Pittman Roland N, Yoshida Tatsuro, Omert Laurel A
Department of Physiology and Biophysics, Virginia Commonwealth University, Richmond, VA, United States.
Research and Development, Hemanext Inc., Lexington, MA, United States.
Front Physiol. 2022 Mar 4;13:842510. doi: 10.3389/fphys.2022.842510. eCollection 2022.
The ability to store red blood cells (RBCs) and other components for extended periods of time has expanded the availability and use of transfusion as a life-saving therapy. However, conventional RBC storage has a limited window of effective preservation and is accompanied by the progressive accumulation of a series of biochemical and morphological modifications, collectively referred to as "storage lesions." These lesions have been associated with negative clinical outcomes (i.e., postoperative complications as well as reduced short-term and long-term survival) in patients transfused with conventionally stored blood with older and deteriorated transfused red cells. Hence, there is an increased unmet need for improved RBC storage. Hypoxic storage of blood entails the removal of large amounts of oxygen to low levels prior to refrigeration and maintenance of hypoxic levels through the entirety of storage. As opposed to conventionally stored blood, hypoxic storage can lead to a reduction of oxidative damage to slow storage lesion development and create a storage condition expected to result in enhanced efficacy of stored RBCs without an effect on oxygen exchange in the lung. Hypoxic blood transfusions appear to offer minimal safety concerns, even in patients with hypoxemia. This review describes the physiology of hypoxically stored blood, how it differs from conventionally stored blood, and its use in potential clinical application, such as massively transfused and critically ill patients with oxygenation/ventilation impairments.
长时间储存红细胞（RBC）和其他成分的能力扩大了输血作为一种挽救生命疗法的可用性和应用范围。然而，传统的红细胞储存有效保存期有限，且伴随着一系列生化和形态学改变的逐步积累，这些改变统称为“储存损伤”。在输注传统储存的、老化且质量下降的红细胞的患者中，这些损伤与不良临床结局（即术后并发症以及短期和长期生存率降低）相关。因此，对改进红细胞储存的需求日益增加且未得到满足。血液的低氧储存需要在冷藏前将大量氧气去除至低水平，并在整个储存过程中维持低氧水平。与传统储存的血液不同，低氧储存可减少氧化损伤，减缓储存损伤的发展，并创造一种预期能提高储存红细胞效力且不影响肺部氧气交换的储存条件。即使在低氧血症患者中，低氧血液输血似乎也几乎没有安全问题。本综述描述了低氧储存血液的生理学、它与传统储存血液的不同之处，以及其在潜在临床应用中的使用情况，如大量输血的患者和有氧合/通气障碍的危重症患者。
