Li Xiu Liang, Dong Peng, Tian Ming, Ni Jia Xiang, Smith Fang Gao
Department of Pain Management, Xuanwu Hospital of Capital Medical University, No. 45, Changchun Street, Xicheng District, 100053, Beijing, China.
Department of Anaesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong'an Road, Xicheng District, 100050, Beijing, China.
J Cardiothorac Surg. 2015 Oct 14;10:126. doi: 10.1186/s13019-015-0330-x.
Intraoperative cell salvage (ICS), hereby referred to 'mechanical red cell salvage', has been widely used and proven to be an effective way to reduce or avoid the need for allogeneic red blood cells (RBCs)transfusion and its associated complications in surgeries involving major blood loss. However, little is known about the influence of this technique on the functional state of salvaged RBCs. Furthermore, there are no articles that describe the change of free hemoglobin (fHb) in salvage blood during storage, which is a key index of the quality control of salvaged blood. Therefore, in this study, the influence of ICS on the function of salvaged RBCs and the changes of salvaged RBCs during storage were studied with respect to the presence of oxyhemoglobin affinity (recorded as a P50 value) and the level of 2, 3-diphosphoglycerate (2, 3-DPG) and fHb by comparing salvaged RBCs with self-venous RBCs and 2-week-old packed RBCs.
Fifteen patients undergoing off-pump coronary artery bypass grafting (OPCAB) surgery were enrolled. Blood was collected and processed using a Dideco Electa device. The level of P50, 2, 3-DPG and fHB from salvaged RBCs, venous RBCs and 2-week-old packed RBCs was measured. We also measured the changes of these indicators among salvaged RBCs at 4 h (storage at 21-24 °C) and at 24 h (storage at 1-6 °C).
The P50 value of salvaged RBCs at 0 h (28.77 ± 0.27 mmHg) was significantly higher than the value of venous RBCs (27.07 ± 0.23 mmHg, p=0.000) and the value of the 2-week-old packed RBCs (16.26 ± 0.62 mmHg, p=0.000). P50 value did not change obviously at 4 h (p=0.121) and 24 h (p=0.384) compared with the value at 0 h. The 2, 3-DPG value of salvaged RBCs at 0 h (17.94 ± 6.91 μmol/g Hb) was significantly higher than the value of venous RBCs (12.73 ± 6.52 mmHg, p = 0.007) and the value of the 2-week-old packed RBCs (2.62 ± 3.13 mmHg, p=0.000). The level of 2, 3-DPG slightly decreased at 4 h (p=0.380) and 24 h (p=0.425) compared with the value at 0 h. Percentage of hemolysis of the salvaged blood at 0 h(0.51 ± 0.27 %) was significantly higher than the level of venous blood (0.07 ± 0.05 %, p=0.000) and the value of 2-week-old packed RBCs (0.07 ± 0.05 %, p=0.000), and reached 1.11 ± 0.42 % at 4 h (p=0.002) and 1.83 ± 0.77 % at 24 h (p=0.000).
The oxygen transport function of salvaged RBCs at 0 h was not influenced by the cell salvage process and was better than that of the venous RBCs and 2-week-old packed RBCs. At the end of storage, the oxygen transport function of salvaged RBCs did not change obviously, but percentage of hemolysis significantly increased.
术中细胞回收（ICS），在此称为“机械性红细胞回收”，已被广泛应用，并被证明是减少或避免在大量失血手术中输注异体红细胞（RBCs）及其相关并发症的有效方法。然而，关于该技术对回收的RBCs功能状态的影响知之甚少。此外，尚无文章描述回收血液在储存期间游离血红蛋白（fHb）的变化，而fHb是回收血液质量控制的关键指标。因此，在本研究中，通过将回收的RBCs与自体静脉RBCs和保存2周的浓缩RBCs进行比较，研究了ICS对回收的RBCs功能以及储存期间回收的RBCs变化的影响，这些影响涉及氧合血红蛋白亲和力（记录为P50值）、2,3-二磷酸甘油酸（2,3-DPG）水平和fHb。
纳入15例行非体外循环冠状动脉旁路移植术（OPCAB）的患者。使用Dideco Electa设备收集和处理血液。测量回收的RBCs、静脉RBCs和保存2周的浓缩RBCs的P50、2,3-DPG和fHB水平。我们还测量了回收的RBCs在4小时（21 - 24°C储存）和24小时（1 - 6°C储存）时这些指标的变化。
回收的RBCs在0小时的P50值（28.77±0.27 mmHg）显著高于静脉RBCs的值（27.07±0.23 mmHg，p = 0.000）和保存2周的浓缩RBCs的值（16.26±0.62 mmHg，p = 0.000）。与0小时的值相比，P50值在4小时（p = 0.121）和24小时（p = 0.384）时无明显变化。回收的RBCs在0小时的2,3-DPG值（17.94±6.91 μmol/g Hb）显著高于静脉RBCs的值（12.73± 6.52 mmHg，p = 0.007）和保存2周的浓缩RBCs的值（2.62±3.13 mmHg，p = 0.000）。与0小时的值相比，2,3-DPG水平在4小时（p = 0.380）和24小时（p = 0.425）时略有下降。回收血液在0小时的溶血百分比（0.51±0.27%）显著高于静脉血水平（0.07±0.05%，p = 0.000）和保存 2周的浓缩RBCs的值（0.07±0.05%，p = 0.000），在4小时时达到1.11±0.42%（p = 0.002），在24小时时达到1.83±0.77%（p = 0.000）。
回收的RBCs在0小时的氧运输功能不受细胞回收过程的影响，且优于静脉RBCs和保存2周的浓缩RBCs。在储存结束时，回收的RBCs的氧运输功能无明显变化，但溶血百分比显著增加。
