Yoshida Tatsuro, Blair Abbejane, D'alessandro Angelo, Nemkov Travis, Dioguardi Michael, Silliman Christopher C, Dunham Andrew
New Health Sciences Inc., Cambridge, MA, United States of America.
University of Colorado, Denver, CO, United States of America.
Blood Transfus. 2017 Mar;15(2):172-181. doi: 10.2450/2017.0325-16.
Recent research focused on understanding stored red blood cell (RBC) quality has demonstrated high variability in measures of RBC function and health across units. Studies have historically linked this high variability to variations in processing, storage method, and age. More recently, a large number of studies have focused on differences in donor demographics, donor iron sufficiency, and genetic predisposition of the donor to poor storage, particularly through mechanisms of accelerated oxidative damage. A study was undertaken to evaluate a potential additional source of unit to unit variation in stored RBC: the role of variable percent oxygen saturation (%SO) levels on blood quality parameters during storage.
%SO data from 492 LR-RBC/AS-3 units used for internal and external collaborative research was included in the analysis. Whole blood units were processed into red blood cells, AS-3 added, leucocyte reduced, in compliance with American Association of Blood Banks guidelines. LR-RBC/AS-3 products were subsequently analysed for %SO levels within 3-24 hours of phlebotomy using a co-oximeter. Separately, to evaluate the impact of pre-storage as well as increasing levels of %SO during storage, a pool-and-split study was performed. Four units of LR-RBC/AS-3 were split 6 ways; "as is" (control), hyperoxygenated to more than 90%, and four levels of pre-storage %SO. The units were periodically sampled up to 42 days and analysed for %SO, pCO, methaemoglobin, ATP, 2,3-BPG as well as with the metabolomics workflow.
The measured mean %SO in LR-RBC/AS-3 within 24 hours of collection was 45.9±17.5% with (32.7-61.0 IQR). %SO in all products increased to approximately 95-100% in three weeks. Measured blood quality parameters including ATP, % haemolysis, methaemoglobin, oxidised lipids, and GSH/GSSG indicated suppressed cellular metabolism and increased red cell degradation in response to higher %SO levels.
The surprisingly high variability in starting %SO levels, coupled with negative impacts of high oxygen saturation on red blood cell quality indicates that oxygen levels may be an important and under-appreciated source of unit-to-unit variability in RBC quality.
近期专注于了解储存红细胞（RBC）质量的研究表明，各单位之间RBC功能和健康指标存在很大差异。历史研究将这种高度变异性与处理、储存方法和储存时间的差异联系起来。最近，大量研究聚焦于献血者人口统计学、献血者铁充足性以及献血者对不良储存的遗传易感性差异，特别是通过加速氧化损伤机制。本研究旨在评估储存RBC单位间变异性的一个潜在额外来源：储存期间可变的氧饱和度百分比（%SO）水平对血液质量参数的作用。
分析纳入了492个用于内部和外部合作研究的LR-RBC/AS-3单位的%SO数据。全血单位按照美国血库协会指南加工成红细胞，添加AS-3并进行白细胞过滤。随后使用共血氧计在采血后3至24小时内分析LR-RBC/AS-3产品的%SO水平。另外，为评估储存前以及储存期间%SO水平升高的影响，进行了一项混合分割研究。将4个LR-RBC/AS-3单位分成6组；“原样”（对照）、超氧合至超过90%以及4个储存前%SO水平。对这些单位进行长达42天的定期采样，并分析%SO、pCO、高铁血红蛋白、ATP、2,3-BPG以及采用代谢组学工作流程进行分析。
采集后24小时内LR-RBC/AS-3中测得的平均%SO为45.9±17.5%（IQR为32.7 - 61.0）。所有产品中的%SO在三周内升至约95 - 100%。测得的血液质量参数包括ATP、溶血百分比、高铁血红蛋白、氧化脂质以及GSH/GSSG表明，较高的%SO水平会抑制细胞代谢并增加红细胞降解。
起始%SO水平令人惊讶的高变异性，以及高氧饱和度对红细胞质量的负面影响表明，氧水平可能是RBC质量单位间变异性的一个重要但未得到充分重视的来源。
