Protection of the Pulmonary Microvasculature by Fine Screen Blood Filtration

¹ Cora and Webb Mading Department of Surgery and the Department of Pathology, Baylor College of Medicine, and Ben Taub General Hospital, Houston

Particulate matter accumulates in stored blood and may be directly infused into the pulmonary microvasculature by blood transfusion, causing the respiratory distress syndrome (RDS). The protective effect of fine screen filtration by a 40-µ filter in massive blood transfusion was studied prospectively in 54 patients with trauma. Seventeen patients (control) received from 10 to 40 units (mean 18.8 units) of blood through the standard 170-µ blood filter and were compared to 27 patients (filter) who received from 10 to 63 units (mean 17.9 units) of blood through the 40-µ filter. Seven of the 17 control patients developed the clinical picture of RDS following treatment of their trauma. Despite the similarity in source of injury, anatomic area injured and surgical treatment, only two of the 27 patients with a filter developed the clinical signs of RDS. Three of the seven patients with RDS in the control group and both of the patients with RDS in the group in whom the filter was used had significant chest injury. Three patients in the control group without chest trauma died of intractable hypoxemia. Open lung biopsies and needle biopsies were performed in ten additional patients. Particulate matter in the precapillary arterioles was present in four patients receiving massive blood transfusion without the fine screen filter and in no patients with the fine screen filter. The fine screen filter is recommended to protect the pulmonary microvasculature in transfusions of stored blood.

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