Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery

M J Wozniak, N Sullo, S Qureshi, W Dott, R Cardigan, M Wiltshire, T Morris, M Nath, N Bittar, S K Bhudia, T Kumar, A H Goodall, G J Murphy (Corresponding Author)

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Background: Experimental studies suggest that mechanical cell washing to remove pro-inflammatory components that accumulate in the supernatant of stored donor red blood cells (RBCs) might reduce inflammation and organ injury in transfused patients.

Methods: Cardiac surgery patients at increased risk of large-volume RBC transfusion were eligible. Participants were randomized to receive either mechanically washed allogenic RBCs or standard care RBCs. The primary outcome was serum interleukin-8 measured at baseline and at four postsurgery time points. A mechanism substudy evaluated the effects of washing on stored RBCs in vitro and on markers of platelet, leucocyte, and endothelial activation in trial subjects.

Results: Sixty adult cardiac surgery patients at three UK cardiac centres were enrolled between September 2013 and March 2015. Subjects received a median of 3.5 (interquartile range 2-5.5) RBC units, stored for a mean of 21 ( sd 5.2) days, within 48 h of surgery. Mechanical washing reduced concentrations of RBC-derived microvesicles but increased cell-free haemoglobin concentrations in RBC supernatant relative to standard care RBC supernatant. There was no difference between groups with respect to perioperative serum interleukin-8 values [adjusted mean difference 0.239 (95% confidence intervals -0.231, 0.709), P =0.318] or concentrations of plasma RBC microvesicles, platelet and leucocyte activation, plasma cell-free haemoglobin, endothelial activation, or biomarkers of heart, lung, or kidney injury.

Conclusions: These results do not support a hypothesis that allogenic red blood cell washing has clinical benefits in cardiac surgery.

Clinical trial registration: ISRCTN 27076315.

Original languageEnglish
Pages (from-to)689-698
Number of pages10
JournalBritish Journal of Anaesthesia
Issue number5
Early online date13 Dec 2017
Publication statusPublished - 2017

Bibliographical note

National Institute for Health Research Programme Grant for Applied Research (RP-PG-0407-10384 for The REDWASH trial); British Heart Foundation (RG/13/6/29947, CH/12/1/29419, and PG/11/95/29173 to G.J.M., M.W., W.D., T.K. and N.S.); Leicester Cardiovascular Biomedical Research Unit (G.J.M., M.W., W.D., T.K. and N.S.).


  • Aged
  • Aged, 80 and over
  • Blood Preservation
  • Cardiac Surgical Procedures/adverse effects
  • Endothelium, Vascular
  • Erythrocyte Transfusion/adverse effects
  • Erythrocytes
  • Female
  • Hemoglobins/analysis
  • Humans
  • Interleukin-8/blood
  • Leukocytes/drug effects
  • Male
  • Middle Aged
  • Platelet Activation
  • Postoperative Complications/prevention & control
  • Single-Blind Method
  • Treatment Outcome


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