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Proven and potential clinical benefits of washing red blood cells before transfusion: current perspectives

Authors Schmidt A, Refaai M, Kirkley S, Blumberg N

Received 18 May 2016

Accepted for publication 8 July 2016

Published 22 August 2016 Volume 2016:4 Pages 79—88


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Prof. Dr. Cees Th. Smit Sibinga

Amy E Schmidt, Majed A Refaai, Scott A Kirkley, Neil Blumberg

Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA

Abstract: Red blood cells (RBCs) are washed for a variety of reasons such as to remove excess potassium, cytokines, and other allergen proteins from the supernatant and/or to mitigate the effects of the storage lesion. The storage lesion is a product of RBC aging and include leakage of potassium and chloride from the RBCs, depletion of 2,3-diphosphoglycerate and adenosine triphosphate, loss of phospholipids and cholesterol, exposure of phosphatidylserine, elaboration of lipid mediators, loss of glutathione, autoxidation of hemoglobin to methemoglobin contributing to decreased blood flow viscosity and adherence to endothelial cells, increased microparticle formation, and disruption of NO-mediated vasodilation. A storage lesion is thought to be caused in part by oxidative stress, which is characterized by functional and structural changes to the RBCs. The effects of the RBC storage lesion on patient morbidity and mortality have been studied intensively with mixed results. Here, we will summarize the potential benefits of RBC washing. Notably, all patient-based studies on washed RBCs are single-center, small randomized studies or observational data, which await replication and tests of generalizability. Some of the most promising preliminary data suggest that washed transfusions of red cells and platelets reduce mortality in low risk, younger patients with acute myeloid leukemia, mitigate lung injury, and substantially reduce mortality in cardiac surgery. Larger randomized trials to replicate or refute these findings are urgently needed and, most importantly, have the potential to strikingly improve clinical outcomes following transfusion.

Keywords: washed blood, transfusion, immunomodulation, red blood cell

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