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This article is part of the supplement: 32nd International Symposium on Intensive Care and Emergency Medicine

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Transfusion of blood stored for longer periods of time does not alter the reactive hyperemia index in healthy volunteers

A Coppadoro1*, L Berra2, B Yu2, C Lei2, E Spagnolli2, AU Steinbicker2, KD Bloch2, T Lin2, HS Warren2, FY Sammy2, BO Fernandez3, M Feelisch3, WH Dzik2, CP Stowell2 and WM Zapol2

  • * Corresponding author: A Coppadoro

Author Affiliations

1 University of Milan-Bicocca, Monza, Italy

2 Massachusetts General Hospital, Boston, MA, USA

3 University of Warwick, Coventry, UK

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Critical Care 2012, 16(Suppl 1):P448  doi:10.1186/cc11055

The electronic version of this article is the complete one and can be found online at:

Published:20 March 2012

© 2012 Coppadoro et al.; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The purpose of this study is to investigate the effects of transfusing human packed red blood cells (PRBC) after prolonged storage, as compared to short storage. Retrospective data suggest that transfusion of PRBC stored for over 2 weeks is associated with increased mortality and morbidity. During storage, PRBC progressively release hemoglobin, which avidly binds nitric oxide (NO). We hypothesized that the NO-mediated hyperemic response following ischemia would be reduced after transfusion of PRBC stored for 40 days.


We conducted a cross-over randomized interventional study, enrolling 10 healthy adults. Nine volunteers completed the study; one volunteer could not complete the protocol because of anemia. Each volunteer received 1 unit of 40-day and 1 unit of 3-day stored autologous leukoreduced PRBC, on different study days according to a randomization scheme. Blood withdrawal and reactive hyperemia index (RHI) measurements were performed before and 10 minutes, 1 hour, 2 hours, and 4 hours after transfusion.


The change of RHI after transfusion of 40-day stored PRBC did not differ as compared to 3-day stored PRBC (P = 0.67). Plasma hemoglobin and bilirubin levels were higher after transfusion of 40-day than after 3-day stored PRBC (P = 0.02 and 0.001, respectively). Plasma levels of potassium, LDH, haptoglobin, cytokines, as well as blood pressure, did not differ between the two transfusions and remained within the normal range. Plasma nitrite concentrations increased after transfusion of 40-day stored PRBC, but not after transfusion of 3-day stored PRBC (P = 0.01).


Transfusion of 1 unit of autologous PRBC stored for longer periods of time is associated with increased hemolysis, an unchanged RHI and increased levels of plasma nitrite in healthy volunteers.