Klein Harvey G, Spahn Donat R, Carson Jeffrey L
Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland 20892, USA.
Lancet. 2007 Aug 4;370(9585):415-26. doi: 10.1016/S0140-6736(07)61197-0.
Every year, about 75 million units of blood are collected worldwide. Red blood cell (RBC) transfusion is one of the few treatments that adequately restore tissue oxygenation when oxygen demand exceeds supply. Although the respiratory function of blood has been studied intensively, the trigger for RBC transfusion remains controversial, and doctors rely primarily on clinical experience. Laboratory assays that indicate failing tissue oxygenation would be ideal to guide the need for transfusion, but none has proved easy, reproducible, and sensitive to regional tissue hypoxia. The clinical importance of the RBCs storage lesion (ie, the time-dependent metabolic, biochemical, and molecular changes that stored blood cells undergo) is poorly understood. RBCs can be filtered, washed, frozen, or irradiated for specific indications. Donor screening and testing have dramatically reduced infectious risks in the developed world, but infection remains a major hazard in developing countries, where 13 million units of blood are not tested for HIV or hepatitis viruses. Pathogen inactivation techniques are in clinical trials for RBCs, but none is available for use. Despite serious immunological and non-immunological complications, RBC transfusion holds a therapeutic index that exceeds that of many common medications.
全球每年采集约7500万单位血液。当氧需求超过供应时，红细胞（RBC）输血是少数能充分恢复组织氧合的治疗方法之一。尽管对血液的呼吸功能已进行了深入研究，但红细胞输血的触发因素仍存在争议，医生主要依靠临床经验。表明组织氧合功能衰竭的实验室检测方法对于指导输血需求来说是理想的，但尚无一种方法被证明操作简便、可重复且对局部组织缺氧敏感。人们对红细胞储存损伤（即储存血细胞所经历的随时间变化的代谢、生化和分子变化）的临床重要性了解甚少。红细胞可根据特定指征进行过滤、洗涤、冷冻或辐照。在发达国家，供血者筛查和检测已大幅降低了感染风险，但在发展中国家，感染仍是一个主要危害，那里有1300万单位血液未进行艾滋病毒或肝炎病毒检测。病原体灭活技术正在针对红细胞进行临床试验，但尚无可用的技术。尽管存在严重的免疫和非免疫并发症，但红细胞输血的治疗指数超过了许多常用药物。
