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Transfusion. 2017 Nov;57(11):2701-2711. doi: 10.1111/trf.14268. Epub 2017 Aug 2.

Microparticles from stored red blood cells enhance procoagulant and proinflammatory activity.

Author information

1
Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
2
Department of Urology and Pediatric Urology, University Hospital of Marburg, Philipps-University, Marburg, Germany.
3
German Red Cross Blood Transfusion Service of Baden-Wuerttemberg-Hessen, Institute of Transfusion Medicine and Immunohematology, University Hospital of Frankfurt, Frankfurt am Main, Germany.

Abstract

BACKGROUND:

The pathomechanisms of morbidity due to blood transfusions are not yet entirely understood. Elevated levels of red blood cell-derived microparticles (RMPs) are found in coagulation-related pathologies and also in stored blood. Previous research has shown that RMPs mediate transfusion-related complications by the intrinsic pathway. We hypothesized that RMPs might play a role in post-transfusion thrombotic complications by enhancing procoagulant activity also through the extrinsic pathway of coagulation.

STUDY DESIGN AND METHODS:

In this laboratory study, blood from 18 healthy volunteers was stimulated with microparticles from expired stored red blood cells. Various clotting parameters were recorded. Flow cytometry, enzyme-linked immunosorbent assays, and real-time polymerase chain reaction were used to investigate possible mediating mechanisms.

RESULTS:

The addition of RMPs shortened the clotting time from 194 to 161 seconds (p < 0.001). After incubation with RMPs, there was increased expression of tissue factor (TF) on monocytes and in plasma. TF messenger RNA expression increased in a time-dependent and concentration-dependent manner. There was a significant induction of interleukin-1β and interleukin-6. After stimulation with RMPs, there was a significant increase in the number of activated platelets, an increased percentage of PAC-1/CD62P (procaspase activating compound-1/platelet surface P-selectin) double-positive platelets, and an increased number of platelet-neutrophil duplets and platelet-monocyte duplets, indicating enhanced interaction of platelets with neutrophils and monocytes. Levels of CXCL-8 (C-X-C motif chemokine ligand 1) and interleukin-6 were significantly higher after treatment with RMPs.

CONCLUSION:

Our results suggest that RMPs trigger coagulation through TF signaling, induce the secretion of proinflammatory cytokines, and induce cell-cell interaction between platelets and neutrophils. Thus, under certain conditions, RMPs could play a role in post-transfusion complications through these mechanisms.

PMID:
28766731
DOI:
10.1111/trf.14268
[Indexed for MEDLINE]

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