Adverse effects of microparticles on transfusion of stored red blood cell concentrates

Jie Yang; Yiming Yang; Li Gao; Xueyu Jiang; Juan Sun; Zhicheng Wang; Rufeng Xie

doi:10.1016/j.htct.2024.01.007

Adverse effects of microparticles on transfusion of stored red blood cell concentrates

Hematol Transfus Cell Ther. 2024 Mar 11:S2531-1379(24)00038-5. doi: 10.1016/j.htct.2024.01.007. Online ahead of print.

Authors

Jie Yang¹, Yiming Yang¹, Li Gao¹, Xueyu Jiang¹, Juan Sun¹, Zhicheng Wang², Rufeng Xie³

Affiliations

¹ Shanghai Institute of Blood Transfusion, Shanghai Blood Center, Shanghai, China.
² Department of Transfusion Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
³ Department of Transfusion Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China. Electronic address: xierufeng@sbc.org.cn.

PMID: 38519412
DOI: 10.1016/j.htct.2024.01.007

Abstract

Background: Systemic and pulmonary coagulopathy and inflammation are important characteristics of transfusion-related acute lung injury (TRALI). Whether microparticles that accumulate in transfused red blood cell concentrates (RBCs) have proinflammatory and procoagulant potential and contribute to adverse reactions of RBC transfusions is unclear.

Aim: To investigate the ability of microparticles in stored RBCs to promote thrombin generation and induce human pulmonary microvascular endothelial cell (HMVEC) activation and damage.

Methods: The number and size of microparticles were determined by flow cytometric and nanoparticle tracking analyses, respectively. Thrombin generation and the intrinsic coagulation pathway were assayed by a calibrated automated thrombogram and by measuring activated partial thromboplastin time (aPTT), respectively. The expression of ICAM-1 and the release of cytokines by endothelial cells were detected by flow cytometric analyses. HMVEC damage was assessed by incubating lipopolysaccharide-activated endothelial cells with MP-primed polymorphonuclear neutrophils (PMNs).

Results: The size of the microparticles in the RBC supernatant was approximately 100-300 nm. Microparticles promoted thrombin generation in a dose-dependent manner and the aPTT was shortened. Depleting microparticles from the supernatant of RBCs stored for 35 days by either filtration or centrifugation significantly decreased the promotion of thrombin generation. The expression of ICAM-1 on HMVECs was increased significantly by incubation with isolated microparticles. Furthermore, microparticles induced the release of interleukin-6 (IL-6) and interleukin-8 (IL-8) from HMVECs. Microparticles induced lipopolysaccharide-activated HMVEC damage by priming PMNs, but this effect was prevented by inhibiting the PMNs respiratory burst with apocynin.

Conclusion: Microparticles in stored RBCs promote thrombin generation, HMVEC activation and damage which may be involved in TRALI development.

Keywords: Microparticles; Procoagulant; Proinflammatory; Stored red blood cell concentrates; Transfusion-related acute lung injury.