in 4 divided doses). Washing red cells (RBC) before transfusion had a significantly different effect on canine survival, multiple organ injury, plasma iron, and cell-free hemoglobin (CFH) levels depending on the age of stored blood (all, P < .05 for interactions). Washing older units of blood improved survival rates, shock score, lung injury, cardiac performance and liver function, and reduced levels of non-transferrin bound iron and plasma labile iron. In contrast, washing fresh blood worsened all these sameclinical parameters and increased CFH levels. Our data indicate that transfusion of fresh blood, which results in less hemolysis, CFH, and iron release, is less toxic than transfusion of older blood in critically ill infected subjects. However, washing older blood prevented elevations in plasma circulating iron and improved survival and multiple organ injury in animals with an established pulmonary infection. Our data suggest that fresh blood should not be washed routinely because, in a setting of established infection, washed RBC are prone to release CFH and result in worsened clinical outcomes.

Original languageEnglish
Pages (from-to)1403-1411
Number of pages9
Issue number9
StatePublished - Feb 27 2014


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