血小板保存白细胞减少和搅拌方法对冷藏全血体外止血功能的影响。
Effects of platelet-sparing leukocyte reduction and agitation methods on in vitro measures of hemostatic function in cold-stored whole blood.
机构信息
From the Division of Pediatric Critical Care Medicine, Department of Pediatrics (K.E.R., A.M-V., S.R.R., P.C.S.), Washington University School of Medicine, St. Louis, Missouri; Institute for Transfusion Medicine (M.H.Y.), University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Pediatric Critical Care Medicine, Department of Pediatrics (A.S.), The University of Tennessee Health Science Center, Memphis, Tennessee; and Coagulation and Blood Research Program (A.P.C., P.C.S.), United States Army Institute of Surgical Research; Ft Sam Houston, Texas.
出版信息
J Trauma Acute Care Surg. 2018 Jun;84(6S Suppl 1):S104-S114. doi: 10.1097/TA.0000000000001870.
BACKGROUND
Agitation of platelet units stored at room temperature is performed routinely to maintain platelet function, and leukoreduction of blood products is the standard of care in many countries to reduce immune consequences of transfusion. The effect of agitation and leukoreduction on whole blood stored at 4°C requires investigation, as reductions in hemostatic capacity of whole blood may reduce its efficacy in treating trauma-induced coagulopathy and platelet dysfunction. We hypothesize that agitation of whole blood will not affect hemostatic function and that leukoreduction will reduce hemostatic function of whole blood.
METHODS
In this in vitro randomized controlled study, 21 units of leukoreduced and 20 nonleukoreduced whole blood units were each randomly assigned into four agitation groups. Hemostatic parameters were measured using viscoelastic assays (rotational thromboelastometry-Extrinsic Screening Test (ROTEM-EXTEM) and thromboelastography (TEG) platelet mapping), impedance aggregometry (agonists-adenosine phosphate, arachidonic acid, thrombin receptor activating peptide, and collagen), and a thrombin generation assay from these whole blood units before and after filtration and on 0, 5, 10, and 15 days of storage at 4°C.
RESULTS
Leukoreduction compared to nonleukoreduction reduced platelet concentration on Day 0. Viscoelastic measures and thrombin generation parameters revealed significant reduction in hemostatic function between the leukoreduced units and the nonleukoreduced units at a few time points. Leukoreduced units consistently demonstrated reduced platelet aggregation compared to the nonleukoreduced units. Agitation methods did not significantly affect any of the hemostatic parameters examined.
CONCLUSIONS
Leukoreduction of whole blood with a platelet-sparing filter caused a moderate but significant reduction in some measures of whole blood hemostatic function most evident early in storage. The benefits of leukoreduction should be weighed against the potential reduced hemostatic function of leukoreduced units. Agitation of whole blood is not required to maintain hemostatic function.
LEVEL OF EVIDENCE
In vitro randomized controlled trial, level 1.
背景
为了维持血小板功能，室温下储存的血小板单位会进行常规振摇，而在许多国家，血液制品的白细胞去除是标准的护理措施，以减少输血的免疫后果。在 4°C 下储存的全血进行振摇和白细胞去除的效果需要进行调查，因为全血止血能力的降低可能会降低其在治疗创伤性凝血病和血小板功能障碍中的效果。我们假设全血的振摇不会影响止血功能，而白细胞去除会降低全血的止血功能。
方法
在这项体外随机对照研究中，将 21 个白细胞去除和 20 个非白细胞去除的全血单位分别随机分配到四个振摇组中。使用粘弹性测定法（旋转血栓弹性仪-外源性筛选试验（ROTEM-EXTEM）和血栓弹性图（TEG）血小板图）、阻抗聚集测定法（激动剂-腺苷酸磷酸盐、花生四烯酸、血栓素受体激活肽和胶原）以及从这些全血单位中测量止血参数在过滤前后以及在 4°C 下储存 0、5、10 和 15 天后。
结果
与非白细胞去除相比，白细胞去除在第 0 天降低了血小板浓度。在一些时间点，粘弹性测量和血栓生成参数显示白细胞去除的单位与非白细胞去除的单位之间止血功能明显降低。白细胞去除的单位与非白细胞去除的单位相比，血小板聚集一直显示出降低。振摇方法均未显著影响所检查的任何止血参数。
结论
用血小板保存过滤器对全血进行白细胞去除会导致一些全血止血功能的适度但显著降低，在储存早期最为明显。白细胞去除的潜在益处应权衡白细胞去除单位潜在的降低止血功能。全血的振摇不是维持止血功能所必需的。
证据等级
体外随机对照试验，一级。
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