Changes in polymorphonuclear leukocyte elastase concentrations and hemolysis parameters in patients transfused with different blood preparations,and in the blood preparations themselves

PURPOSE: Massive blood transfusion induces hemolysis and increases polymorphonuclear leukocyte elastase (PMNE) concentration. The purpose of this study was to compare hemolysis and PMNE concentrations in massive blood transfusions with three different preparations. METHODS: In an in vitro study, eight 2-day-old packs of concentrated red blood cells in mannitol, adenine, glucose, phosphate, and citrate solution (MAP-CRC); concentrated red blood cells in citrate, phosphate, and glucose solution (CPD-CRC); or whole blood in citrate, phosphate, and glucose solution (WB) were stored at 4 degrees C. Supernatant concentrations of total and free hemoglobin, total haptoglobin, and PMNE were measured. In an in vivo study, 24 surgical patients with expected bleeding exceeding 3000 ml were transfused with CPD-CRC or MAP-CRC with fresh frozen plasma, or with WB. Platelet count, prothrombin time, activated partial thromboplastin time, serum total and free hemoglobin, and total haptoglobin and plasma PMNE concentrations were measured. RESULTS: In the in vitro study, total and free hemoglobin concentrations were significantly higher in CPD-CRC than in the other two preparations. Total haptoglobin concentration was highest in the order of WB > MAP-CRC > CPD-CRC. The PMNE concentration was significantly higher in WB than in the other two preparations. In the in vivo study, at 3000-ml transfusion, total and free hemoglobin concentrations were significantly lower and activated partial thromboplastin time was longer in the patients with MAP-CRC compared with values in the other two groups. The PMNE concentration was significantly higher in the order of the WB > CPD-CRC > MAP-CRC groups. CONCLUSION: During the storage of MAP-CRC, CPD-CRC, and WB, CPD-CRC had the greatest hemolysis and WB had the highest concentration of PMNE. Patients who received massive blood transfusion of MAP-CRC had the least hemolysis and the lowest concentration of PMNE.