Vitalant Research Institute, Denver, Colorado, USA.
RTI International, Research Triangle Park, North Carolina, USA.
Transfusion. 2021 Feb;61(2):435-448. doi: 10.1111/trf.16168. Epub 2020 Nov 4.
Obesity is a global pandemic characterized by multiple comorbidities, including cardiovascular and metabolic diseases. The aim of this study was to define the associations between blood donor body mass index (BMI) and RBC measurements of metabolic stress and hemolysis.
The associations between donor BMI (<25 kg/m , normal weight; 25-29.9 kg/m , overweight; and ≥30 kg/m , obese) and hemolysis (storage, osmotic, and oxidative; n = 18 donors) or posttransfusion recovery (n = 14 donors) in immunodeficient mice were determined in stored leukocyte-reduced RBC units. Further evaluations were conducted using the National Heart, Lung, and Blood Institute RBC-Omics blood donor databases of hemolysis (n = 13 317) and metabolomics (n = 203).
Evaluations in 18 donors revealed that BMI was significantly (P < 0.05) and positively associated with storage and osmotic hemolysis. A BMI of 30 kg/m or greater was also associated with lower posttransfusion recovery in mice 10 minutes after transfusion (P = 0.026). Multivariable linear regression analyses in RBC-Omics revealed that BMI was a significant modifier for all hemolysis measurements, explaining 4.5%, 4.2%, and 0.2% of the variance in osmotic, oxidative, and storage hemolysis, respectively. In this cohort, obesity was positively associated (P < 0.001) with plasma ferritin (inflammation marker). Metabolomic analyses on RBCs from obese donors (44.1 ± 5.1 kg/m ) had altered membrane lipid composition, dysregulation of antioxidant pathways (eg, increased oxidized lipids, methionine sulfoxide, and xanthine), and dysregulation of nitric oxide metabolism, as compared to RBCs from nonobese (20.5 ± 1.0 kg/m ) donors.
Obesity is associated with significant changes in RBC metabolism and increased susceptibility to hemolysis under routine storage of RBC units. The impact on transfusion efficacy warrants further evaluation.
肥胖是一种全球性的流行疾病，其特征是多种合并症，包括心血管和代谢疾病。本研究的目的是定义献血者体重指数（BMI）与 RBC 代谢应激和溶血指标之间的关联。
在储存白细胞减少的 RBC 单位中，确定了捐赠者 BMI（<25kg/m²，正常体重；25-29.9kg/m²，超重；≥30kg/m²，肥胖）与溶血（储存、渗透和氧化；n=18 名供体）或输血后恢复（n=14 名供体）之间的关联。使用国家心肺血液研究所 RBC-Omics 溶血（n=13317）和代谢组学（n=203）血液库进一步评估。
在 18 名供体中的评估表明，BMI 与储存和渗透溶血呈显著（P<0.05）和正相关。BMI 为 30kg/m²或更高也与小鼠输血后 10 分钟的输血后恢复较低相关（P=0.026）。RBC-Omics 中的多变量线性回归分析表明，BMI 是所有溶血测量的显著修饰因子，分别解释了渗透、氧化和储存溶血的 4.5%、4.2%和 0.2%的方差。在该队列中，肥胖与血浆铁蛋白（炎症标志物）呈正相关（P<0.001）。与非肥胖（20.5±1.0kg/m²）供体的 RBC 相比，肥胖（44.1±5.1kg/m²）供体的 RBC 膜脂质组成发生改变，抗氧化途径失调（例如，氧化脂质、甲硫氨酸亚砜和黄嘌呤增加），以及一氧化氮代谢失调。
肥胖与 RBC 代谢的显著变化有关，并使 RBC 单位在常规储存下更容易发生溶血。对输血效果的影响需要进一步评估。
