林格氏乳酸盐与生理盐水-腺嘌呤-葡萄糖-甘露醇保存的浓缩红细胞相容，可用于快速输血。

Ringer's lactate is compatible with saline-adenine-glucose-mannitol preserved packed red blood cells for rapid transfusion.

机构信息

Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston General Hospital, ON, Canada.

出版信息

Can J Anaesth. 2010 Dec;57(12):1071-7. doi: 10.1007/s12630-010-9396-z. Epub 2010 Oct 5.

DOI:10.1007/s12630-010-9396-z

PMID:20922586

Abstract

PURPOSE

Guidelines state that Ringer's lactate (RL) should not be co-administered with packed red blood cells (PRBC) due to a potential risk of clotting. The purpose of this study was to determine whether RL causes clotting in PRBC with the currently used preservative, saline-adenine-glucose-mannitol (SAGM).

METHODS

Phase 1: Samples from 12 units of SAGM-PRBC were diluted from 0-97.5% with RL and normal saline (NS), incubated for 30 min, and passed through 40 μm filters. Additional samples were frozen and batch analyzed using an enzyme-linked immunosorbent assay (ELISA) to measure prothrombin activation fragment 1 + 2 (F1 + 2), indicative of thrombin generation. Packed red blood cells were also diluted, flushed with crystalloid using a rapid transfusion model, and filtered. Phase 2: Eight further units were serially diluted with RL and incubated for 30, 60, 120, 180, and 240 min. Fresh samples were analyzed by filtration and ELISA.

RESULTS

Phase 1: No clotting was seen during filtration or using the transfusion model with NS or RL. The F1 + 2 ranged from 2.28 to 154.37 pmol·L⁻¹ in NS dilutions and from 2.80 to 1675.93 pmol·L⁻¹ in RL dilutions, indicating coagulation in some samples. Phase 2: No clotting was observed within 60 min by filtration or ELISA. However, 4 of the 8 units showed clots in the filters of some dilutions between 120 and 240 min.

CONCLUSIONS

No clotting was detected at any dilution of RL with SAGM- preserved PRBC within 60 min, but clotting was detected with extended incubation. The results indicate RL can be safely co-administered with PRBC during rapid transfusion (< 60 min).

摘要

目的

指南指出，由于潜在的凝血风险，林格氏乳酸盐（RL）不应与浓缩红细胞（PRBC）同时使用。本研究的目的是确定 RL 是否会与目前使用的保存液（SAGM）导致 PRBC 凝血。

方法

第 1 阶段：从 12 个 SAGM-PRBC 单位中取样本，用 RL 和生理盐水（NS）稀释 0-97.5%，孵育 30 分钟，然后通过 40μm 过滤器。另外的样本被冷冻，并使用酶联免疫吸附测定（ELISA）批量分析，以测量凝血酶原激活片段 1+2（F1+2），这是凝血酶生成的指标。PRBC 也被稀释，使用快速输血模型用晶体液冲洗，并过滤。第 2 阶段：另外 8 个单位的 RL 进行连续稀释，并孵育 30、60、120、180 和 240 分钟。使用过滤和 ELISA 分析新鲜样本。

结果

第 1 阶段：用 NS 或 RL 过滤或使用输血模型时未观察到凝血。F1+2 范围在 NS 稀释液中为 2.28 至 154.37 pmol·L⁻¹，在 RL 稀释液中为 2.80 至 1675.93 pmol·L⁻¹，表明一些样本中有凝血。第 2 阶段：在 60 分钟内通过过滤或 ELISA 未观察到凝血。然而，8 个单位中有 4 个在 120 至 240 分钟的某些稀释度下在过滤器中显示出凝块。