Russell Lene, Holst Lars Broksø, Lange Theis, Liang Xuan, Ostrowski Sisse Rye, Perner Anders
Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Copenhagen Academy for Medical Education and Simulation-Rigshospitalet, Copenhagen, Denmark.
Transfusion. 2018 Dec;58(12):2807-2818. doi: 10.1111/trf.14904. Epub 2018 Nov 5.
The effects of anemia and red blood cell (RBC) transfusion on markers of clot formation and platelet function in patients with septic shock are unknown. We assessed these effects in a randomized transfusion trial of patients with septic shock.
We performed a prospective substudy of the Transfusion Requirements in Septic Shock (TRISS) trial, randomly assigning patients in the intensive care unit with septic shock and hemoglobin concentration of 9.0 g/dL or less to transfusion with one unit of RBCs at a hemoglobin level of 9.0 g/dL or a level of 7.0 g/dL. We assessed thromboelastography (TEG), multiple electrode aggregometry (MEA), platelet count, and international normalized ratio (INR) immediately before and after the first blood transfusion and again 3 hours after. The effects of hemoglobin level were analyzed using multiple linear regression and the association between markers of hemostasis and subsequent bleeding by Cox regression models.
We included 58 patients in this substudy. We observed no differences in whole blood clot formation, platelet count or function, or INR between patients with hemoglobin levels of 7.0 and 9.0 g/dL, and we found no effect of RBC transfusion on these markers. Platelet function, assessed by MEA, but not whole blood clot formation, was associated with subsequent bleeding.
In patients with septic shock, the level of anemia and the transfusion of RBCs did not appear to influence clot formation or platelet function. Low platelet function, as evaluated by MEA, was associated with increased risk of subsequent bleeding.
贫血和红细胞（RBC）输注对感染性休克患者凝血形成标志物和血小板功能的影响尚不清楚。我们在一项感染性休克患者的随机输血试验中评估了这些影响。
我们对感染性休克输血需求（TRISS）试验进行了一项前瞻性子研究，将重症监护病房中血红蛋白浓度为9.0 g/dL或更低的感染性休克患者随机分配，在血红蛋白水平达到9.0 g/dL或7.0 g/dL时输注1单位红细胞。我们在首次输血前、输血后立即以及输血后3小时评估血栓弹力图（TEG）、多电极聚集测定法（MEA）、血小板计数和国际标准化比值（INR）。使用多元线性回归分析血红蛋白水平的影响，并通过Cox回归模型分析止血标志物与随后出血之间的关联。
我们在这项子研究中纳入了58名患者。我们观察到血红蛋白水平为7.0 g/dL和9.0 g/dL的患者在全血凝血形成、血小板计数或功能或INR方面没有差异，并且我们发现红细胞输注对这些标志物没有影响。通过MEA评估的血小板功能而非全血凝血形成与随后的出血相关。
在感染性休克患者中，贫血程度和红细胞输注似乎并未影响凝血形成或血小板功能。通过MEA评估的低血小板功能与随后出血风险增加相关。
