Resuscitation with a blood substitute abrogates pathologic postinjury neutrophil cytotoxic function

Background: Resuscitation with oxygen-carrying fluids is critically importa nt in the patient with hemorrhagic shock caused by trauma. However, it is c lear that a number of biologic mediators present in stored blood (packed re d blood cells [PRBCs]) have the potential to exacerbate early postinjury hy perinflammation and multiple organ failure through priming of circulating n eutrophils (PMNs), PolyHeme (Northfield Laboratories, Evanston, IL), a hemo globin-based substitute that is free of priming agents, provides an alterna tive. We hypothesized that PMN priming would be attenuated in patients resu scitated with PolyHeme in lieu of stored blood. Methods: Injured patients requiring urgent transfusion were given either Po lyHeme (up to 20 units) or PRBCs, Early postinjury PMN priming was measured via beta -2 integrin expression, superoxide production, and elastase relea se. Results: Treatment groups were comparable with respect to extent of injury and early physiologic compromise. PMNs from patients resuscitated with PRBC s showed priming in the early postinjury period by all three measures. No s uch priming was evident in patients resuscitated with PolyHeme. Conclusion: The use of a blood substitute in the early postinjury period av oids PMN priming and may thereby provide an avenue to decrease the incidenc e or severity of postinjury multiple organ failure.