Department of Anesthesiology & Intensive Care, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
Crit Care Med. 2013 Mar;41(3):842-9. doi: 10.1097/CCM.0b013e3182711b38.
Blood loss and transfusion are frequent among patients undergoing liver surgery. Concerns have been raised about the safety and efficacy of transfusing stored blood. The influence of transfusing fresh vs. stored blood on the liver has not been studied to date. We tested the hypothesis that transfusion of stored, but not fresh blood, adversely affects liver outcome in vivo following acute hemorrhage. Additionally, possible mechanisms linking adverse liver outcome with increased storage duration were evaluated.
Prospective, controlled, animal study.
University research laboratory.
Adult male Sprague-Dawley rats
Anesthetized rats were randomized to control, hemorrhagic and shock group (acute bleeding; HSG), or hemorrhagic and blood resuscitation groups (BR) (with fresh blood [BR-d0], blood stored for 4 [BR-d4] or 7 [BR-d7] days, or packed RBCs stored for 7 days [packed RBC-d7]).
Administration of blood or packed RBC stored for 7 days exacerbated liver injury as reflected by liver necrosis and enhanced apoptosis (p < 0.001). Functional MRI analysis of the liver demonstrated significant improvement in liver perfusion with fresh blood (% change in functional MRI signal intensity due to hyperoxia was 16% ± 3% in BR-d0 vs. 4% ± 3% in hemorrhagic group, p < 0.001) but not with stored blood (12% ± 2% and 9% ± 5% for BR-d4 and BR-d7, respectively). Analysis of stored blood showed reduction in RBC deformability at 7 days of storage, reflecting a five-fold increase in the number of undeformable cells.
Liver injury is exacerbated by the transfusion of stored blood, primarily due to the change in the rheological properties of RBC. This data call for clinical studies in patients undergoing liver resection or transplantation.
肝切除术后患者常发生失血和输血。人们对输注储存血液的安全性和有效性表示担忧。迄今为止，尚未研究输注新鲜与储存血液对肝脏的影响。我们检验了一个假设，即输注储存的血液（而非新鲜血液）会在急性出血后对肝脏的恢复产生不利影响。此外，还评估了将储存时间延长与肝脏不良预后之间的可能联系。
前瞻性、对照、动物研究。
大学研究实验室。
成年雄性 Sprague-Dawley 大鼠。
麻醉大鼠随机分为对照组、失血性和休克组（急性出血；HSG）或失血性和血液复苏组（BR）（输注新鲜血液[BR-d0]、储存 4 天[BR-d4]或 7 天[BR-d7]的血液或储存 7 天的浓缩红细胞[packed RBC-d7]）。
输注储存 7 天的血液或浓缩红细胞会加重肝脏损伤，表现为肝坏死和凋亡增加（p < 0.001）。对肝脏的功能磁共振成像分析显示，新鲜血液可显著改善肝脏灌注（由于缺氧导致的功能磁共振成像信号强度的变化百分比，BR-d0 组为 16% ± 3%，HSG 组为 4% ± 3%，p < 0.001），但储存血液不能改善（BR-d4 组和 BR-d7 组分别为 12% ± 2%和 9% ± 5%）。储存血液分析显示，储存 7 天后红细胞变形能力下降，表明不可变形细胞数量增加了五倍。
输注储存血液会加重肝脏损伤，主要是由于红细胞流变性的改变。这些数据呼吁在肝切除术或肝移植患者中进行临床研究。
