Relation between in vitro parameters of stored red blood cells and in vivo survival of these red blood cells after autologous transfusion

Many side effects of red blood cell transfusion have been described. They
include iron-overload, as well as allo-and auto antibody formation against red
cells. During storage, erythrocytes undergo complex structural and biochemical
changes. It has been suggested that accelerated and/or aberrant forms of the
physiological erythrocyte aging process underlie the red cell storage lesion.
This storage lesion may contribute to side effects of transfusion as
endothelial damage by release of internal erythrocyte constituents,
(pro)inflammatory consequences, hampered microcirculation and oxygen delivery.
Understanding the process that determines the fate of red blood cells after
transfusion may contribute to the prevention of side effects after red blood
cell transfusion. Physiological, age-dependent removal of erythrocytes is an
efficient and well-regulated process, with controlled exposure of the molecules
that determine recognition by the autoimmune system (senescent cell antigen on
band 3, phosphatidylserine in the outer leaflet of the membrane, decreased
CD47), resulting in binding of autologous IgG and phagocytosis by the
reticulo-endothelial system [5, 16, 17]. A molecular picture of the pathways
involved in this process (oxidative damage-induced, high-affinity binding of
hemoglobin to band 3, activation of Ca2+-permeable channels,
phosphorylation-controlled loss of metabolism and structure, degradation of
band 3 and aggregation of band 3 fragments, vesicle formation) is gradually
emerging [5], but precise data on the initial triggers and cross-talk between
these pathways are lacking. In addition, it is becoming clear that the
erythrocyte contains a complex, functional set of regulatory systems that
trigger erythrocyte removal after physiological or pathological injury such as
osmotic shock, oxidative stress and/or energy depletion [17]. Modulation of
these pathways becomes progressively lost during storage [4, 18], resulting in
accelerated aging and fast (< 24 hours) removal of up to 30% of the transfused
erythrocytes. Erythrocyte aging is associated with a selective increase of
autoimmune epitope expression, and accelerated aging may be associated with
increased vesiculation and expression of pathogenic epitopes on erythrocytes
and their vesicles [19]. Frequent blood transfusions may lead to immunization
and formation of alloantibodiesand other side effects..

To determine the relation between in vitro parameters of stored red blood cells
and in vivo survival of these red blood cells after autologous transfusion. To
identify the relationbetween the recipients immune response to stored
autologous red cells in comparison with allogeneic transfused red cells.

Patients of which autologous red cells are taken preoperatively will be
included. Samples of the unit of autologous red cell and samples from patient
taken before transfusion and samples post-transfusion during an interval of 8
hours after transfusion will be taken. Biochemical evaluation of parameters
known to be associated with red cell damege (PS expression, badn 3 changes, red
cell vesucluation will be tested. Results will be compared with the a
historical control group of patient sin which allogeniec rd cells were
transfused.

5 times addiotional blood sampling