- •Unbalanced crystalloids (e.g., NS) are commonly used in HSCT.
- •Crystalloids may be associated with hemolysis and immune dysfunction.
- •Markers of hemolysis significantly changed pre- to post-crystalloid infusion.
- •Crystalloid volume was associated with greater hemolysis and endothelial damage.
- •Alternatives like buffered solutions may be considered in the HSCT population.
Endothelial cell activation and injury is common after hematopoietic stem cell transplant (HSCT) and is associated with many post-transplant complications. An underexplored mechanism of endothelial cell damage in this population is the infusion of normal saline (NS, 0.9 % sodium chloride) and other crystalloids, as NS use is associated with adverse outcomes in other patient populations. We hypothesized that the infusion of unbalanced crystalloids during HSCT may lead to changes in biomarkers commonly associated with red blood cell (RBC) hemolysis in patients before and after infusion, and that markers of endothelial and end-organ damage during admission may be associated with markers of hemolysis and total crystalloid use. Samples were collected from 97 patients. From pre-fluid infusion to post-fluid infusion, mean haptoglobin decreased (11.7 ug/ml vs 8.4 ug/ml; p < 0.0001), hemopexin decreased (549 vs 512 μg/ml; p = 0.005), and red cell distribution width (RDW) decreased (15.7 vs 15.6; p = 0.0009). During admission (mean 19.4 days, SD 9.9), all markers of tissue and organ damage, including mean creatinine, lactate dehydrogenase (LDH), blood urea nitrogen (BUN), total bilirubin, AST, and ALT, increased from admission to peak levels (p < 0.0001). On linear regression, fluid volume (ml/kg) of crystalloid infusion positively predicted post-fluid infusion cell-free hemoglobin (r(96) = 0.34, p < 0.0001), free heme (r(96) = 0.36, p < 0.0001), and peak LDH during admission (r(75) = 0.23, p = 0.041), and negatively predicted post-fluid infusion hemopexin (r(96) = − 0.34, p < 0.0001). Unbalanced crystalloids may contribute to hemolysis and endothelial damage in HSCT patients. Alternatives such as buffered crystalloid solutions (PlasmaLyte, Lactated Ringer’s) may be worth investigating in this population.
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- Hepatic veno-occlusive disease after hematopoietic stem cell transplantation: risk factors and stratification, prophylaxis, and treatment.Biol Blood Marrow Transpl. 2016; 22: 400-409
- New approaches in the diagnosis, pathophysiology, and treatment of pediatric hematopoietic stem cell transplantation-associated thrombotic microangiopathy.Transfus Apher Sci. 2016; 54: 181-190
- Chimerism and tolerance without GVHD or engraftment syndrome in HLA-mismatched combined kidney and hematopoietic stem cell transplantation.Sci Transl Med. 2012; 4: 124ra28
- Endothelial dysfunction after hematopoietic stem cell transplantation: role of the conditioning regimen and the type of transplantation.Biol Blood Marrow Transpl. 2010; 16: 985-993
- Plasma-lyte 148: a clinical review.World J Crit Care Med. 2016; 5: 235-250
- Major complications, mortality, and resource utilization after open abdominal surgery: 0.9 % saline compared to plasma-lyte.Ann Surg. 2012; 255: 821-829
- Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults.JAMA. 2012; 308: 1566-1572
- Balanced crystalloids versus saline in critically Ill adults.N Engl J Med. 2018; 378: 829-839
- Balanced crystalloids versus saline in noncritically Ill adults.N Engl J Med. 2018; 378: 819-828
- 0.9 % NaCl (normal saline) – perhaps not so normal after all?.Transfus Apher Sci. 2018; 57: 127-131
- Impact of fluid overload as new toxicity category on hematopoietic stem cell transplantation outcomes.Biol Blood Marrow Transpl. 2017; 23: 2166-2171
- Hemolysis derived products toxicity and endothelium: model of the second hit.Toxins. 2019; 11
Justiz Vaillant AA, MP, Mohammadi O. Graft versus host disease. StatPearls Publishing; 2021.
- Severe cytokine release syndrome after haploidentical peripheral blood stem cell transplantation.Biol Blood Marrow Transpl. 2019; 25: 2431-2437
Published online: January 12, 2023
Accepted: January 12, 2023
Received in revised form: December 11, 2022
Received: June 6, 2022
Publication stageIn Press Journal Pre-Proof
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