Luten Marleen, Roerdinkholder-Stoelwinder Bregt, Schaap Nicolaas P M, de Grip Willem J, Bos Harry J, Bosman Giel J C G M
The Department of Research and Education, Sanquin Blood Bank Southeast Region, Nijmegen, the Netherlands.
Transfusion. 2008 Jul;48(7):1478-85. doi: 10.1111/j.1537-2995.2008.01734.x. Epub 2008 May 13.
The use of fresh red blood cells (RBCs) is recommended for critically ill patients and patients undergoing surgery, although there is no conclusive evidence that this is beneficial. In this follow-up study, the short-term and the long-term recovery of irradiated, leukoreduced RBCs transfused after either a short storage (SS) or a long storage (LS) period were compared. By consecutive transfusion of RBCs with a SS and LS period, a direct comparison of their survival within the same patient was possible.
Ten transfusion-requiring patients each received a SS RCCs (stored 0-10 days) and a LS RCCs (stored 25-35 days) consecutively. Short-term and long-term survival of the transfused RBCs was followed by flow cytometry using natural differences in RBC antigens between donors and patients. Posttransfusion recovery (PTR) was measured at several time points after transfusion.
The mean 24-hour PTR of SS RBCs is 86.4 +/- 17.8 percent and that of LS RBCs 73.5 +/- 13.7 percent. After the first 24 hours, the mean times to reach a PTR of 50 percent of the 24-hour PTR (T50) and mean potential life spans (mPLs) of the surviving SS and LS RBCs (41 and 116 days and 41 and 114 days, respectively) do not differ.
The mean 24-hour PTR of both SS and LS RBCs complies with the guidelines, even in a compromised patient population. The 24-hour PTR of SS RBCs, however, is significantly higher than that of LS RBCs. The remaining population of SS and LS RBCs has a nearly identical long-term survival. Therefore, depletion of the removal-prone RBCs before transfusion may be an efficient approach for product improvement.
对于重症患者和接受手术的患者，推荐使用新鲜红细胞（RBC），尽管尚无确凿证据表明这有益处。在这项随访研究中，比较了短期储存（SS）或长期储存（LS）后输注的辐照、白细胞滤除红细胞的短期和长期恢复情况。通过连续输注SS期和LS期的红细胞，可以在同一患者体内直接比较它们的存活情况。
10名需要输血的患者每人连续接受一次SS期红细胞（储存0 - 10天）和一次LS期红细胞（储存25 - 35天）。利用供体和患者之间红细胞抗原的天然差异，通过流式细胞术追踪输注红细胞的短期和长期存活情况。在输血后的几个时间点测量输血后恢复率（PTR）。
SS期红细胞的平均24小时PTR为86.4±17.8%，LS期红细胞为73.5±13.7%。在最初24小时后，存活的SS期和LS期红细胞达到24小时PTR的50%的平均时间（T50）以及平均潜在寿命（mPLs）（分别为41天和116天以及41天和114天）没有差异。
即使在病情复杂的患者群体中，SS期和LS期红细胞的平均24小时PTR均符合指南要求。然而，SS期红细胞的24小时PTR显著高于LS期红细胞。SS期和LS期红细胞的剩余群体具有几乎相同的长期存活率。因此，输血前去除易于清除的红细胞可能是一种有效的产品改进方法。
