Ünlü Aytekin, Yılmaz Soner, Yalçın Özlem, Uyanık Metin, Petrone Patrizio, Çetinkaya Rıza Aytaç, Eker İbrahim, Urkan Murat, Özgürtaş Taner, Avcı İsmail Yaşar, Zeybek Nazif, Aksu Ali Cenk
University of Health Sciences, Gülhane Training and Research Hospital, Clinic of General Surgery, Ankara, Turkey
University of Health Sciences, Gülhane Training and Research Hospital, Regional Blood and Training Center, Ankara, Turkey
Turk J Haematol. 2018 Aug 3;35(3):185-191. doi: 10.4274/tjh.2018.0081. Epub 2018 May 28.
Hemorrhage is the leading cause of injury-related prehospital mortality. We investigated worst-case scenarios and possible requirements of the Turkish military. As we plan to use blood resources during casualty transport, the impact of transport-related mechanical stress on packed red blood cells (PRBCs) was analyzed.
The in vitro experiment was performed in the environmental test laboratories of ASELSAN. Operational vibrations of potential casualty transport mediums such as Sikorsky helicopters, Kirpi armored vehicles, and the NATO vibration standard MIL-STD-810G software program were recorded. The most powerful mechanical stress, which was created by the NATO standard, was applied to 15 units of fresh (≤7 days) and 10 units of old (>7 days) PRBCs in a blood cooler box. The vibrations were simulated with a TDS v895 Medium-Force Shaker Device. On-site blood samples were analyzed at 0, 6, and 24 h for biochemical and biomechanical analyses.
The mean (±standard deviation) age of fresh and old PRBCs was 4.9±2.2 and 32.8±11.8 days, respectively. Six-hour mechanical damage of fresh PRBCs was demonstrated by increased erythrocyte fragmentation rates (p=0.015), hemolysis rates (p=0.003), and supernatant potassium levels (p=0.003) and decreased hematocrit levels (p=0.015). Old PRBC hemolysis rates (p=0.015), supernatant potassium levels (p=0.015), and supernatant hemoglobin (p=0.015) were increased and hematocrit levels were decreased (p=0.015) within 6 h. Two (13%) units of fresh PRBCs and none of the old PRBCs were eligible for transfusion after 6 h of mechanical stress.
When an austere combat environment was simulated for 24 h, fresh and old PRBC hemolysis rates were above the quality criteria. Currently, the technology to overcome this mechanical damage does not seem to exist. In light of the above data, a new national project is being performed.
出血是与损伤相关的院前死亡的主要原因。我们调查了最坏情况以及土耳其军队的可能需求。由于我们计划在伤员转运过程中使用血液资源，因此分析了转运相关机械应力对浓缩红细胞（PRBCs）的影响。
体外实验在阿塞尔桑公司的环境测试实验室进行。记录了潜在伤员转运工具（如西科斯基直升机、基尔皮装甲车）的运行振动以及北约振动标准MIL-STD-810G软件程序。由北约标准产生的最强大机械应力被施加到血液冷却箱中的15单位新鲜（≤7天）和10单位陈旧（>7天）的PRBCs上。使用TDS v895中力振动台装置模拟振动。在0、6和24小时对现场血液样本进行生化和生物力学分析。
新鲜和陈旧PRBCs的平均（±标准差）保存天数分别为4.9±2.2天和32.8±11.8天。新鲜PRBCs在6小时的机械损伤表现为红细胞破碎率增加（p = 0.015）、溶血率增加（p = 0.003）、上清钾水平增加（p = 0.003）以及血细胞比容水平降低（p = 0.015）。陈旧PRBCs在6小时内溶血率（p = 0.015）、上清钾水平（p = 0.015）和上清血红蛋白（p = 0.015）增加，血细胞比容水平降低（p = 0.015）。经过6小时机械应力后，2单位（13%）新鲜PRBCs不符合输血标准，而陈旧PRBCs均不符合。
当模拟24小时的严峻战斗环境时，新鲜和陈旧PRBCs的溶血率均高于质量标准。目前，似乎不存在克服这种机械损伤的技术。根据上述数据，正在开展一项新的国家项目。
