The effect of red blood cell transfusion on peripheral tissue oxygen delivery and consumption in septic patients.

OBJECTIVES: The impact of blood transfusion on tissue oxygen delivery (DO2) and tissue oxygen consumption (VO2) is a subject of current clinical studies. The primary objective of this observational study is to evaluate and measure the parameters involved in determining DO2 and VO2, in early phase of septic patients. A secondary objective of this study is to assess the potential benefit of blood transfusion on tissue metabolism by serial measurements of lactic acid (Ac. Lac.). MATERIAL AND METHODS: A group of 29 patients were studied, each patient received between one to three units of fresh packed red blood cells (pRBC). Clinical and paraclinical criteria for sepsis as well as the plasma value of haemoglobin (Hb) below 10g/dL represented the inclusion criteria in this study. We evaluated Hb, haematocrit (HCT), arterial blood oxigen saturation (SAO2), central venous oxygen saturation (SCVO2), parameters which are involved in determination of DO2 and VO2, before and after the transfusion of one unit of pRBC. Values of Ac. Lac. were also assessed in order to determine the type of metabolism (aerobic or anaerobic). SCVO2, SAO2, Hb, HCT and Ac. Lac. were determined using Epoc blood analyser. The cardiac output (CO) and systemic vascular resistance (SVR) were monitored during blood transfusion, using Vigileo monitor (Edward's Life Science, PreSep catheter kit). SAO2 was also monitored by pulse-oximetry. RESULTS: Changes in Hb, HCT and SCVO2 before and after pRBC transfusion (which further determine VO2) were statistically significant (P<0.001). A statistically significant increase (P<0.001) was obtained in Ac. Lac. values, before and after pRBC transfusion. SAO2 and CO directly involved in producing DO2, were clinically monitored during blood transfusion and the results remained constant. CONCLUSION: Results obtained in this clinical study show an increase in DO2 in critically ill septic patients and also an increase in oxygen tissue uptake which is similar to VO2, clearly pointing out the benefit of pRBC transfusion. The benefits of pRBC transfusion on tissue metabolism in critically ill septic patients remain elusive because of lactic acid values increase during and after transfusion. Based on our findings we recommend that Hb values used as a single trigger for pRBC transfusion should be further studied and that additional parameters such as SCVO2 and lactic acid should be considered as possible triggers for transfusion. Values of Hb and HCT should never be neglected.

Chrysin attenuates cardiomyocyte apoptosis and loss of intermediate filaments in a mouse model of mitoxantrone cardiotoxicity.

Chrysin (CHR) is a natural flavonoid and is present in high concentration in honey, propolis and many plant extracts. The aim of the present study was to evaluate the effects of CHR to reduce cardiomyocyte apoptosis and loss of intermediate filaments in a mouse model of mitoxantrone cardiotoxicity. Morphology of the cardiomyocytes was determined by optic and transmission electron microscopy and biochemistry methods. The expression of Bcl-2, Bax and Caspase-3 were assessed by immunofluorecence. Tunel assay was used to assess apoptosis in cardiomyocytes. In addition, the distribution of desmin protein was evaluated using immunohistochemistry. Our results show that MTX treatment significantly increased serum levels of creatine kinase isoenzyme (CK-MB), indicator of cardiac injury and withdrawn under CHR protection. Expression levels of Bcl-2 decreased, while those of Bax and caspase-3 increased following MTX treatment. 50 mg/kg of daily CHR intake reduced Bax and caspase-3 immunopositivity and restored Bcl-2 levels to a value comparable to the control. TUNEL (+) cardiomyocyte nuclei of MTX group showed typical signs of apoptosis which almost completely disappeared in response to 50 mg/kg CHR treatment. In parallel, an irregular distribution and a weak expression of desmin is associated with MTX induced cardiotoxic effects which was also restored by CHR treatment. In conclusion chrysin inhibits MTX-triggered cardiomyocyte apoptosis via multiple pathways, including decrease of the Bax/Bcl-2 ratio and caspase-3 expression along with preservation of the desmin disarray.