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Transfusion. 2019 Jul;59(7):2264-2275. doi: 10.1111/trf.15310. Epub 2019 Apr 19.

Reexamination of the chromium-51-labeled posttransfusion red blood cell recovery method.

Author information

1
Pathology and Cell Biology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York.
2
Nuclear Medicine, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York.
3
Pôle Neuroscience Tête et Cou, Département d'Anesthésie -Réanimation Hôpital Gui de Chauliac- Centre Hospitalier Universitaire, Montpellier, France.
4
Versiti Medical Sciences Institute, Milwaukee, Wisconsin.
5
Division of Hematology Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
6
New York Blood Center, New York, New York.
7
BloodWorks Northwest, Seattle, Washington.
8
Biologie Intégrée du Globule Rouge UMR_S1134, INSERM, Univ. Paris Diderot, Sorbonne Paris Cité, Univ. de la Réunion, Univ. des Antilles, Institut National de la Transfusion Sanguine, Laboratory of Excellence GR-Ex, Paris, France.
9
Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications U1163/CNRS ERL 8254, INSERM, CNRS, Univ Paris Descartes, Sorbonne Paris Cité, Paris, France.
10
Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
11
University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado.

Abstract

BACKGROUND:

The chromium-51-labeled posttransfusion recovery (PTR) study has been the gold-standard test for assessing red blood cell (RBC) quality. Despite guiding RBC storage development for decades, it has several potential sources for error.

METHODS:

Four healthy adult volunteers each donated an autologous, leukoreduced RBC unit, aliquots were radiolabeled with technetium-99m after 1 and 6 weeks of storage, and then infused. Subjects were imaged by single-photon-emission computed tomography immediately and 4 hours after infusion. Additionally, from subjects described in a previously published study, adenosine triphosphate levels in transfusates infused into 52 healthy volunteers randomized to a single autologous, leukoreduced, RBC transfusion after 1, 2, 3, 4, 5, or 6 weeks of storage were correlated with PTR and laboratory parameters of hemolysis.

RESULTS:

Evidence from one subject imaged after infusion of technetium-99m-labeled RBCs suggests that, in some individuals, RBCs may be temporarily sequestered in the liver and spleen immediately following transfusion and then subsequently released back into circulation; this could be one source of error leading to PTR results that may not accurately predict the true quantity of RBCs cleared by intra- and/or extravascular hemolysis. Indeed, adenosine triphosphate levels in the transfusates correlated more robustly with measures of extravascular hemolysis in vivo (e.g., serum iron, indirect bilirubin, non-transferrin-bound iron) than with PTR results or measures of intravascular hemolysis (e.g., plasma free hemoglobin).

CONCLUSIONS:

Sources of measurement error are inherent in the chromium-51 PTR method. Transfusion of an entire unlabeled RBC unit, followed by quantifying extravascular hemolysis markers, may more accurately measure true posttransfusion RBC recovery.

PMID:
31002399
DOI:
10.1111/trf.15310

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