Start date
07/01/2009
Primary investigator
Martin A. Schreiber, MD
schreibm@ohsu.edu
(503) 494-6518
3181 SW Sam Jackson Park Rd Mail Code L611
Portland, OR 97239
Number of sites
1
Existing site names
Oregon Health & Science University
Sponsoring organization
Pending
Abstract
Blood transfusion is one of the most commonly utilized therapies in the care of trauma patients. Recent data suggest that the liberal use of blood transfusion is associated with an increase in infection, multiorgan failure and mortality. Transfusion of older blood has been implicated as a major cause of these negative outcomes. Donated blood is stored for up to 42 days during which a “storage lesion” develops that may impair the blood’s ability to carry oxygen or even paradoxically cause tissue ischemia. Nitric oxide (NO) depletion is known to occur with blood storage and is a strong candidate for mediating these effects. NO depletion may lead to capillary vasoconstriction impairing oxygen delivery to tissues and counteracting the intended purpose of transfusion. It is our hypothesis that NO depletion in blood older than 14 days will lead to vasoconstriction and decreased tissue oxygenation. We also hypothesize that metabolic derangements in blood greater than 14 days old will lead to a trend toward increased morbidity and mortality. In order to prove our hypothesis, we will perform a prospective randomized study in critically injured trauma patients who are receiving blood transfusion. Patients will be randomized to receive blood that is either < 14 days old or > 14 days old to determine whether the age of the transfused blood alters physiologic parameters, biochemical measures and clinical outcomes. To test our hypothesis, we propose the following specific aims. 1. To determine whether transfusion of blood greater than or equal to 14 days old is associated with vasoconstriction and decreased tissue oxygenation. 2. To correlate biochemical changes in transfused blood and the recipient with decreases in tissue oxygenation and vasoconstriction. 3. To determine if transfusion of blood greater than or equal to 14 days old is associated with increased risk of infection, multiorgan failure, acute respiratory distress syndrome and death.