From the Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
J Trauma Acute Care Surg. 2020 Oct;89(4):665-672. doi: 10.1097/TA.0000000000002839.
Recent military and civilian experience suggests that fresh whole blood may be the preferred for treatment of hemorrhagic shock, but its use is limited by its 21-day shelf life. The red blood cell storage lesion and coagulation status of packed red blood cells (pRBCs) salvaged from expired whole blood are unknown. We hypothesized that pRBCs can be salvaged from previously stored whole blood.
Cold stored, low-titer, O-positive, nonleukoreduced, whole blood units were obtained at 21 days of storage. Erythrocytes were separated by centrifugation, resuspended in AS-3, and stored for 21 additional days as salvaged pRBCs. The red blood cell storage lesion parameters of microvesicles, Band-3, free hemoglobin, annexin V, and erythrocyte osmotic fragility were measured and compared with pRBCs prepared at the time of donation and stored in AS-3 for 42 days (standard pRBCs). In additional experiments, murine pRBCs were prepared from expired whole blood units and compared with those stored under standard conditions. Mice underwent hemorrhage and resuscitation with standard and salvaged pRBC units, and serum cytokines and free hemoglobin were determined.
There were no significant differences in microvesicle formation or cell-free hemoglobin concentration between salvaged and standard pRBCs. There was decreased Band-3 and increased phosphatidylserine in the salvaged units as well as greater osmotic fragility. Salvaged pRBCs maintained consistent clot firmness. After hemorrhage and resuscitation in a murine model, salvaged pRBCs did not demonstrate increased serum cytokine levels.
Salvaged pRBCs from previously stored whole blood accumulate the red blood cell storage lesion in a similar fashion to standard pRBCs and maintain consistent coagulability when reconstituted with plasma. Salvaged pRBCs are not associated with an increased inflammatory response when used for resuscitation in a murine model. Salvaged pRBCs may be a viable product for utilization in the treatment of traumatic hemorrhagic shock.
最近的军事和民用经验表明，新鲜全血可能是治疗失血性休克的首选，但由于其 21 天的保质期限制了其使用。从过期全血中回收的浓缩红细胞（pRBC）的红细胞储存损伤和凝血状态尚不清楚。我们假设可以从先前储存的全血中回收 pRBC。
在储存 21 天时，从冷藏、低滴度、O 阳性、非白细胞减少的全血单位中获得红细胞。通过离心分离红细胞，重悬于 AS-3 中，并再储存 21 天作为回收的 pRBC。测量并比较微囊泡、Band-3、游离血红蛋白、膜联蛋白 V 和红细胞渗透脆性等红细胞储存损伤参数，与捐献时制备并在 AS-3 中储存 42 天的 pRBC（标准 pRBC）进行比较。在额外的实验中，从过期的全血单位中制备鼠 pRBC，并与在标准条件下储存的 pRBC 进行比较。用标准和回收的 pRBC 单位对小鼠进行出血和复苏，并测定血清细胞因子和游离血红蛋白。
回收的 pRBC 和标准 pRBC 之间在微囊泡形成或细胞游离血红蛋白浓度方面没有显著差异。回收单位中的 Band-3 减少，磷脂酰丝氨酸增加，渗透脆性增加。回收的 pRBC 保持一致的凝块硬度。在小鼠模型中进行出血和复苏后，回收的 pRBC 未显示出血清细胞因子水平增加。
从先前储存的全血中回收的 pRBC 以类似于标准 pRBC 的方式积累红细胞储存损伤，并且在用血浆重新配制时保持一致的凝血能力。在小鼠模型中用于复苏时，回收的 pRBC 不会引起炎症反应增加。回收的 pRBC 可能是一种可行的产品，可用于治疗创伤性失血性休克。
