用于血液制品洗涤和体积减小的传统技术与新兴技术。

Traditional and emerging technologies for washing and volume reducing blood products.

作者信息

Lu Madeleine, Lezzar Dalia L, Vörös Eszter, Shevkoplyas Sergey S

机构信息

Department of Biomedical Engineering, University of Houston, Houston, TX 77204-5060, USA,

出版信息

J Blood Med. 2019 Jan 3;10:37-46. doi: 10.2147/JBM.S166316. eCollection 2019.

Abstract

Millions of blood components including red blood cells, platelets, and granulocytes are transfused each year in the United States. The transfusion of these blood products may be associated with adverse clinical outcomes in some patients due to residual proteins and other contaminants that accumulate in blood units during processing and storage. Blood products are, therefore, often washed in normal saline or other media to remove the contaminants and improve the quality of blood cells before transfusion. While there are numerous methods for washing and volume reducing blood components, a vast majority utilize centrifugation-based processing, such as manual centrifugation, open and closed cell processing systems, and cell salvage/autotransfusion devices. Although these technologies are widely employed with a relatively low risk to the average patient, there is evidence that centrifugation-based processing may be inadequate when transfusing to immunocompromised patients, neonatal and infant patients, or patients susceptible to transfusion-related allergic reactions. Cell separation and volume reduction techniques that employ centrifugation have been shown to damage blood cells, contributing to these adverse outcomes. The limitations and disadvantages of centrifugation-based processing have spurred the development of novel centrifugation-free methods for washing and volume reducing blood components, thereby causing significantly less damage to the cells. Some of these emerging technologies are already transforming niche applications, poised to enter mainstream blood cell processing in the not too distant future.

摘要

在美国,每年有包括红细胞、血小板和粒细胞在内的数百万血液成分被输注。由于在加工和储存过程中血液单位中积累的残留蛋白质和其他污染物,这些血液制品的输注在某些患者中可能与不良临床结果相关。因此,血液制品在输注前通常用生理盐水或其他介质洗涤以去除污染物并提高血细胞质量。虽然有许多洗涤和减少血液成分体积的方法,但绝大多数方法都采用基于离心的处理方式,如手动离心、开放式和封闭式细胞处理系统以及细胞回收/自体输血装置。尽管这些技术被广泛应用,对普通患者的风险相对较低,但有证据表明,在给免疫功能低下的患者、新生儿和婴儿患者或易发生输血相关过敏反应的患者输血时,基于离心的处理方式可能并不充分。已证明采用离心的细胞分离和体积减少技术会损害血细胞,导致这些不良后果。基于离心的处理方式的局限性和缺点促使了用于洗涤和减少血液成分体积的新型无离心方法的开发,从而对细胞造成的损害显著减少。其中一些新兴技术已经在改变特定应用领域,并有望在不久的将来进入主流血细胞处理领域。

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