Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School at Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Anesthesiology. 2012 Jul;117(1):56-63. doi: 10.1097/ALN.0b013e31825575e6.
Transfusion of human blood stored for more than 2 weeks is associated with increased mortality and morbidity. During storage, packed erythrocytes progressively release hemoglobin, which avidly binds nitric oxide. We hypothesized that the nitric oxide mediated hyperemic response after ischemia would be reduced after transfusion of packed erythrocytes stored for 40 days.
We conducted a crossover randomized interventional study, enrolling 10 healthy adults. Nine volunteers completed the study. Each volunteer received one unit of 40-day and one of 3-day stored autologous leukoreduced packed erythrocytes, on different study days according to a randomization scheme. Blood withdrawal and reactive hyperemia index measurements were performed before and 10 min, 1 h, 2 h, and 4 h after transfusion. The reactive hyperemia index during the first 4 h after transfusion of 40-day compared with 3-day stored packed erythrocytes was unchanged. Plasma hemoglobin and bilirubin concentrations were higher after transfusion of 40-day than after 3-day stored packed erythrocytes (P = 0.02, [95% CI difference 10-114 mg/l] and 0.001, [95% CI difference 0.6-1.5 mg/dl], respectively). Plasma concentrations of potassium, lactate dehydrogenase, haptoglobin, and cytokines, as well as blood pressure, did not differ between the two transfusions and remained within the normal range. Plasma nitrite concentrations increased after transfusion of 40-day stored packed erythrocytes, but not after transfusion of 3-day stored packed erythrocytes (P = 0.01, [95% CI difference 0.446-0.66 μM]).
Transfusion of autologous packed erythrocytes stored for 40 days is associated with increased hemolysis, an unchanged reactive hyperemia index, and increased concentrations of plasma nitrite.
输注储存超过 2 周的人血与死亡率和发病率增加有关。在储存过程中，浓缩红细胞逐渐释放血红蛋白，血红蛋白会强烈结合一氧化氮。我们假设在输注储存 40 天的浓缩红细胞后，缺血后的一氧化氮介导的充血反应会降低。
我们进行了一项交叉随机干预研究，纳入了 10 名健康成年人。9 名志愿者完成了这项研究。根据随机方案，每位志愿者在不同的研究日接受了 1 单位储存 40 天和 1 单位储存 3 天的自体去白细胞浓缩红细胞。在输血前和输血后 10 分钟、1 小时、2 小时和 4 小时进行血液抽取和反应性充血指数测量。与输注储存 3 天的浓缩红细胞相比，输注储存 40 天的浓缩红细胞在输血后 4 小时内的反应性充血指数没有变化。输注储存 40 天的浓缩红细胞后，血浆血红蛋白和胆红素浓度高于输注储存 3 天的浓缩红细胞（P = 0.02，[95%置信区间差值 10-114mg/l]和 0.001，[95%置信区间差值 0.6-1.5mg/dl]）。两种输血之间的血浆钾、乳酸脱氢酶、触珠蛋白和细胞因子浓度以及血压没有差异，均在正常范围内。输注储存 40 天的浓缩红细胞后，血浆中亚硝酸盐浓度增加，但输注储存 3 天的浓缩红细胞后则没有增加（P = 0.01，[95%置信区间差值 0.446-0.66μM]）。
输注储存 40 天的自体浓缩红细胞与溶血增加、反应性充血指数不变和血浆中亚硝酸盐浓度增加有关。
