全血病原体减少：补充纤维蛋白原部分纠正大量输血模型中的凝血形成。
Pathogen reduction of whole blood: Supplementing fibrinogen partly corrects clot formation in a massive transfusion model.
机构信息
Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.
出版信息
Transfusion. 2021 Jun;61(6):1884-1893. doi: 10.1111/trf.16382. Epub 2021 Mar 21.
BACKGROUND
The use of whole blood (WB) to treat trauma patients is becoming more common. Similar to the treatment of individual components, pathogen inactivation (PI) technologies are available to treat WB. The impact of PI on WB function is not well understood. This study investigated the impact of PI of WB with riboflavin/ultraviolet (UV) light on its hemostatic function by modeling transfusion scenarios for trauma patients and assessing transfusion efficacy by rotational thromboelastometry (ROTEM). As fibrinogen is affected by PI of WB, the effect of fibrinogen supplementation commonly used in trauma patients was also analyzed in this model.
STUDY DESIGN AND METHODS
Trauma transfusion scenarios were simulated by mixing untreated WB or WB treated with the Mirasol PI technology (riboflavin/UV) in different ratios with hemodiluted blood, and the thromboelasticity was monitored by ROTEM. The impact of supplementation with the fibrinogen concentrate RiaSTAP was investigated in this model.
RESULTS
Pathogen-inactivated WB (PI-WB) showed decreased activity in the hemostatic profile compared to the untreated control. Hemodiluted blood at a hematocrit (hct) of 20%, which was reconstituted with PI-WB or untreated WB, exhibited increased alpha values, maximum clot firmness, and clot formation time. Simulating transfusion scenarios by blood replacement with PI-WB resulted in a significant difference in ROTEM parameters between reconstituted PI-treated and -untreated WB (p ≥ .05). The effect of PI treatment waned when PI-WB was enriched with fibrinogen.
CONCLUSION
ROTEM investigations suggest that PI treatment has a negative impact on WB clot formation unless fibrinogen supplementation is used.
背景
全血（WB）在创伤患者中的应用越来越普遍。与处理单个成分类似，病原体灭活（PI）技术可用于处理 WB。PI 对 WB 功能的影响尚未得到充分理解。本研究通过模拟创伤患者的输血场景，使用旋转血栓弹性描记术（ROTEM）评估输血效果，研究了用核黄素/紫外线（UV）光对 WB 进行 PI 处理对其止血功能的影响。由于 PI 会影响 WB 中的纤维蛋白原，因此本模型还分析了在创伤患者中常用的纤维蛋白原补充的效果。
研究设计和方法
通过将未处理的 WB 或用 Mirasol PI 技术（核黄素/UV）处理的 WB 以不同比例与血液稀释液混合，模拟创伤输血场景，并通过 ROTEM 监测血栓弹性。在此模型中研究了纤维蛋白原浓缩物 RiaSTAP 的补充效果。
结果
与未处理的对照相比，病原体灭活的 WB（PI-WB）在止血谱中表现出活性降低。在血细胞比容（hct）为 20%的血液稀释液中，用 PI-WB 或未处理的 WB 重建后，alpha 值、最大凝块硬度和凝块形成时间增加。用 PI-WB 进行血液置换模拟输血场景，导致再处理的 PI 处理和未处理的 WB 之间 ROTEM 参数存在显著差异（p ≥.05）。当 PI-WB 富含纤维蛋白原时，PI 处理的效果减弱。
结论
ROTEM 研究表明，PI 处理对 WB 凝块形成有负面影响，除非使用纤维蛋白原补充。
Zotero 插件