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Microcirculation and blood transfusions during sepsis: leukoreduced (LR) versus non-LR red blood cells


Microcirculatory alterations during sepsis impair tissue oxygenation, which may be further worsened by anemia. Blood transfusions proved not to restore O2 delivery during sepsis [1]. The impact of storage lesions and/or leukocyte-derived mediators in red blood cell (RBC) units has not yet been clarified [2]. We compared the effects of leukoreduced (LR) versus nonLR packed RBCs on microcirculation and tissue oxygenation during sepsis.


A prospective randomized study. Twenty patients with either sepsis, severe sepsis or septic shock requiring RBC transfusion randomly received nonLR (Group 1, n = 10) or LR (Group 2, n = 10) fresh RBCs (<10 days old). Before and 1 hour after transfusion, microvascular density and flow were assessed with sidestream dark-field imaging sublingually. Thenar tissue O2 saturation (StO2) was measured using near-infrared spectroscopy and a vascular occlusion test was performed.


The De Backer score (P = 0.02), total vessel density (P = 0.08), perfused vessel density (P = 0.04), proportion of perfused vessels (P = 0.01), and microvascular flow index (P = 0.04, Figure 1) increased only in Group 2. The StO2 upslope (Figure 2) during reperfusion increased in both groups (P < 0.05). In Group 1 the baseline StO2 and StO2 downslope during ischemia increased, probably reflecting a lower O2 consumption.


Unlike nonLR RBCs, the transfusion of fresh LR RBCs seems to improve microvascular perfusion and might help to restore tissue oxygenation during sepsis.

Figure 1

Blood transfusion and microvascular flow.

Figure 2

Blood transfusion and microvascular reactivity.


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Correspondence to A Donati.

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Donati, A., Damiani, E., Domizi, R. et al. Microcirculation and blood transfusions during sepsis: leukoreduced (LR) versus non-LR red blood cells. Crit Care 17, P369 (2013).

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  • Tissue Oxygenation
  • Vessel Density
  • Microvascular Perfusion
  • Perfuse Vessel
  • Microvascular Flow Index