Blood Transfusion Service, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md.
J Thorac Cardiovasc Surg. 2017 Mar;153(3):610-619.e2. doi: 10.1016/j.jtcvs.2016.11.029. Epub 2016 Nov 19.
Although storage alters red blood cells, several recent, randomized trials found no differences in clinical outcomes between patients transfused with red blood cells stored for shorter versus longer periods of time. The objective of this study was to see whether storage impairs the in vivo ability of erythrocytes to traverse the microcirculation and deliver oxygen at the tissue level.
A subset of subjects from a clinical trial of cardiac surgery patients randomized to receive transfusions of red blood cells stored ≤10 days or ≥21 days were assessed for thenar eminence and cerebral tissue hemoglobin oxygen saturation (SO) via the use of near-infrared spectroscopy and sublingual microvascular blood flow via side-stream darkfield videomicroscopy.
Among 55 subjects, there was little change in the primary endpoint (thenar eminence SO from before to after transfusion of one unit) and the change was similar in the 2 groups: +1.7% (95% confidence interval, -0.3, 3.8) for shorter-storage and +0.8% (95% confidence interval, -1.1, 2.9) for longer-storage; P = .61). Similarly, no significant differences were observed for cerebral SO or sublingual microvascular blood flow. These parameters also were not different from preoperatively to 1 day postoperatively, reflecting the absence of a cumulative effect of all red blood cell units transfused during this period.
There were no differences in thenar eminence or cerebral SO, or sublingual microcirculatory blood flow, in cardiac surgery patients transfused with red blood cells stored ≤10 days or ≥21 days. These results are consistent with the clinical outcomes in the parent study, which also did not differ, indicating that storage may not impair oxygen delivery by red blood cells in this setting.
尽管储存会改变红细胞，但最近几项随机试验发现，输注储存时间较短和较长的红细胞的患者在临床结局方面没有差异。本研究的目的是观察储存是否会损害红细胞在体内穿越微循环并在组织水平输送氧气的能力。
从一项心脏手术患者随机接受储存≤10 天或≥21 天的红细胞输注的临床试验中抽取一部分受试者，通过近红外光谱法评估鱼际和大脑组织血红蛋白氧饱和度（SO），并通过侧流暗场视频显微镜评估舌下微血管血流。
在 55 名受试者中，主要终点（输注 1 单位红细胞前后鱼际 SO 的变化）几乎没有变化，两组之间的变化相似：较短储存组为+1.7%（95%置信区间，-0.3，3.8），较长储存组为+0.8%（95%置信区间，-1.1，2.9）；P=0.61）。同样，大脑 SO 或舌下微血管血流也没有观察到显著差异。这些参数与术前到术后 1 天也没有差异，反映了在此期间输注的所有红细胞单位没有累积效应。
输注储存≤10 天或≥21 天的红细胞的心脏手术患者，鱼际或大脑 SO 或舌下微循环血流无差异。这些结果与母研究的临床结局一致，也没有差异，表明在这种情况下储存不会损害红细胞的氧输送。
