Zimrin A B, Hess J R
Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Vox Sang. 2009 Feb;96(2):93-103. doi: 10.1111/j.1423-0410.2008.01117.x.
The development of blood storage systems allowed donation and transfusion to be separated in time and space. This separation has permitted the regionalization of donor services with subsequent economies of scale and improvements in the quality and availability of blood products. However, the availability of storage raises the question of how long blood products can and should be stored and how long they are safe and effective. The efficacy of red blood cells was originally measured as the increment in haematocrit and safety began with typing and the effort to reduce the risk of bacterial contamination. Appreciation of a growing list of storage lesions of red blood cells has developed with our increasing understanding of red blood cell physiology and our experience with red blood cell transfusion. However, other than frank haemolysis, rare episodes of bacterial contamination and overgrowth, the reduction of oxygen-carrying capacity associated with the failure of some transfused cells to circulate, and the toxicity of lysophospholipids released from membrane breakdown, storage-induced lesions have not had obvious correlations with safety or efficacy. The safety of red blood cell storage has also been approached in retrospective epidemiologic studies of transfused patients, but the results are frequently biased by the fact that sicker patients are transfused more often and blood banks do not issue blood products in a random order. Several large prospective studies of the safety of stored red blood cells are planned.
血液储存系统的发展使得献血和输血在时间和空间上得以分离。这种分离使得献血服务能够实现区域化，进而带来规模经济，并提高血液制品的质量和可及性。然而，储存的可行性引发了这样一个问题：血液制品能够且应该储存多长时间，以及它们在多长时间内是安全有效的。红细胞的功效最初是以血细胞比容的增加来衡量的，而安全性则始于血型鉴定以及降低细菌污染风险的努力。随着我们对红细胞生理学的理解不断加深以及我们在红细胞输血方面的经验积累，对红细胞越来越多的储存损伤的认识也在不断发展。然而，除了明显的溶血、罕见的细菌污染和过度生长事件、与一些输注的细胞无法循环导致的携氧能力下降，以及膜破裂释放的溶血磷脂的毒性之外，储存引起的损伤与安全性或功效并没有明显的关联。红细胞储存的安全性也在对输血患者的回顾性流行病学研究中进行了探讨，但结果常常受到病情较重的患者输血更频繁以及血库并非随机发放血液制品这一事实的影响。目前正在计划开展几项关于储存红细胞安全性的大型前瞻性研究。
