Arbaeen Ahmad F, Schubert Peter, Serrano Katherine, Carter Cedric J, Culibrk Brankica, Devine Dana V
Department of Pathology and Laboratory Medicine and Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.
Faculty of Applied Medical Sciences, Department Laboratory Medicine, Umm al-Qura University, Makkah Al Mukarramah, Saudi Arabia.
Transfusion. 2017 May;57(5):1208-1217. doi: 10.1111/trf.14043. Epub 2017 Feb 24.
Trauma transfusion packages for hemorrhage control consist of red blood cells, plasma, and platelets at a set ratio. Although pathogen reduction improves the transfusion safety of platelet and plasma units, there is an associated reduction in quality. This study aimed to investigate the impact of riboflavin/ultraviolet light-treated plasma or platelets in transfusion trauma packages composed of red blood cell, plasma, and platelet units in a ratio of 1:1:1 in vitro by modeling transfusion scenarios for trauma patients and assessing function by rotational thromboelastometry.
Pathogen-reduced or untreated plasma and buffy coat platelet concentrate units produced in plasma were used in different combinations with red blood cells in trauma transfusion packages. After reconstitution of these packages with hemodiluted blood, the hemostatic functionality was analyzed by rotational thromboelastometry.
Hemostatic profiles of pathogen-inactivated buffy coat platelet concentrate and plasma indicated decreased activity compared with their respective controls. Reconstitution of hemodiluted blood (hematocrit = 20%) with packages that contained treated or nontreated components resulted in increased alpha and maximum clot firmness and enhanced clot-formation time. Simulating transfusion scenarios based on 30% blood replacement with a transfusion trauma package resulted in a nonsignificant difference in rotational thromboelastometry parameters between packages containing treated and nontreated blood components (p ≥ 0.05). Effects of pathogen inactivation treatment were evident when the trauma package percentage was 50% or greater and contained both pathogen inactivation-treated plasma and buffy coat platelet concentrate.
Rotational thromboelastometry investigations suggest that there is relatively little impact of pathogen inactivation treatment on whole blood clot formation unless large amounts of treated components are used.
用于控制出血的创伤输血套餐由按设定比例的红细胞、血浆和血小板组成。尽管病原体灭活提高了血小板和血浆单位的输血安全性，但质量会相应降低。本研究旨在通过模拟创伤患者的输血场景并采用旋转血栓弹力图评估功能，在体外研究核黄素/紫外线处理的血浆或血小板对由红细胞、血浆和血小板单位按1:1:1比例组成的创伤输血套餐的影响。
在创伤输血套餐中，将血浆中生产的经病原体灭活或未处理的血浆和富血小板血浆浓缩物单位与红细胞以不同组合使用。用血液稀释液重构这些套餐后，通过旋转血栓弹力图分析止血功能。
与各自的对照相比，经病原体灭活的富血小板血浆浓缩物和血浆的止血曲线显示活性降低。用含有处理或未处理成分的套餐重构血液稀释液（血细胞比容 = 20%）导致α角和最大血凝块硬度增加，凝血形成时间延长。用创伤输血套餐模拟基于30%血液置换的输血场景，含处理和未处理血液成分的套餐之间旋转血栓弹力图参数无显著差异（p≥0.05）。当创伤套餐比例为50%或更高且包含经病原体灭活处理的血浆和富血小板血浆浓缩物时，病原体灭活处理的效果明显。
旋转血栓弹力图研究表明，除非使用大量经处理的成分，病原体灭活处理对全血凝血形成的影响相对较小。
