LEUKOREDUCTION OF PACKED RED BLOOD CELLS PRIOR TO STORAGE ATTENUATES LUNG INJURY FROM RBC
MICROPARTICLES FOLLOWING HEMORRHAGE AND RESUSCITATION
Jeffrey M. Sutton MD, Jillian R. Richter PhD, Taylor A. Johannigman, Rebecca M. Schuster MS,
Alex B. Lentsch PhD, Timothy A. Pritts MD PhD.
Department of Surgery, University of Cincinnati, Cincinnati, OH
Background: Leukoreduction prior to packed red blood cell (pRBC) storage is not universally performed due to
unclear benefit. We previously demonstrated that microparticles (MP) from stored pRBC units increase systemic
inflammation and lung injury, but the effect of leukoreduction on this response is unknown. We hypothesized
that pRBC leukoreduction prior to storage would decrease RBC-derived MPs and pulmonary inflammation after
hemorrhage.
Methods: pRBCs units were prepared from donor C57/Bl6 mice and 50% underwent leukoreduction. At storage
days 0, 7, and 14, MPs were isolated from pRBC units and quantified via flow cytometry. In additional
experiments, mice underwent hemorrhage followed by resuscitation with normal saline (NS) with or without
MPs isolated from leukoreduced (LR’d) or non-leukoreduced (nLR’d) stored blood. Lung histology sections were
evaluated for the presence of neutrophils in a blinded fashion.
Results: During storage, the number of MPs significantly increased in both groups; however, there were
significantly fewer microparticles present in leukoreduced pRBC units (Figure A). Mice subjected to hemorrhage
and resuscitation with NS experienced increased pulmonary inflammation as compared to sham mice as
evidenced by significantly increased pulmonary parenchymal inflammatory cell counts (Figure B). Mice
resuscitated with NS+MPs from leukoreduced pRBCs demonstrated significantly attenuated pulmonary
inflammation as evidenced by fewer neutrophils within the pulmonary parenchyma compared to those
resuscitated with NS+MPs isolated from non-leukoreduced pRBCs (Figure B).
Conclusions: Leukoreduction of pRBC units is associated with formation of decreased numbers of MPs during
storage and a significantly attenuated pulmonary inflammatory response after hemorrhage and resuscitation.
These findings support routine leukoreduction prior to pRBC storage.
Figure A. Microparticle counts increased by day 14 in each group, with significantly fewer MPs present in the
leukoreduced units at the end of the storage period. ** p < 0.001 vs all groups. * p < 0.001 vs D0 and D7
leukoreduced blood.
Figure B. Leukoreduction of pRBCs reduces inflammatory cell recruitment to the lung following hemorrhage and
resuscitation. **p < 0.001 vs all groups. *p < 0.005 vs Sham.