Westphal-Varghese B, Erren M, Westphal M, Van Aken H, Ertmer C, Lange M, Booke M
Department of Transfusion Medicine, University of Muenster, Muenster, Germany.
Transfus Med. 2007 Apr;17(2):89-95. doi: 10.1111/j.1365-3148.2007.00732.x.
The aim of the study was to compare the potential of autotransfusion devices to reduce non-infectious complications related to transfusion of long-stored packed red blood cells (PRBC; n= 57), such as changes in electrolytes, blood cells and the load of free microaggregates. Following a baseline measurement, a blood pool of three PRBC was divided into three equal volumes and washed with either the Haemonetics Cell Saver (HCS) or the continuous autotransfusion system (C.A.T.S), using the quality (CATS(quality)) and emergency (CATS(emergency)) mode. After the washing procedure, measurements for electrolytes, blood cells and free microaggregates were repeated (n= 19 each). Compared with baseline, the investigated autotransfusion devices reduced the median load of potassium (baseline: 52 mEq L(-1); HCS: 4 mEq L(-1); CATS(quality): 4 mEq L(-1); CATS(emergency): 17 mEq L(-1); each P < 0.001), restored a physiologic electrolyte balance and significantly decreased the load of leucocytes, glucose and protein. Whereas the quantity of microaggregates was not reduced by HCS, CATS(emergency) decreased the load of cell fragments below 7.8 microm (P < 0.05 vs. baseline). Using CATS(quality) decreased the load of cell fragments not only to a diameter below 7.8 microm (P < 0.001 vs. baseline) but also of microaggregates between 7.8 and 17.6 microm (P < 0.05 vs. baseline). In situations where long-stored PRBC have to be transfused, the procedure described here may be feasible to reduce clinically relevant side effects, i.e. hyperkalaemia and microvascular obstruction secondary to free cell fragments. This approach could be especially useful in patients undergoing massive transfusion and/or suffering from renal failure.
本研究的目的是比较自体输血装置在减少与长期储存的浓缩红细胞（PRBC；n = 57）输注相关的非感染性并发症方面的潜力，如电解质、血细胞的变化以及游离微聚集体的负荷。在进行基线测量后，将三单位PRBC的血池分成三个等份体积，并用Haemonetics细胞回收器（HCS）或连续自体输血系统（C.A.T.S）进行洗涤，分别使用质量（CATS(质量)）和紧急（CATS(紧急)）模式。洗涤程序后，重复进行电解质、血细胞和游离微聚集体的测量（每组n = 19）。与基线相比，所研究的自体输血装置降低了钾的中位数负荷（基线：52 mEq L⁻¹；HCS：4 mEq L⁻¹；CATS(质量)：4 mEq L⁻¹；CATS(紧急)：17 mEq L⁻¹；每组P < 0.001），恢复了生理电解质平衡，并显著降低了白细胞、葡萄糖和蛋白质的负荷。虽然HCS未降低微聚集体的数量，但CATS(紧急)将细胞碎片负荷降低至7.8微米以下（与基线相比P < 0.05）。使用CATS(质量)不仅将细胞碎片负荷降低至直径低于7.8微米（与基线相比P < 0.001），还降低了7.8至17.6微米之间的微聚集体负荷（与基线相比P < 0.05）。在必须输注长期储存的PRBC的情况下，此处描述的程序可能有助于减少临床相关的副作用，即高钾血症和游离细胞碎片继发的微血管阻塞。这种方法在接受大量输血和/或患有肾衰竭的患者中可能特别有用。
