Larsen A M, Leinøe E B, Johansson P I, Birgens H, Ostrowski S R
Department of Haematology, Copenhagen University Hospital, Herlev, Denmark.
Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Vox Sang. 2015 Jul;109(1):52-61. doi: 10.1111/vox.12249. Epub 2015 Mar 6.
Transfusion of red blood cells (RBC) is beneficial for the patient but can also be harmful, as randomized trials have demonstrated increased infection rates, bleeding and mortality. The study aim was to investigate the response of the vascular system (the haemostatic function and the endothelium) to RBC transfusion.
Blood was sampled from patients with various transfusion-dependent haematologic diseases before 1 and 24 h after RBC transfusion. Primary and secondary haemostasis was evaluated by whole-blood impedance aggregometry (Multiplate) and by thromboelastography (TEG). Samples were analysed by ELISA for biomarkers reflecting endothelial activation and damage (sICAM-1, syndecan-1, sThrombomodulin (sTM), sVE-Cadherin), platelet activation (sCD40L) and inflammation (hsCRP).
A total of 58 patients were enrolled in the study. Median age was 71 years. Compared to before transfusion, patients had slightly reduced coagulability 1 h after RBC transfusion, assessed by TEG. However, transfusion of older RBC products (>14 days) was associated with increased coagulability (all P < 0·05). The level of syndecan-1 increased slightly 24 h after transfusion (median 12·4 (IQR 9-23) vs. 13·2 (9-25) ng/ml, P < 0·01), indicating increased glycocalyx degradation.
Overall, RBC transfusion was associated with reduced coagulability and endothelial glycocalyx degradation. Transfusion of older RBCs was however associated with increased coagulability. The changes observed were small to moderate and the clinical relevance of these findings should be investigated in larger studies.
红细胞（RBC）输血对患者有益，但也可能有害，因为随机试验表明感染率、出血和死亡率会增加。本研究的目的是调查血管系统（止血功能和内皮）对RBC输血的反应。
从各种依赖输血的血液系统疾病患者中采集血液，分别在RBC输血前1小时和输血后24小时进行采样。通过全血阻抗聚集法（Multiplate）和血栓弹力图（TEG）评估初级和次级止血功能。通过ELISA分析样本中的生物标志物，以反映内皮激活和损伤（可溶性细胞间黏附分子-1（sICAM-1）、多配体蛋白聚糖-1、可溶性血栓调节蛋白（sTM）、可溶性血管内皮钙黏蛋白（sVE-钙黏蛋白））、血小板激活（可溶性CD40配体（sCD40L））和炎症（高敏C反应蛋白（hsCRP））。
共有58名患者纳入本研究。中位年龄为71岁。通过TEG评估，与输血前相比，患者在RBC输血后1小时的凝血能力略有降低。然而，输注保存时间较长（>14天）的RBC产品与凝血能力增加有关（所有P<0.05）。输血后24小时，多配体蛋白聚糖-1水平略有升高（中位数12.4（四分位间距9-23）对13.2（9-25）ng/ml，P<0.01），表明糖萼降解增加。
总体而言，RBC输血与凝血能力降低和内皮糖萼降解有关。然而，输注保存时间较长的RBC与凝血能力增加有关。观察到的变化较小至中等，这些发现的临床相关性应在更大规模的研究中进行调查。
