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[红细胞储存期间潜在的致病性变化]

[Potentially pathogenic changes in red blood cells during their storage].

作者信息

Gmerek Katarzyna, Fabijańska-Mitek Jadwiga

机构信息

Centrum Medyczne Kształcenia Podyplomowego w Warszawie, Zakład Biofizyki.

出版信息

Pol Merkur Lekarski. 2011 Mar;30(177):224-7.

Abstract

Blood fractionation and storage improve the availability of blood products, e.g., packed red blood cells (RBCs) for transfusion. But the following question appears: how long-stored RBCs are safe and effective? In many clinical retrospective studies authors indicated risk of transfusion of stored RBCs, especially in critically ill patients eg. with acute myocardial infarction syndrome. They observed higher frequency of mortality, morbidity, infections, renal and lung failure, inflammation and thrombosis when RBC units were long-stored and non-leucoreduced than when they were fresh and leucoreduced. Responsible mechanisms are unknown but some factors are suspected eg.: RBCs do not deliver oxygen, because they have low concentration of ATP and 2.3 DPG and their shape changes. Also cytokines, enzymes and ions (K, Ca) from white blood cells (WBCs) can influence RBCs and transfused patients. Changes involve some membrane molecules associated with adhesion, oxygen transport, complement regulation during the storage of RBCs. It is interesting how the long-period storage and presence of WBCs can influence the membrane surface of RBCs and then their biological functions. Proposed study can improve our knowledge about changes in RBCs during their storage and then may be safety of blood transfusion.

摘要

血液成分分离和储存提高了血液制品的可用性,例如用于输血的浓缩红细胞(RBC)。但出现了以下问题:储存多久的红细胞是安全有效的?在许多临床回顾性研究中,作者指出了输注储存红细胞的风险,尤其是在重症患者中,例如患有急性心肌梗死综合征的患者。他们观察到,与新鲜且去除白细胞的红细胞相比,长期储存且未去除白细胞的红细胞单位在输注时,死亡率、发病率、感染、肾和肺衰竭、炎症及血栓形成的发生率更高。相关机制尚不清楚,但怀疑有一些因素,例如:红细胞不能输送氧气,因为它们的三磷酸腺苷(ATP)和2,3-二磷酸甘油酸(2,3-DPG)浓度较低且形状发生了变化。此外,来自白细胞(WBC)的细胞因子、酶和离子(钾、钙)会影响红细胞及接受输血的患者。这些变化涉及红细胞储存期间一些与黏附、氧气运输、补体调节相关的膜分子。长期储存和白细胞的存在如何影响红细胞的膜表面进而影响其生物学功能,这一点很有趣。拟开展的研究可以增进我们对红细胞储存期间变化的了解,进而可能提高输血的安全性。

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