The effect of ulinastatin, a human protease inhibitor, on the transfusion-induced increase of plasma polymorphonuclear granulocyte elastase

Ulinastatin (UTI), a human protease inhibitor, inhibits polymorphonuclear granulocyte elastase (PMNE) release from granulocytes stimulated by several pathologic inflammatory processes. Blood transfusions increase plasma PMNE concentrations. We evaluated the effects of UTI on the transfusion-induced increase in PMNE. Thirty-nine patients undergoing gastrectomy were divided into four groups: Group A (n = 8), blood transfusion (-), UTI(-); Group B (n = 9), blood transfusion (+), UTI (-); Group C (n = 12), blood transfusion (-), UTI(+); and Group D (n = 10), blood transfusion (+), UTI (+). UTI of 300,000 U was infused in Groups C and D. White blood cell count (WBC), segmented cell count, plasma PMNE concentration, and PMNE release (PMNE concentration/segmented cell) were measured before, at the end of, and at 1 and 3 days after the operation. Although no significant differences were seen in WBC and segmented cell count among the groups, plasma PMNE concentration and PMNE release in Group B (transfusion without UTI) were significantly more than in Group A (no treatment) and Group D (transfusion with UTI) at the end of the operation, but the concentrations of the variables were not significantly different between Groups A and C (only UTI treatment). These results indicate that a single injection of 300,000 U of UTI inhibited transfusion-induced PMNE increase at the end of the operation. Thus, the present results may facilitate future studies testing the effects of UTI given at larger doses, or by a continuous administration, on the prevention of organ derangement after blood transfusion.