Rejuvenated RBC and VO2 Max in Healthy Subjects

Overview

To compare the physiologic benefits of rejuvenated RBCs (rejRBCs) to standards RBCs (PRBCs), we will emulate critical conditions by safely maximizing stress on the cardiovascular system, in an elective, feasible volunteer study. Maximal oxygen uptake (VO2max) will be measured in an anemic, post-donation, pre-transfusion state, and also after transfusing 14-day-old, autologous blood randomized to standard storage or standard storage with rejuvenation. We hypothesize that transfusion of standard PRBCs is less effective at increasing oxygen delivery (measured by VO2max) compared with transfusion of rejRBCs.

VISIT A ( - Screening) Written informed consent will be obtained from subjects who respond to an IRB-approved advertisement/flyer and fulfill eligibility requirements. The following video will help explain the study: vimeo.com/167291799. Individuals who respond to an IRB approved advertisement/flyer (uploaded to eIRB) will be given information about the study and asked to read an IRB approved consent form. An investigator or designee will obtain written informed consent from each individual participating in this study, after adequate explanation of the methods, objectives, and potential hazards of the study. The investigator or designee will also explain to the subjects that they are completely free to refuse to enter the study and free to withdraw from it at any time. A copy of the signed consent form will be given to the subject and will be shared with The Blood Connection to ensure proper labeling of autologous units. After subjects have provided written informed consent, they will be asked to answer several questions in 2 written questionnaires (uploaded to eIRB) in order to confirm that they are eligible to donate blood. These questions are similar to those routinely asked to people prior to a blood donation. These are focused upon keeping the risks of blood donation to the lowest possible level. Subject will undergo screening lab tests for baseline hemoglobin, sickle cell trait, serum pregnancy tests only for women of child-bearing potential, ECG, exercise test. Subject will receive a phone confirmation from the investigator or delegated research staff after review of the screening lab results. Subject will bring a copy of the signed consent form to The Blood Connection if qualified. VISIT B (Day 0 - Blood donation) The Blood Connection (TBC), Raleigh, NC, is registered and licensed by the US FDA and accredited by the American Association of Blood Banks (AABB) to manufacture RBCs and other blood products. Two units of blood will be withdrawn from each subject according to standards for double, AS-3, apheresis units, and will be marked for autologous donation, and purchased by Duke Transfusion Services, as arranged with the medical director of TBC (Robert Rainer, MD). RBC handling and storage will meet FDA and AABB standards; units will be stored with Duke Transfusion Services c/o Dr. Poisson. VISIT C (Day 14 - "Anemic" VO2 max, Transfusion (Tx) and "post-Tx" VO2max)) Small amount of blood \[3 lavender topped tubes\] will be collected from subject to test for hemoglobin, type \& screen and 1 cross match to verify the donated blood received from The Blood Connection belongs to the same subject who arrives at the appointed date at Duke facility Anemic VO2max Three minutes of resting baseline measures will be recorded before the start of exercise. The subject will then begin to pedal the cycle ergometer at a cadence of 75 rpm. Resistance will be manually set according to a standardized, progressive protocol. A rating of perceived exertion (RPE) will be obtained at the end of each exercise stage. Vital signs will be recorded every 3 minutes, and ECG monitoring will be continuous. Exercise will be terminated when the subject reaches volitional fatigue. VO2max will be reported as the highest oxygen consumption averaged over two 30-second periods, which typically occurs in the last stage of the progressive maximal exercise test. Maximum heart rate will be the heart rate at or near VO2max. To minimize variability in VO2max testing procedures, the same 2 facilitators (an engineer/technician and a research staff) will be present at every test. Radial arterial access will be obtained for cardiac output monitoring (LiDCO pulse contour analysis) at this visit. Tx and post-Tx VO2max Duke Transfusion Services will randomize each subject to receive 2 units of standard PRBCs or rejRBCs over 120 minutes using a standard infusion pump. All units will be washed to equalize the transfusion volumes; rejuvenation includes a mandatory washing step. Rejuvenation of donated blood will be done according to the procedures in the labeling of the Rejuvesol product. Vital signs will be monitored and recorded every 15 minutes. After a total 4-hour rest after completing the first VO2max testing, and a light snack, the exercise test will be repeated. Laboratory testing: The p50 will be measured in one of the blood units transfused and in the subject before the exercise test. Radial arterial access will be obtained for serial cardiac output monitoring (LiDCO Pulse Contour Analysis, LiDCO Products, London, UK), arterial blood gas analysis and lactate measurement before and after transfusion, and after exercise testing. Final blood collected for a hemoglobin level will be done at the conclusion of blood transfusion. This is the final visit and participation is completed.

Conditions

Interventions

Eligibility

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Outcomes