氧平衡的分子标志物和组织氧测量能否被利用来优化红细胞输注？

Can molecular markers of oxygen homeostasis and the measurement of tissue oxygen be leveraged to optimize red blood cell transfusions?

机构信息

Laboratory of Biochemistry and Vascular Biology, Division of Blood Components and Devices, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA.

出版信息

Curr Opin Hematol. 2019 Nov;26(6):453-460. doi: 10.1097/MOH.0000000000000533.

DOI:10.1097/MOH.0000000000000533

PMID:31483333

Abstract

PURPOSE OF REVIEW

The clinical indication for transfusing red blood cells (RBCs) is to restore or maintain adequate oxygenation of respiring tissue. Oxygen (O2) transport, delivery, and utilization following transfusion are impacted by perfusion, hemoglobin (Hb) allosteric saturation/desaturation, and the concentration of tissue O2. Bioavailable O2 maintains tissue utilization and homeostasis; therefore, measuring imbalances in supply and demand could be valuable to assessing blood quality and transfusion effectiveness. O2 homeostasis is critically intertwined with erythropoietic response in blood loss and anemia and the hormones that modulate iron mobilization and RBC production (e.g., erythropoietin, erythroferrone, and hepcidin) are intriguing markers for the monitoring of transfusion effectiveness in acute and chronic settings. The evaluation of RBC donor unit quality and the determination of RBC transfusion needs are emerging areas for biomarker development and minimally invasive O2 measurements.

RECENT FINDINGS

Novel methods for assessing circulatory and tissue compartment biomarkers of transfusion effectiveness are suggested. In addition, monitoring of tissue oxygenation by indirect and direct measurements of O2 is available and applied in experimental settings.

SUMMARY

Herein, we discuss tissue O2 homeostasis, related aspects of erythropoiesis, molecular markers and measurements of tissue oxygenation, all aimed at optimizing transfusion and assessing blood quality.

摘要

目的综述

输注红细胞（RBC）的临床指征是恢复或维持呼吸组织的充足氧合。输血后氧（O2）的运输、输送和利用受灌注、血红蛋白（Hb）变构饱和度/去饱和度以及组织 O2 浓度的影响。生物可利用的 O2 维持组织利用和动态平衡；因此，测量供需失衡可能有助于评估血液质量和输血效果。O2 动态平衡与血液丢失和贫血中的红细胞生成反应密切交织在一起，调节铁动员和 RBC 生成的激素（例如，促红细胞生成素、红细胞生成素和铁调素）是监测急性和慢性情况下输血效果的有趣标志物。评估 RBC 供者单位质量和确定 RBC 输血需求是生物标志物开发和微创 O2 测量的新兴领域。