Vol. 221, No.

4S1, October 2015 Scientific Forum Abstracts S167

vs 36.4%, p<0.001). There were no differences in comorbidities be- Surveillance and Early Management of Deep Vein
tween survivors and non-survivors. Independent predictors of mor- Thrombosis Decreases the Rate of Pulmonary Embolism
tality were age (odds ratio [OR] 1.14,CI,1.05e1.23, p¼0.002), in High-Risk Trauma Patients
laparotomy (OR 4.04, CI,1.18e13.84 ,p¼0.026,) maximum lactate Casey J Allen, MD, Jonathan P Meizoso, MD, Joyce Kaufman, MD,
(OR 1.32, CI,1.01e1.71, p¼0.041) and pre-injury use of calcium- Laura F Teisch, Xiomara D Ruiz, MD,
channel blockers (OR 14.93, CI,1.70e130.90, p¼0.015). Among Robert M Van Haren, MD, MSPH,
all elderly patients who had a laparotomy, mortality was 45.2%; Carl I Schulman, MD, PhD, FACS, Edward B Lineen, MD, FACS,
for those on pre-injury calcium channel blockers, mortality was 52%. Nicholas Namias, MD, FACS, Kenneth G Proctor, PhD
University of Miami, Ryder Trauma Center, Miami, FL
CONCLUSIONS: Increasing age, maximum lactate, laparotomy,
INTRODUCTION: Pulmonary embolism (PE) is a source of
and pre-injury use of calcium-channel blockers are independently
morbidity and mortality after trauma. In 2011, we imple-
associated with mortality in the elderly after blunt traumatic hem-
mented a process to identify patients at high-risk for venous
orrhagic shock. The role of calcium-channel blockers deserves
thromboembolism (VTE) for early recognition and manage-
further evaluation in a large follow-up study.
ment of thrombotic disease in an effort to reduce our rate of
PE. We hypothesized that deep vein thrombosis (DVT) sur-
Previous Cryopreservation Alters the Red Blood Cell veillance in patients at high-risk for VTE have a decreased
Storage Lesion and Glutathione Equilibrium rate of PE.
Alex L Chang, MD, Richard S Hoehn, MD, Michael Edwards, MD,
Peter L Jernigan, MD, Timothy A Pritts, MD, PhD, FACS METHODS: We screened trauma ICU admissions with Green-
University of Cincinnati, Cincinnati, OH field’s Risk Assessment Profile (RAP) from August 2011 to
September 2014. In patients at high-risk for VTE (RAP10),
INTRODUCTION: Cryopreservation of packed red blood cell units a designated team made recommendations to the treating
(pRBCs) offers many advantages over standard blood banking tech- physicians to order weekly venous duplex ultrasound (VDU)
niques. Previous studies have described the biochemical, metabolic, to evaluate for DVT. Management was determined by the
and morphologic changes known as the “red blood cell storage treating physicians. All DVT/PE were identified by thorough
lesion” under standard blood banking conditions, but the effect review of patient records. Because this was a new practice
of cryopreservation on the storage lesion is unknown. initiative at our institution, all high-risk patients did not
receive surveillance VDU. High-risk patients with or without
surveillance VDU were compared. Data are expressed as
METHODS: Human pRBC units (n¼5) previously cryopreserved
meanSD and compared using a t-test or Fisher’s exact test
in 40% glycerol at -80 C and age-matched pRBC units stored un-
with significance at p0.05.
der standard conditions (n¼5) were obtained from a local blood
bank. We determined the pH, lactic acid, cell-free hemoglobin,
RESULTS: We screened 1,282 ICU patients: 402 were identified
and cell-free potassium using clinical blood analyzers. Micropar-
as high-risk for VTE; age 4719 years, 75% were male, 78% had
ticle accumulation was estimated using flow cytometry. Total and
blunt mechanism, Injury Severity Score (ISS) 2813, and RAP
reduced glutathione was determined by fluorometric assays. Signif-
13.73.5. Of all high-risk patients, 259 (64%) underwent DVT
icance testing was performed using Wilcoxon rank-sum tests.
surveillance (Table). Asymptomatic DVTs detected by surveillance
were managed with IVC filter placement (56%) or systemic anti-
RESULTS: Previously cryopreserved human pRBCs contained coagulation (44%).
fewer erythrocytes than controls (3.7x106/mL vs 6.1x106/mL,
p<0.01). By day 14 after thawing, the pH was significantly lower
than that in controls (6.07 vs 6.37, p<0.01). Previously frozen Table. Patients at High-Risk for VTE (RAP 210)
units exhibited higher free hemoglobin (0.69 vs 0.37 g/dL, No surveillance Surveillance
p<0.01), higher microparticle counts (317.3 vs 234.8 events/uL Variable (n¼143) (n¼259) p Value
Injury Severity Score 27  12 29  13 0.055
p<0.01), lower free potassium (12.36 vs 17.28 meq/L,
Revised Trauma Score 6.64  1.96 6.27  1.83 0.465
p<0.01), and lactate (7.45 vs 18.24 meq/L, p<0.01). Although
Abbreviated Injury Score Chest >2, % 49 58 0.095
total glutathione relative to the erythrocyte mass was equivalent, Risk Assessment Profile Score 12.5  2.8 14.3  3.7 <0.001
previously frozen units showed significantly lower ratios of Deep vein thrombosis, % 3.5 14.3 <0.001
reduced to oxidized glutathione (GSH:GSSG 0.0005 vs 0.0101, Pulmonary embolism, % 7.0 1.9 0.014
p<0.01). Mortality, % 15.5 13.6 0.655

CONCLUSIONS: Previous cryopreservation alters several impor-

tant characteristics of pRBC units, including glutathione equilib- CONCLUSIONS: Trauma patients at high-risk for VTE who
rium. These changes potentially alter the pRBC unit’s ability to received VDU surveillance and early management of asymptomatic
defend against oxidative stress. DVT have a decreased rate of PE.

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