在恶劣环境下制备用于输血的去白细胞全血；强制过滤、储存搅拌和高温对止血功能的影响。
Preparation of leukoreduced whole blood for transfusion in austere environments; effects of forced filtration, storage agitation, and high temperatures on hemostatic function.
机构信息
From the Department of Immunology and Transfusion Medicine (J.S., H.B., T.H.F.L., G.S., T.O.A., T.A.H., E.K.K.), Haukeland University Hospital, Bergen, Norway; Department of Pediatrics (P.C.S.), Washington University St Louis School of Medicine, Washington; Trauma/Acute Care Surgery, Medical Center of the Rockies, Medical Center of the Rockies, Denver, Colorado (W.D.); Norwegian Naval Special Operations Command (G.S.), Bergen, Norway; and Department of Clinical Science (T.A.H., E.K.K.), University of Bergen, Bergen, Norway.
出版信息
J Trauma Acute Care Surg. 2018 Jun;84(6S Suppl 1):S93-S103. doi: 10.1097/TA.0000000000001896.
BACKGROUND
Damage control resuscitation principles advocate the use of blood to treat traumatic hemorrhage. Hemorrhage is a leading cause of preventable death on the battlefield, but making blood components available far forward presents logistical challenges due to shelf life and storage requirements. Whole blood simplifies logistics and enables collection in the field but can cause leukocyte-related transfusion reactions. A field-adapted leukoreduction system must be fast and safe, and storage of whole blood should preserve hemostatic function.
METHODS
Blood was collected using Imuflex WB-SP and leukoreduced at 0, 150, or 300 mm Hg. Additional bags were stored at 4°C for 21 days unagitated, mixed daily, agitated or head-over-heel rotated, at 22°C for 3 days, or 32°C for 2 hours. Hematology, coagulation, CD62P/CD42b, thromboelastography (TEG)/thromboelastometry (ROTEM), and Multiplate was performed.
RESULTS
Filtration time was 35 ± 1, 14 ± 0, and 9 ± 0 minutes at 0, 150, and 300 mm Hg, respectively. One of 10 units at 150 mm Hg and 4 of 11 at 300 mm Hg had residual whole blood cells greater than 5.0 × 10 per unit. One of 11 at 300 mm Hg had platelet recovery of less than 80%. Hemolysis was less than 0.2%. Filtration decreased thromboelastography/thromboelastometry and Multiplate aggregation response. Stored at 4°C, α and MA/MCF moderately decreased regardless of mixing. Significant loss of aggregation response and increased CD62P expression was seen by Day 10. By Day 3, storage at 22°C caused loss of most aggregation. Two-hour storage at 32°C did not significantly affect hemostatic capacity.
CONCLUSION
Forced filtration reduced leukoreduction time, but increased residual whole blood cells reduced hemostatic function. Aggregation response deteriorated early in storage, while viscoelastic assays decreased more gradually. Mixing showed no benefits.
LEVEL OF EVIDENCE
Diagnostic study, level IV.
背景
损伤控制性复苏原则主张使用血液治疗创伤性出血。出血是战场上可预防死亡的主要原因，但由于保质期和储存要求，使血液成分在前线可用存在后勤挑战。全血简化了后勤工作，使野外采集成为可能，但会引起白细胞相关的输血反应。一种适应野外的白细胞减少系统必须快速且安全，并且储存全血应保持止血功能。
方法
使用 Imuflex WB-SP 采集血液，并在 0、150 或 300mmHg 下进行白细胞减少处理。另外的袋子在 4°C 下不搅拌储存 21 天，每天混合，在 22°C 下搅拌或头对头旋转 3 天，或在 32°C 下旋转 2 小时。进行血液学、凝血、CD62P/CD42b、血栓弹性图（TEG）/血栓弹性测定（ROTEM）和 Multiplate 检测。
结果
过滤时间分别为 0、150 和 300mmHg 时为 35±1、14±0 和 9±0 分钟。在 150mmHg 时有 10 个单位中的 1 个和在 300mmHg 时有 11 个单位中的 4 个残留的全血细胞超过 5.0×10 个/单位。在 300mmHg 时有 11 个单位中的 1 个血小板回收率低于 80%。溶血小于 0.2%。过滤降低了血栓弹性图/血栓弹性测定和 Multiplate 聚集反应。在 4°C 下储存时，无论是否混合，α 和 MA/MCF 均适度降低。在第 10 天观察到聚集反应和 CD62P 表达的显著损失。在第 3 天，在 22°C 下储存导致大多数聚集丧失。在 32°C 下储存 2 小时不会显著影响止血能力。
结论
强制过滤减少了白细胞减少处理时间，但残留的全血细胞增加会降低止血功能。在储存早期，聚集反应恶化，而粘弹性测定则逐渐降低。混合没有带来好处。
证据水平
诊断研究，IV 级。
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