Keir Amy K, Hansen Adele L, Callum Jeannie, Jankov Robert P, Acker Jason P
Division of Neonatology, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia.
Transfusion. 2014 Aug;54(8):2068-76. doi: 10.1111/trf.12618. Epub 2014 Mar 28.
Transfusion guidelines advise against coinfusing red blood cells (RBCs) with solutions other than 0.9% saline. We evaluated the impact of coinfusion with dextrose-containing fluids (DW) on markers of RBC quality.
A pool-and-split design was used to allow conditions to be tested on each pool within 2 hours of irradiation. Three pools at each storage age (5, 14, and 21 days) were created for each phase. In Phase 1, samples were infused through a neonatal transfusion apparatus alone or with treatment solutions: D5W, D10W, D5W/0.2% saline, and 0.9% saline. In Phase 2, samples were incubated alone or in a 1:1 ratio with treatment solutions and tested after 5, 30, and 180 minutes. Hemolysis, supernatant potassium, RBC indices, morphology, and deformability were measured on all samples.
In Phase 1, RBCs transfused alone through the apparatus had higher (p<0.01) hematocrit, total hemoglobin, and supernatant potassium compared to all other groups. No statistical differences were identified between groups for other measured variables. In Phase 2, mean corpuscular volume of all samples containing DW increased with incubation length and were higher (p<0.01) than RBCs incubated alone or with 0.9% saline after 30 and 180 minutes. RBCs incubated with D5W and D5W/0.2% saline had greater (p<0.05) hemolysis than RBCs alone after 180 minutes.
In vitro characteristics of RBCs coinfused with 0.9% saline or D10W were not adversely impacted. When developing clinical studies in neonates, we recommend use of D10W and a transfusion apparatus that minimizes the contact volume of the coinfusate with the RBC.
输血指南建议不要将红细胞（RBC）与0.9%生理盐水以外的溶液混合输注。我们评估了与含葡萄糖液体（DW）混合输注对红细胞质量标志物的影响。
采用混合分割设计，以便在辐照后2小时内在每个混合样本上测试各种条件。在每个储存年龄（5天、14天和21天）为每个阶段创建三个混合样本。在第1阶段，样本单独通过新生儿输血装置输注，或与治疗溶液一起输注：5%葡萄糖溶液（D5W）、10%葡萄糖溶液（D10W）、5%葡萄糖溶液/0.2%生理盐水以及0.9%生理盐水。在第2阶段，样本单独孵育或与治疗溶液按1:1比例孵育，并在5分钟、30分钟和180分钟后进行测试。对所有样本测量溶血、上清钾、红细胞指数、形态和变形性。
在第1阶段，与所有其他组相比，单独通过该装置输注的红细胞具有更高（p<0.01）的血细胞比容、总血红蛋白和上清钾。其他测量变量在组间未发现统计学差异。在第2阶段，所有含DW的样本的平均红细胞体积随孵育时间延长而增加，并且在30分钟和180分钟后高于单独孵育或与0.9%生理盐水孵育的红细胞（p<0.01）。与5%葡萄糖溶液和5%葡萄糖溶液/0.2%生理盐水孵育的红细胞在180分钟后比单独孵育的红细胞有更大（p<0.05）的溶血。
与0.9%生理盐水或10%葡萄糖溶液混合输注的红细胞的体外特性未受到不利影响。在开展新生儿临床研究时，我们建议使用10%葡萄糖溶液和一种能使混合输注液与红细胞的接触体积最小化的输血装置。
