BIOACTIVE SUBSTANCE ACCUMULATION AND SEPTIC COMPLICATIONS IN A BURN TRAUMA PATIENT - EFFECT OF PERIOPERATIVE BLOOD-TRANSFUSION

Evidence has emerged that suggests adverse effects to perioperative ho mologous blood transfusion are related to the age of the blood product s. Recently, time-dependent accumulation of bioactive substances in re d cell suspensions, standard platelet concentrates and fresh plasma du ring storage have been shown. The potential adverse effects of these b ioactive substances were analysed in a burn trauma patient. A patient with 40 per cent second and third degree burn trauma without other inj uries underwent a two-step transplantation operation. Samples for anal yses of histamine, eosinophil cationic protein (ECP), eosinophil prote in X (EPX), neutrophil myeloperoxidase (MPO) and interleukin 6 (IL-6) were drawn frequently from the patient before, during and after the op erations, and from all transfused red cell, platelet and fresh frozen plasma units. Urine was sampled every hour during the first operation for analyses of ECP and EPX excretion. All analyses were performed by ELISA and RIA methods, and results compared to patient outcome. The pa tient received a total of 48 and 8 SAGM blood, 6 and 0 platelet and 12 and 4 fresh frozen plasma units at the two operations, respectively. Transfused products contained a total of 64.54 nmol and 17.50 nmol his tamine, 115518 ng and 25764 ng ECP, 174457 ng and 38770 ng EPX, 695091 5 ng and 1505125 ng MPO, and 14740 pg and 5600 pg IL-6 at the two oper ations, respectively. The accumulation of the substances in patient pl asma correlated to postoperative septic reactions, without any disclos ure of bacteraemia after the first operation, while the accumulation a t the second operation correlated to the septic reaction and Pseudomon as aeruginosa infection. Time-dependent accumulation of bioactive subs tances in blood products during storage may be related to the developm ent of post-transfusion adverse effects. (C) 1997 Elsevier Science Ltd for ISBI.