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Impact of a single packed red blood cell unit on recipient phosphatidylethanol

Abstract:

Phosphatidylethanol (PEth) is a marker of alcohol consumption present on erythrocytes. Consensus guidelines suggest that PEth concentrations ≥20 ng/mL and ≥ 200 ng/mL are consistent with alcohol consumption or chronic excessive consumption, respectively. However, packed red blood cell (pRBC) transfusion is a potential source of PEth in transfusion recipients. Currently, the prevalence of this phenomenon and the magnitude of PEth elevation after transfusion of a single pRBC unit remain uncertain. This study evaluated the impact of single-unit pRBC transfusion on observed PEth concentrations in recipients. The 16:0/18:1 homologue of PEth was measured in pre-transfusion, post-transfusion, and pRBC samples using liquid chromatography – tandem mass spectrometry with lower limit of quantitation (LLOQ) 10 ng/mL. In 99 consecutively-enrolled recipients, pRBC transfusion was responsible for 60.9 % of post-transfusion PEth concentrations ≥LLOQ and 60.0 % of post-transfusion concentrations ≥20 ng/mL. In the full study population (n = 143), 56 recipients had pre-transfusion PEth <LLOQ and received a PEth-positive pRBC unit. Of these, 26 (46.4 %) and 11 (19.6 %) had post-transfusion PEth ≥LLOQ and ≥ 20 ng/mL, respectively; the highest post-transfusion PEth in this group was 83.4 ng/mL. In recipients with pre-transfusion PEth ≥LLOQ (n = 36), clinical interpretation changed for 5 individuals whose post-transfusion PEth concentrations decreased below interpretive thresholds (LLOQ, 20 ng/mL, 200 ng/mL) and for 2 other recipients whose concentrations increased above interpretive thresholds. These findings indicate the prevalence and magnitude of impact of pRBC transfusion are likely greater than previously recognized, and even one pRBC unit can meaningfully increase or decrease post-transfusion PEth.