Impact of Red Blood Cell Transfusion on Platelet Aggregation and Inflammatory Response in Anemic Coronary and Non-Coronary Patients: The TRANSFUSION-2 Study

Study Questions:

What is the impact of red blood cell (RBC) transfusion on platelet aggregation and inflammation?

Methods:

The authors measured platelet reactivity before and after RBC transfusion in 61 patients. Acute coronary syndrome (ACS) was present in 33 patients and 28 had other cardiac illnesses. Patients with a suspected ACS were treated with both a P2Y12 inhibitor and aspirin. Relative changes between baseline and post-transfusion measurements of maximum (MPA) and residual platelet aggregation (RPA) were considered with different agonists. Further, change in vasodilator-stimulated phosphoprotein platelet reactivity index (VASP-PRI) and P-selectin expression and inflammatory and thrombotic biomarkers were also measured.

Results:

Platelet reactivity as measured with adenosine diphosphate (ADP)-induced light transmission aggregometry was increased after transfusion (+11.6% relative increase of MPA; p = 0.004 and +10.8% increase of RPA; p = 0.005). There was also an increase in VASP-PRI (relative increase of +20.7%; p = 0.002). There was an increase in platelet reactivity in response to 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.

Conclusions:

After red blood cell transfusion, there is an increase in platelet reactivity on tests measuring the ADP-P2Y12 receptor pathway without significant variation in inflammatory or thrombotic biomarkers.

Perspective:

Transfusion in patients with recent percutaneous coronary intervention has been associated with an increased mortality hazard. There is ongoing debate whether this association is causal or casual and this study provides some evidence to support a direct link between transfusion and thrombotic events. The magnitude of the change in platelet reactivity by itself is unlikely to be of clinical importance in every patient, but could contribute to increased thrombotic risk in certain patients who are predisposed due to other reasons. In the absence of randomized data to the contrary, the decision to transfuse patients with ACS should be made after careful deliberation.

Clinical Topics: Acute Coronary Syndromes, Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, ACS and Cardiac Biomarkers, Lipid Metabolism, Heart Failure and Cardiac Biomarkers, Interventions and ACS

Keywords: Inflammation, Acute Coronary Syndrome, Erythrocyte Transfusion, Microfilament Proteins, Platelet Transfusion, Platelet Function Tests, Angioplasty, Percutaneous Coronary Intervention, Blood Transfusion, P-Selectin, Biological Markers, Platelet Aggregation, Phosphoproteins, Cell Adhesion Molecules, Collagen, Arachidonic Acid


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