Impact of Red Blood Cell Transfusion on Platelet Aggregation and Inflammatory Response in Anemic Coronary and Noncoronary Patients

  • Silvain J
  • Abtan J
  • Kerneis M
  • et al.
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Abstract

OBJECTIVES: To determine whether RBC transfusion increases in-vivo platelet aggregation and inflammation in coronary and non-coronary patients.<br /><br />BACKGROUND: Red blood cell (RBC) transfusion increases in-vitro platelet activation and aggregation in healthy volunteers, providing a possible explanation for the increase in recurrent ischemic events and mortality reported after RBC transfusion in ACS patients.<br /><br />METHODS: Platelet reactivity was measured before and after RBC transfusion in 61 patients (33 ACS patients and 28 non-ACS patients). Relative changes between baseline and post-transfusion measurements of maximum (MPA) and residual platelet aggregation (RPA) were considered with different agonists as well as changes in Vasodilatator-Stimulated Phosphoprotein Platelet Reactivity Index (VASP-PRI) and P-selectin expression. Inflammatory and thrombotic biomarkers were also measured before and after transfusion.<br /><br />RESULTS: After RBC transfusion, platelet reactivity was increased when measured with adenosine diphosphate (ADP)-induced light transmission aggregometry (+11.6% relative increase of MPA; p = 0.004 and +10.8% increase of RPA; p = 0.005) and VASP PRI (relative increase of +20.7%; p=0.002) while there was a non-significant trend towards an increase of P-selectin expression. Similar results were found with the non-specific agonist thrombin receptor activated peptide (TRAP) (relative increase of +11.7% for MPA p=0.04 and+12.7% for RPA; p=0.02) but not with collagen or arachidonic acid agonists. There were no significant differences in inflammatory and thrombotic biomarkers before and after transfusion.<br /><br />CONCLUSIONS: After red blood cell transfusion, there is an increase in platelet reactivity, especially with tests measuring the ADP-P2Y12receptor pathway without significant variation in inflammatory or thrombotic biomarkers. This in-vivo effect may account for the excess in ischemic events observed in the context of ACS treated by PCI and P2Y12inhibitors.

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APA

Silvain, J., Abtan, J., Kerneis, M., Martin, R., Finzi, J., Vignalou, J.-B., … Montalescot, G. (2014). Impact of Red Blood Cell Transfusion on Platelet Aggregation and Inflammatory Response in Anemic Coronary and Noncoronary Patients. Journal of the American College of Cardiology, 63(13), 1289–1296. https://doi.org/10.1016/j.jacc.2013.11.029

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