Oyet Caesar, Okongo Benson, Onyuthi Richard Apecu, Muwanguzi Enoch
Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda,
J Blood Med. 2018 Jun 25;9:111-115. doi: 10.2147/JBM.S163651. eCollection 2018.
Blood transfusion with allogeneic blood products is a common medical intervention to treat anemia or prepare patients for surgical procedures. Generally, the blood units are secured and stored prior to expected transfusion. During storage, a number of biochemical changes occur (generally known as storage lesion), which can affect the efficacy of blood transfusion. The aim of the study was to evaluate the biochemical changes that occur in blood units during storage and to project the impact of these changes on transfusion.
The study protocol was approved by the Faculty of Medicine Research Ethics committee of Mbarara University of Science and Technology. A total of 200 blood recipients were categorized into two study arms: group I received fresh blood (n=100) and group II received old blood (n=100), who were formally consented and recruited consecutively. A total of 2 mL of venous blood was collected from each participant in EDTA tubes before transfusion (for pre-transfusion hemoglobin [Hb] estimation) and after transfusion (for post-transfusion Hb estimation). Each crossmatched unit was sampled to collect plasma for pH, lactate and potassium assays. Data were analyzed with STATA version 12.0.
A total of 200 blood transfusion recipients aged 1-60 years were enrolled in the study. Up to 60% of the participants were females. The pH of the stored blood dropped from 7.4 to 7.2 in the first 3 days to ~7.0 by day 11 and to <7.0 by day 35 (=0.03). The average rise in lactate level was 25 g/dL in blood stored for 0 to 11 days and 32.4 g/dL in blood stored for 21-35 days. The highest increase was encountered in blood stored beyond 28 days: 40-57 g/dL by 35 days (=0.001). Potassium levels equally increased from ~4.6 mmol/L in the first 5 days of storage to ~14.3 mmol/L by 11 days. From the third week of blood storage and beyond, there was exponential increase in potassium levels, with the highest record in blood units stored from 30 to 35 days (=0.068).
Whole blood stored for >14 days has reduced efficacy with increased markers of red cell storage lesion such as increased potassium level, lactate and fall in pH. These lesions increase the length of hospital stay.
输注异体血制品是治疗贫血或为手术做准备的常见医疗干预措施。一般来说，血液单位会在预期输注前采集并储存。储存期间会发生一些生化变化（通常称为储存损伤），这可能会影响输血效果。本研究的目的是评估血液单位在储存期间发生的生化变化，并预测这些变化对输血的影响。
该研究方案经姆巴拉拉科技大学医学院研究伦理委员会批准。共有200名输血受者被分为两个研究组：第一组接受新鲜血液（n = 100），第二组接受陈旧血液（n = 100），两组均正式签署知情同意书并连续招募。在输血前（用于输血前血红蛋白[Hb]测定）和输血后（用于输血后Hb测定），从每位参与者的乙二胺四乙酸（EDTA）管中采集2 mL静脉血。对每个交叉配血的血液单位进行采样以收集血浆用于pH、乳酸和钾测定。数据用STATA 12.0版进行分析。
共有200名年龄在1至60岁的输血受者纳入本研究。多达60%的参与者为女性。储存血液的pH在最初3天从7.4降至7.2，到第11天降至约7.0，到第35天降至<7.0（P = 0.03）。储存0至11天的血液中乳酸水平平均升高25 g/dL，储存21至35天的血液中乳酸水平平均升高32.4 g/dL。储存超过28天的血液中乳酸水平升高最高：到第35天为40 - 57 g/dL（P = 0.001）。钾水平同样从储存的前5天约4.6 mmol/L升高到第11天约14.3 mmol/L。从血液储存第三周及以后，钾水平呈指数级增加，在储存30至35天的血液单位中记录最高（P = 0.068）。
储存超过14天的全血效力降低，红细胞储存损伤标志物增加，如钾水平升高、乳酸增加和pH下降。这些损伤会延长住院时间。
