Iron-related adverse effects from stored blood

Abstract

In this issue of Blood, Cortés-Puch and colleagues investigate a strategy to improve the quality of stored red blood cells (RBCs) by washing the blood, thereby removing "noxious" substances, including cell-free hemoglobin, transferrin-bound iron, non-transferrin-bound iron (NTBI), and plasma labile iron, that accumulate during storage.1 Cortés-Puch and colleagues found that in a canine model of Staphylococcus aureus pneumonia, transfusion of "old" (42-day) blood was associated with impaired hemodynamics, greater lung injury and shock index, and reduced survival. These outcomes were improved upon when washing RBCs, which was associated with a reduction of NTBI in the circulation. Importantly, washing "fresh" (7-day) RBCs had the opposite effect, reversing the improved survival that was observed after exchange transfusion with younger RBCs; this effect was also related to an increased release of NTBI. © 2014 by The American Society of Hematology.