Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, University of Rochester Medical Center, Rochester, NY, USA.
Vox Sang. 2021 Feb;116(2):190-196. doi: 10.1111/vox.13005. Epub 2020 Sep 23.
In recent years, there has been renewed interest in whole blood (WB) transfusion, particularly in damage control resuscitation, in part due to the ability to provide the adequate ratio of blood components in a single transfusion. However, there is insufficient evidence to suggest that WB units maintain their haemostatic function during storage, which could compromise their quality and efficacy if transfused. Here, we evaluate the in vitro haemostatic function of stored WB units over a 28-day refrigeration period.
Standard WB units were collected from healthy volunteers and stored at 4°C for 28 days. Samples were collected from each unit on several days throughout the storage period and tested for complete blood count (CBC), WB aggregation, clot kinetics as measured by thromboelastography (TEG), closure time and plasma-free haemoglobin.
Throughout the storage period, there were gradual, significant decreases in platelet count and function, including WB aggregation in response to collagen (P < 0·05) and closure time with epinephrine (P < 0·0005). Plasma-free haemoglobin increased substantially (by 163%) throughout the storage period. However, TEG results remained relatively stable for 3 weeks, indicating possible preservation of haemostatic function during that time.
This study shows that clot kinetics (as measured by TEG) in WB units stored at 4°C are preserved for up to 21 days. However, high levels of free haemoglobin raise concern for the potential risks of transfusing stored WB. Clinical studies are required to evaluate optimal storage times and outcomes of patients resuscitated with WB as compared to blood components.
近年来，人们对全血（WB）输注重新产生了兴趣，尤其是在损伤控制性复苏方面，部分原因是其能够在一次输注中提供适当比例的血液成分。然而，目前没有足够的证据表明储存过程中的 WB 单位能够保持其止血功能，如果输注这些血液，可能会影响其质量和疗效。在此，我们评估了储存 28 天冷藏期内 WB 单位的体外止血功能。
从健康志愿者中采集标准 WB 单位，并在 4°C 下储存 28 天。在储存期的几天内从每个单位采集样本，并进行全血细胞计数（CBC）、WB 聚集、血栓弹性描记法（TEG）测量的凝块动力学、闭合时间和血浆游离血红蛋白检测。
在整个储存期间，血小板计数和功能逐渐显著下降，包括对胶原的 WB 聚集反应（P<0·05）和肾上腺素诱导的闭合时间（P<0·0005）。血浆游离血红蛋白在整个储存期间显著增加（增加了 163%）。然而，TEG 结果在 3 周内相对稳定，表明在此期间可能保持了止血功能。
本研究表明，在 4°C 下储存的 WB 单位的凝块动力学（通过 TEG 测量）可保持稳定达 21 天。然而，游离血红蛋白含量较高引起了人们对输注储存 WB 可能带来的潜在风险的关注。需要进行临床研究来评估与血液成分相比，用 WB 复苏的最佳储存时间和患者结局。
