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RBC clearance


- candidate number19439
- NTR NumberNTR4783
- ISRCTNISRCTN no longer applicable
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR11-sep-2014
- Secondary IDsABR nummer: 44711 NLRBCC0813
- Public TitleRBC clearance
- Scientific TitleIdentification of removal signals on donor erythrocytes after transfusion
- ACRONYMStorage lesion
- hypothesisRBC clearance is caused by "removal signals".
- Healt Condition(s) or Problem(s) studiedBlood transfusions, Erythrocytes/Red blood cells
- Inclusion criteria- A low WPSS 0-1 with transfusion requirement who are not eligible for intensive treatment or Clinical trials (i.e. elderly MDS patients);
- A life expectancy of a minimum of 6 months;
- Age > 18 years;
- Full knowledge of the Dutch language.
- Exclusion criteria- If no minor antigen mismatch can be made;
- No informed consent (IC);
- Patients under the age of eighteen;
- Patients that have a medical history with an autoimmune haemolytic anemia (AIHA) or patients that will develop an AIHA during the study;
- Patients with an enlarged spleen;
- Pregnancy;
- Patients with intensive MDS treatment.
- mec approval receivedno
- multicenter trialyes
- randomisedyes
- masking/blindingDouble
- controlActive
- groupCrossover
- Type2 or more arms, randomized
- Studytypeintervention
- planned startdate 1-dec-2014
- planned closingdate
- Target number of participants20
- InterventionsVenipuncture
- Primary outcomeChanges in all possible “removal signals” on the outer layer of the RBC membrane compared to short versus long stored RBC, like upregulation of phosphatidylserine (PS), conformation of CD47, and auto-antibody binding. We would also like to study the binding of PS-bridging proteins such as lactadherin, Von Willebrand Factor (vWF) and Protein S, as well as the CD47-binding protein thrombospondin-1.
- Secondary outcomeStandard of care parameters:
Hemoglobin, platelets, WBC and differentiation, ferritin, CRP

Additional measured parameters for study:
Other parameters on infection (CRP), iron status (Fe, hemopexin, hepcidin, NTBI), cytokines (TNFa, IL-1/IL-6, IL8), complement (C3 and C4) and antigens in complement biology (CD35, CD55, CD59, and factor H), antigens for adhesive capacities: CD44, CD147, ICAM-4, L-selectin for activation of monocyte, sICAM-1/sVCAM1 for endothelial activation and monocyte markers (CD14, CD11b), will also be studied.
- TimepointsFor each transfusion given (in total 2)
T0: blood sample prior to blood transfusion (includes blood typing and matching);
Randomization takes place with short (<10 days) vs. long (>25 days) stored erythrocytes;
T1h: blood sample taken 1 hour after blood transfusion;
T24h: blood sample taken 24 hours after blood transfusion;
T7d: blood sample taken 7 days after blood transfusion;
T14d: blood sample taken 14 days after blood transfusion;
During the course of this study all patients will receive one short and one long stored blood transfusion (including a wash-out period of 120 days between transfusions).
In addition, standardized questionnaires will be used to assess the quality of life at two different time points: pre-transfusion (baseline) and 14 days post-transfusion.
- Trial web sitewww.toetsingonline.nl
- statusplanned
- CONTACT FOR PUBLIC QUERIES D. Back, de
- CONTACT for SCIENTIFIC QUERIES D. Back, de
- Sponsor/Initiator Leiden University Medical Center (LUMC)
- Funding
(Source(s) of Monetary or Material Support)
Sanquin Bloodbank Amsterdam
- Publications
- Brief summaryRationale: The molecular mechanisms by which red blood cells (RBCs) are cleared in vivo are still elusive. Identification of the routes that lead to RBCs clearance are in particular important for transfusion practice, since 10-25% of the donor RBCs are cleared within 24 hrs after transfusion. This phenomenon will not only decrease the efficacy of transfusions but moreover, may be associated with serious side-effects in the recipient. While, in the normal life span of erythrocytes, RBCs are probably cleared by gradual acquisition of “eat me” signals that regulate progressive phagocytosis by macrophages predominantly in the spleen and liver. However, these normal mechanisms seem dysregulated for allogeneic transfused RBCs while additionally monocytes in the blood stream and endothelial cells seem to participate in their clearance.
In the Netherlands donor erythrocytes are stored for a maximum of 35 days. Storage induces several changes in the erythrocytes that are collectively defined as the “storage lesion”. The exact nature of these changes is unclear. We hypothesize that storage of RBCs is associated with an increased number or change of removal signals on the RBCs and, therefore, with a faster clearance after transfusion.
Objective: To determine the critical ‘removal mechanisms’ for donor RBCs by comparing clearance characteristics of both short and longer stored donor RBCs within patients and correlating these to “removal signals” on the membrane of the donor RBCs as well as their rheologic, adhesive, metabolic, complement activating and proteomic characteristics.
Study design: Prospective, randomized, double blinded, cross-over trial.
Study population: 20 myelodysplastic syndrome (MDS) patients with low WPSS (WHO classification-based prognostic scoring system 0-1) with transfusion requirement who are not eligible for intensive treatment or clinical trials (i.e. elderly MDS patients).
Main study endpoints: Primarily to determine the difference in percentage of clearance for and between short and longer stored donor RBCs within patients and secondary the possible determinants for this clearance.
Intervention arms: Patients will be randomized to either first receive a transfusion of one unit of RBCs stored for < 10 days and subsequently one unit of RBCs stored for > 25 days or vice versa.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The 2 to study RBC transfusions are part of standard patient care. Standard processed RBC units will be transfused although they are selected for storage time and are of a special blood group typing to facilitate detection of these RBCs from patients own and previous transfused circulating RBCs. From all MDS patients 5 times 5 ml blood will be collected along each of the 2 studied RBC transfusions of 350 ml, equalling 50 ml of additional blood collections in total. Of these, 2 will be done via the infusion system that is standard needed for the transfusion but 3 collections will require an additional vena puncture. At every sampling moment there is a minimal risk of a puncture hematoma and infection. In addition, patients are asked to answer detailed questionnaires to asses the Quality of Life.
- Main changes (audit trail)
- RECORD11-sep-2014 - 8-okt-2014


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