Weiskopf Richard B, Feiner John, Hopf Harriet, Lieberman Jeremy, Finlay Heather E, Quah Cheng, Kramer Joel H, Bostrom Alan, Toy Pearl
Department of Anesthesia and Cardiovascular Research Institute, University of California, San Francisco, USA.
Anesthesiology. 2006 May;104(5):911-20. doi: 10.1097/00000542-200605000-00005.
Erythrocytes are transfused to treat or prevent imminent inadequate tissue oxygenation. 2,3-diphosphoglycerate concentration decreases and oxygen affinity of hemoglobin increases (P50 decreases) with blood storage, leading some to propose that erythrocytes stored for 14 or more days do not release sufficient oxygen to make their transfusion efficacious. The authors tested the hypothesis that erythrocytes stored for 3 weeks are as effective in supplying oxygen to human tissues as are erythrocytes stored for less than 5 h.
Nine healthy volunteers donated 2 units of blood more than 3 weeks before they were tested with a standard, computerized neuropsychological test (digit-symbol substitution test [DSST]) on 2 days, 1 week apart, before and after acute isovolemic reduction of their hemoglobin concentration to 7.4 and 5.5 g/dl. Volunteers randomly received autologous erythrocytes stored for either less than 5 h ("fresh") or 3 weeks ("stored") to return their hemoglobin concentration to 7.5 g/dl (double blinded). Erythrocytes of the alternate storage duration were transfused on the second experimental day. The DSST was repeated after transfusion.
Acute anemia slowed DSST performance equivalently in both groups. Transfusion of stored erythrocytes with decreased P50 reversed the altered DSST (P < 0.001) to a time that did not differ from that at 7.4 g/dl hemoglobin during production of acute anemia (P = 0.88). The erythrocyte transfusion-induced DSST improvement did not differ between groups (P = 0.96).
Erythrocytes stored for 3 weeks are as efficacious as are erythrocytes stored for 3.5 h in reversing the neurocognitive deficit of acute anemia. Requiring fresh rather than stored erythrocytes for augmentation of oxygen delivery does not seem warranted.
输注红细胞用于治疗或预防即将出现的组织氧合不足。随着血液储存，2,3 - 二磷酸甘油酸浓度降低，血红蛋白的氧亲和力增加（P50降低），这使得一些人提出储存14天或更长时间的红细胞不能释放足够的氧气以使输血有效。作者检验了以下假设：储存3周的红细胞在向人体组织供氧方面与储存少于5小时的红细胞一样有效。
9名健康志愿者在接受标准的计算机化神经心理学测试（数字符号替换测试[DSST]）前3周以上捐献2单位血液，在急性等容性降低血红蛋白浓度至7.4和5.5 g/dl之前和之后的2天（间隔1周）进行测试。志愿者随机接受储存少于5小时（“新鲜”）或3周（“储存”）的自体红细胞，以使血红蛋白浓度恢复至7.5 g/dl（双盲）。在第二个实验日输注另一种储存时间的红细胞。输血后重复DSST测试。
急性贫血使两组的DSST表现同等程度减慢。输注P50降低的储存红细胞将改变的DSST（P < 0.001）恢复到与急性贫血产生期间血红蛋白浓度为7.4 g/dl时无差异的时间（P = 0.88）。两组之间红细胞输血诱导的DSST改善无差异（P = 0.96）。
储存3周的红细胞在逆转急性贫血的神经认知缺陷方面与储存3.5小时的红细胞一样有效。似乎没有必要要求使用新鲜而非储存的红细胞来增加氧输送。
