输注后红细胞变形能力降低和红细胞储存时间的影响。
Decreased erythrocyte deformability after transfusion and the effects of erythrocyte storage duration.
机构信息
From the Departments of Anesthesiology/Critical Care Medicine, Surgery, Division of Cardiac Surgery, Orthopedic Surgery, Anesthesiology/Critical Care Medicine and Biomedical Engineering, and Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
出版信息
Anesth Analg. 2013 May;116(5):975-981. doi: 10.1213/ANE.0b013e31828843e6. Epub 2013 Feb 28.
BACKGROUND
Erythrocyte cell membranes undergo morphologic changes during storage, but it is unclear whether these changes are reversible. We assessed erythrocyte cell membrane deformability in patients before and after transfusion to determine the effects of storage duration and whether changes in deformability are reversible after transfusion.
METHODS
Sixteen patients undergoing posterior spinal fusion surgery were studied. Erythrocyte deformability was compared between those who required moderate transfusion (≥ 5 units erythrocytes) and those who received minimal transfusion (0-4 units erythrocytes). Deformability was measured in samples drawn directly from the blood storage bags before transfusion and in samples drawn from patients before and after transfusion (over 3 postoperative days). In samples taken from the blood storage bags, we compared deformability of erythrocytes stored for a long duration (≥ 21 days), those stored for a shorter duration (<21 days), and cell-salvaged erythrocytes. Deformability was assessed quantitatively using the elongation index (EI) measured by ektacytometry, a method that determines the ability for the cell to elongate when exposed to shear stress.
RESULTS
Erythrocyte deformability was significantly decreased from the preoperative baseline in patients after moderate transfusion (EI decreased by 12% ± 4% to 20% ± 6%; P = 0.03) but not after minimal transfusion (EI decreased by 3% ± 1% to 4% ± 1%; P = 0.68). These changes did not reverse over 3 postoperative days. Deformability was significantly less in erythrocytes stored for ≥ 21 days (EI = 0.28 ± 0.02) than in those stored for <21 days (EI = 0.33 ± 0.02; P = 0.001) or those drawn from patients preoperatively (EI = 0.33 ± 0.02; P = 0.001). Cell-salvaged erythrocytes had intermediate deformability (EI = 0.30 ± 0.03) that was greater than that of erythrocytes stored ≥ 21 days (P = 0.047), but less than that of erythrocytes stored <21 days (P = 0.03).
CONCLUSIONS
The findings demonstrate that increased duration of erythrocyte storage is associated with decreased cell membrane deformability and that these changes are not readily reversible after transfusion.
背景
红细胞膜在储存过程中会发生形态变化，但尚不清楚这些变化是否可逆。我们评估了输血前后患者的红细胞膜变形能力，以确定储存时间的影响，以及变形能力在输血后是否可逆。
方法
研究了 16 名接受后路脊柱融合手术的患者。比较了需要中度输血（≥ 5 单位红细胞）和接受最小输血（0-4 单位红细胞）的患者之间的红细胞变形能力。在输血前直接从血袋中抽取样本和在输血前和输血后（3 天术后）从患者中抽取样本，测量变形能力。在从血袋中抽取的样本中，我们比较了储存时间较长（≥ 21 天）、储存时间较短（<21 天）和细胞回收红细胞的变形能力。使用 ektacytometry 测量的伸长指数（EI）定量评估变形能力，该方法可确定细胞在受到切应力时伸长的能力。
结果
中度输血后的患者红细胞变形能力明显低于术前基线（EI 从 12%±4%下降至 20%±6%；P=0.03），但最小输血后患者的红细胞变形能力没有下降（EI 从 3%±1%下降至 4%±1%；P=0.68）。这些变化在 3 天术后并未逆转。储存时间≥21 天的红细胞变形能力明显低于储存时间<21 天的红细胞（EI=0.28±0.02，P=0.001）或从术前患者抽取的红细胞（EI=0.28±0.02，P=0.001）。细胞回收的红细胞变形能力中等（EI=0.30±0.03），大于储存时间≥21 天的红细胞（P=0.047），但小于储存时间<21 天的红细胞（P=0.03）。
结论
研究结果表明，红细胞储存时间的延长与细胞膜变形能力下降有关，并且这些变化在输血后不易逆转。
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