Thomas Kimberly A, Shea Susan M, Yazer Mark H, Spinella Philip C
Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri.
Institute for Transfusion Medicine, The University of Pittsburgh, Pittsburgh, Pennsylvania.
Transfusion. 2019 Apr;59(S2):1539-1548. doi: 10.1111/trf.15175.
There is renewed interest in the use of whole blood (WB) for resuscitation of patients in hemorrhagic shock. Leukoreduction with platelet-sparing filters and pathogen reduction may be used to improve the safety profile of WB, yet the effects of leukoreduction and pathogen reduction on WB hemostatic function are not well characterized.
Blood from 32 healthy group O donors was divided into treatment groups (n = 8 for each group): untreated, pathogen reduced (PR ), leukoreduced using an in-line filter (LR ), or PR LR . Units were stored without agitation for 21 days between 1° and 6°C, with sampling on days 0 (pre- and post-treatments), 1, 3, 5, 10, 15, and 21 for hemostatic function as assessed by thromboelastometry, thrombin generation, platelet activation factors, and platelet impedance aggregometry.
From day 3 (D3) to D15 of storage, platelet count was reduced in PR /LR units compared to PR /LR units. From D10 to D21 of storage, maximum clot firmness (MCF) was reduced in PR /LR units compared to PR /LR units. From D3 to D21 of storage, platelet aggregation was reduced in PR /LR units compared to PR /LR units. Total thrombin generation was similar in all groups from D0 to D21.
The combination of LR with a platelet-sparing filter and PR significantly reduces hemostatic function compared to either treatment alone or untreated WB. The clinical consequences of LR and PR of WB in patients with severe bleeding should be examined in trials before both are used in combination in patients.
对于使用全血（WB）复苏失血性休克患者，人们重新产生了兴趣。使用保留血小板的滤器进行白细胞去除和病原体灭活可用于改善全血的安全性，然而白细胞去除和病原体灭活对全血止血功能的影响尚未得到充分描述。
从32名健康的O型血供者采集的血液被分为治疗组（每组n = 8）：未处理组、病原体灭活组（PR）、使用在线滤器进行白细胞去除组（LR）或PR+LR组。血袋在1℃至6℃下静置储存21天，在第0天（处理前后）、1天、3天、5天、10天、15天和21天进行采样，通过血栓弹力图、凝血酶生成、血小板激活因子和血小板阻抗聚集测定法评估止血功能。
在储存第3天（D3）至第15天，与PR/LR组相比，PR/LR组的血小板计数降低。在储存第10天至第21天，与PR/LR组相比，PR/LR组的最大血凝块硬度（MCF）降低。在储存第3天至第21天，与PR/LR组相比，PR/LR组的血小板聚集降低。从D0至D21，所有组的总凝血酶生成相似。
与单独进行白细胞去除或病原体灭活或未处理的全血相比，白细胞去除联合保留血小板的滤器和病原体灭活显著降低了止血功能。在将全血的白细胞去除和病原体灭活联合用于患者之前，应在试验中检查其对严重出血患者的临床影响。
