Red blood cell transfusion‐induced non‐transferrin‐bound iron promotes Pseudomonas aeruginosa biofilms in human sera and mortality in catheterized mice

• Published in: British journal of haematology Vol. 196; no. 4; pp. 1105 - 1110
• Main Authors: La Carpia, Francesca, Slate, Andrea, Bandyopadhyay, Sheila, Wojczyk, Boguslaw S., Godbey, Elizabeth A., Francis, Kevin P., Prestia, Kevin, Hod, Eldad A.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.02.2022
• Subjects: Animals; Apotransferrin; Bioavailability; biofilm; Biofilms; Blood transfusion; Erythrocyte Transfusion - methods; Erythrocyte Transfusion - mortality; Erythrocytes; Erythrocytes - metabolism; Healthy Volunteers; Hematology; Humans; infection; Iron; Iron - blood; Male; Mice; Mortality; non‐transferrin bound iron; Pseudomonas aeruginosa; Survival Analysis; Transferrins; Virulence; blood transfusion; iron; infection; non-transferrin bound iron; biofilm
• ISSN: 0007-1048; 1365-2141; 1365-2141
• DOI: 10.1111/bjh.17934

Summary Transfusion of storage‐damaged red blood cells (RBCs) increases non‐transferrin‐bound iron (NTBI) levels in humans. This can potentially enhance virulence of microorganisms. In this study, Pseudomonas aeruginosa replication and biofilm production in vitro correlated with NTBI levels of transfused subjects (R2 = 0·80; P < 0·0001). Transfusion of stored RBCs into catheterized mice enhanced P. aeruginosa virulence and mortality in vivo, while pre‐administration of apotransferrin reduced NTBI levels improving survival (69% vs 27% mortality; P < 0·05). These results suggest that longer RBC storage, by modulating the bioavailability of iron, may increase the risk of P. aeruginosa biofilm‐related infections in transfused patients.