From the Section of General Surgery, Department of Surgery, University of Cincinnati, OH.
From the Section of General Surgery, Department of Surgery, University of Cincinnati, OH.
Surgery. 2022 Mar;171(3):833-842. doi: 10.1016/j.surg.2021.11.020. Epub 2021 Dec 30.
BACKGROUND: Massive transfusion with older packed red blood cells is associated with increased morbidity and mortality. As packed red blood cells age, they undergo biochemical and structural changes known as the storage lesion. We developed a novel solution to increase viscosity in stored packed red blood cells. We hypothesized that packed red blood cell storage in this solution would blunt storage lesion formation and mitigate the inflammatory response after resuscitation. METHODS: Blood was obtained from 8- to 10-week-old C57BL/6 male donor mice or human volunteers and stored as packed red blood cell units for 14 days for mice or 42 days for humans in either standard AS-3 storage solution or EAS-1587, the novel packed red blood cell storage solution. Packed red blood cells were analyzed for microvesicles, cell-free hemoglobin, phosphatidylserine, band-3 protein, glucose utilization, and osmotic fragility. Additional mice underwent hemorrhage and resuscitation with packed red blood cells stored in either AS-3 or EAS-1587. Serum was analyzed for inflammatory markers. RESULTS: Murine packed red blood cells stored in EAS-1587 demonstrated reductions in microvesicle and cell-free hemoglobin accumulation as well as preserved band-3 expression, increase glucose utilization, reductions in phosphatidylserine expression, and susceptibility to osmotic stress. Serum from mice resuscitated with packed red blood cells stored in EAS-1587 demonstrated reduced proinflammatory cytokines. Human packed red blood cells demonstrated a reduction in microvesicle and cell-free hemoglobin as well as an increase in glucose utilization. CONCLUSION: Storage of packed red blood cells in a novel storage solution mitigated many aspects of the red blood cell storage lesion as well as the inflammatory response to resuscitation after hemorrhage. This modified storage solution may lead to improvement of packed red blood cell storage and reduce harm after massive transfusion.
背景:大量输注陈旧的浓缩红细胞会增加发病率和死亡率。随着浓缩红细胞的老化,它们会发生生化和结构变化,称为储存损伤。我们开发了一种新的解决方案来增加储存浓缩红细胞的粘度。我们假设在这种溶液中储存浓缩红细胞会阻止储存损伤的形成,并减轻复苏后炎症反应。
方法:从 8-10 周龄的 C57BL/6 雄性供体小鼠或人类志愿者中采集血液,并将其储存为浓缩红细胞单位,在标准 AS-3 储存液或新型浓缩红细胞储存液 EAS-1587 中储存 14 天用于小鼠或 42 天用于人类。分析浓缩红细胞的微泡、游离血红蛋白、磷脂酰丝氨酸、带 3 蛋白、葡萄糖利用和渗透脆性。另外,一些小鼠接受了用 AS-3 或 EAS-1587 储存的浓缩红细胞进行的出血和复苏。分析血清中的炎症标志物。
结果:在 EAS-1587 中储存的小鼠浓缩红细胞显示微泡和游离血红蛋白积累减少,带 3 蛋白表达保存,葡萄糖利用增加,磷脂酰丝氨酸表达减少,对渗透应激的敏感性增加。从用 EAS-1587 储存的浓缩红细胞复苏的小鼠血清中显示促炎细胞因子减少。人类浓缩红细胞显示微泡和游离血红蛋白减少,葡萄糖利用增加。
结论:在新型储存液中储存浓缩红细胞减轻了红细胞储存损伤的许多方面以及出血后复苏的炎症反应。这种改良的储存液可能会改善浓缩红细胞的储存并减少大量输血后的危害。
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