Association of crystalloid fluid infusion with intravascular hemolysis and organ dysfunction in hematopoietic stem cell transplant patients |
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| Affiliation: | 1. University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave., PO Box 255, Rochester, NY 14642, USA;2. Department of Medicine, Division of Hematology-Oncology, University of Rochester Medical Center, James P. Wilmot Cancer Center, 90 Crittenden Blvd., Rochester, NY 14642, USA;3. Department of Pathology and Laboratory Medicine (Transfusion Medicine), University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, USA;4. Tmunity Therapeutics Inc., 3020 Market Street, Suite 535, Philadelphia, PA 19104, USA;1. Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, USA;2. Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA;3. College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA;4. Department of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA, USA;5. Division of Emergency Medicine, Department of Medicine, Boston Children''s Hospital, Boston, MA, USA;6. Department of Pediatrics, Harvard Medical School, Boston, MA, USA;7. The Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA;8. Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA, USA;9. Massachusetts General Hospital, Boston, MA, USA;10. Brigham and Women''s Hospital, Boston, MA, USA;11. Spaulding Rehabilitation Hospital, Boston, MA, USA;1. Nursing Clinical Services, Division of Nursing, KK Women''s and Children''s Hospital, Singapore;2. Department of Paediatric Anaesthesia, KK Women''s and Children''s Hospital, Singapore;3. Cardiothoracic Surgery Service, KK Women''s and Children''s Hospital, Singapore;4. Safety & Risk Management, KK Women''s and Children''s Hospital, Singapore;5. Haematology Laboratory & Blood Bank, Department of Pathology and Laboratory Medicine, KK Women''s and Children''s Hospital, Singapore;6. Nursing Clinical Services, Division of Nursing, KK Women''s and Children''s Hospital, Singapore;1. SAINBIOSE INSERM U1049, Université de Saint-Etienne, Saint-Etienne, France;2. CPER INSERM U1100 and Université de Tours, and CHRU de Tours, Tours, France;1. DeGowin Blood Center, Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA;2. Biostatistician with the Institute for Clinical and Translation Research, University of Iowa, Iowa City, IA, USA |
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| Abstract: | Endothelial cell activation and injury is common after hematopoietic stem cell transplant (HSCT) and is associated with many post-transplant complications. An underexplored mechanism of endothelial cell damage in this population is the infusion of normal saline (NS, 0.9 % sodium chloride) and other crystalloids, as NS use is associated with adverse outcomes in other patient populations. We hypothesized that the infusion of unbalanced crystalloids during HSCT may lead to changes in biomarkers commonly associated with red blood cell (RBC) hemolysis in patients before and after infusion, and that markers of endothelial and end-organ damage during admission may be associated with markers of hemolysis and total crystalloid use. Samples were collected from 97 patients. From pre-fluid infusion to post-fluid infusion, mean haptoglobin decreased (11.7 ug/ml vs 8.4 ug/ml; p < 0.0001), hemopexin decreased (549 vs 512 μg/ml; p = 0.005), and red cell distribution width (RDW) decreased (15.7 vs 15.6; p = 0.0009). During admission (mean 19.4 days, SD 9.9), all markers of tissue and organ damage, including mean creatinine, lactate dehydrogenase (LDH), blood urea nitrogen (BUN), total bilirubin, AST, and ALT, increased from admission to peak levels (p < 0.0001). On linear regression, fluid volume (ml/kg) of crystalloid infusion positively predicted post-fluid infusion cell-free hemoglobin (r(96) = 0.34, p < 0.0001), free heme (r(96) = 0.36, p < 0.0001), and peak LDH during admission (r(75) = 0.23, p = 0.041), and negatively predicted post-fluid infusion hemopexin (r(96) = − 0.34, p < 0.0001). Unbalanced crystalloids may contribute to hemolysis and endothelial damage in HSCT patients. Alternatives such as buffered crystalloid solutions (PlasmaLyte, Lactated Ringer’s) may be worth investigating in this population. |
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| Keywords: | Hematopoietic stem cell transplant Crystalloids Hemolysis Endothelial damage Normal saline |
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