Siletz Anaar, Burruss Sigrid, Gruber Terry, Ziman Alyssa, Marder Victor, Cryer Henry Magill
From the Department of Surgery (A.S., H.M.C.), David Geffen School of Medicine at UCLA, Los Angeles; Department of Surgery (S.B.), Loma Linda University Medical Center, Loma Linda; Department of Hematology (T.G., V.M.); and Department of Laboratory Medicine (A.Z.), David Geffen School of Medicine at UCLA, Los Angeles, California.
J Trauma Acute Care Surg. 2017 Sep;83(3):420-426. doi: 10.1097/TA.0000000000001535.
Whole blood (WB) transfusion is a promising alternative to component therapy in hemostatic resuscitation. Use of banked WB requires filtration of white blood cells (leukoreduction) and an established shelf life during which WB retains coagulant capacities. The goal of this study was to define the time course of coagulation stability in leukoreduced compared to unfiltered WB under standard refrigeration conditions.
Twelve WB units were donated by healthy volunteers after routine screening. Five units underwent standard leukocyte filtration and five did not. Two units were aliquoted into filtered and unfiltered samples, with platelets added to each sample on day 14. Units were stored at 4°C and sampled on days 0, 1, 2, 3, 4, 5, 6, 7, 10, 14, 21, 28, and 35 for immediate thromboelastography (TEG) analysis, and centrifuged and stored at -80°C for later calibrated automated thrombogram and coagulation factor assays.
K-dependent factors and fibrinogen were low normal, decreased slightly over 35 days and were similar between unfiltered and filtered units. Labile factors were better preserved in filtered units, although unfiltered units did not show impaired coagulation over 35 days. Filtered blood had delayed clot initiation on days 0, 1, and 2 as measured by TEG R (p < 0.021); slower clot progression (TEG α-angle) on days 0, 1, 2, 3, 4, 5, and 6 (p < 0.023); weaker final clot (TEG MA) on all days (p < 0.0001). Thrombin generation was delayed on day 28 (p = 0.046) and decreased on days 10, 21, 28, and 35 (p < 0.034). Addition of platelets to filtered WB rescued TEG MA.
Filtered WB had decreased functional clotting capacity and thrombin generation and may not be suitable for hemostatic resuscitation as the sole blood product.
Therapeutic, level IV.
在止血复苏中，全血（WB）输注是成分输血的一种有前景的替代方法。使用库存全血需要过滤白细胞（白细胞去除），并且全血在既定的保质期内要保持凝血能力。本研究的目的是确定在标准冷藏条件下，与未过滤的全血相比，白细胞去除后的全血凝血稳定性的时间进程。
12个全血单位由健康志愿者在常规筛查后捐献。5个单位进行标准白细胞过滤，5个单位未过滤。2个单位分别分装成过滤和未过滤的样本，在第14天向每个样本中添加血小板。单位样本在4°C储存，并在第0、1、2、3、4、5、6、7、10、14、21、28和35天取样进行即时血栓弹力图（TEG）分析，然后离心并储存在-80°C以备后续校准自动血栓图和凝血因子检测。
依赖K的因子和纤维蛋白原处于低正常水平，在35天内略有下降，未过滤和过滤后的单位之间相似。不稳定因子在过滤后的单位中保存得更好，尽管未过滤的单位在35天内未显示凝血功能受损。通过TEG R测量，过滤后的血液在第0、1和2天凝血启动延迟（p < 0.021）；在第0、1、2、3、4、5和6天凝血进展较慢（TEG α角）（p < 0.023）；在所有天数最终血凝块较弱（TEG MA）（p < 0.0001）。凝血酶生成在第28天延迟（p = 0.046），在第10、21、28和35天减少（p < 0.034）。向过滤后的全血中添加血小板可挽救TEG MA。
过滤后的全血功能性凝血能力和凝血酶生成降低，可能不适合作为唯一的血液制品用于止血复苏。
治疗性，IV级。
