Meledeo Michael Adam, Peltier Grantham C, McIntosh Colby S, Bynum James A, Cap Andrew P
United States Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas.
Transfusion. 2019 Apr;59(S2):1549-1559. doi: 10.1111/trf.15164.
Transitioning from whole blood (WB) to components developed from efforts to maximize donor yield. Components are advantageous for specific derangements, but treating hemorrhage with components requires significantly more volume to provide similar effects to WB. Because storage lesion and waste remain problematic, this study examined hemostatic function of refrigerated WB stored for 35 days in anticoagulants citrate-phosphate-dextrose-adenosine (CPDA-1), citrate-phosphate-dextrose (CPD), or citrate-phosphate-double dextrose (CP2D).
Refrigerated WB units from healthy donors were sampled over 35 days. Global hemostatic parameters were measured by thromboelastometry, thrombogram, platelet aggregometry, and platelet adhesion to collagen under shear conditions. The effects of transfusion filtration and mixing 35-day stored product with fresh WB were evaluated.
Countable platelets declined as aggregation clusters appeared in microscopy. While gross platelet agonist-induced aggregation declined over time, normalization revealed aggregation responses in remaining platelets. Peak thrombin generation increased over time. Clot strength diminished over storage in tissue factor-activated samples (normalized by filtration of aggregates). Functional fibrinogen responses remained consistent throughout. Filtration was necessary to maintain consistent platelet adhesion to collagen beyond collection day. Few differences were observed between anticoagulants, and stored/fresh mixing studies normalized coagulation parameters.
WB is easier to collect, store, and transfuse. WB provides platelets, an oft-neglected, critical resuscitation component, but their individual numbers decline as aggregates appear, resulting in diminished coagulation response. WB has better performance in these assays when examined at earlier time points, but expirations designated to specific anticoagulants appear arbitrary for hemostatic functionality, as little changes beyond 21 days regardless of anticoagulant.
从全血（WB）向为最大化献血量而研发的成分血过渡。成分血对特定紊乱情况具有优势，但用成分血治疗出血需要显著更多的血量才能产生与全血相似的效果。由于储存损伤和浪费问题仍然存在，本研究检测了在抗凝剂枸橼酸盐 - 磷酸盐 - 葡萄糖 - 腺苷（CPDA - 1）、枸橼酸盐 - 磷酸盐 - 葡萄糖（CPD）或枸橼酸盐 - 磷酸盐 - 双葡萄糖（CP2D）中冷藏35天的全血的止血功能。
在35天内对来自健康献血者的冷藏全血样本进行采样。通过血栓弹力图、血栓图、血小板聚集测定法以及在剪切条件下血小板与胶原蛋白的黏附来测量整体止血参数。评估了输血过滤以及将储存35天的产品与新鲜全血混合的效果。
随着显微镜下出现聚集簇，可计数的血小板数量下降。虽然总的血小板激动剂诱导的聚集随时间下降，但标准化显示剩余血小板中有聚集反应。凝血酶生成峰值随时间增加。在组织因子激活的样本中（通过聚集物过滤进行标准化），凝块强度在储存过程中降低。功能性纤维蛋白原反应在整个过程中保持一致。为了在采血日之后维持血小板与胶原蛋白的一致黏附，过滤是必要的。在抗凝剂之间观察到的差异很少，并且储存/新鲜混合研究使凝血参数标准化。
全血更易于采集、储存和输血。全血提供血小板，这是一个经常被忽视的关键复苏成分，但随着聚集物出现，其个体数量会下降，导致凝血反应减弱。在早期时间点进行检测时，全血在这些检测中表现更好，但对于止血功能而言，指定给特定抗凝剂的有效期似乎是任意的，因为无论使用何种抗凝剂，21天之后变化很小。
