Department of Pathology.
UNC Blood Research Center.
Curr Opin Hematol. 2023 Nov 1;30(6):194-202. doi: 10.1097/MOH.0000000000000780. Epub 2023 Aug 2.
Packed red blood cells (PRBCs) are the most commonly transfused blood products. Preparation of PRBCs requires blood collection from donors, processing, and storage prior to transfusion to recipients. Stored red blood cells (RBCs) undergo structural and metabolic changes collectively known as the storage lesion. RBC extracellular vesicles (sREVs) are released in PRBC units during storage, and are transfused along with intact RBCs into recipients. For several decades, extracellular vesicles have been the focus of intense research, leading to the discovery of a wide variety of endogenous biological properties that may impact numerous physiologic and/or pathologic pathways.
This study reviews the characteristics of extracellular vesicles present in PRBC units and the impact of prestorage and pretransfusion processing, as well as storage conditions, on their generation. Importantly, we discuss recently described interactions of sREVs with coagulation pathways and related interplay with inflammatory pathways in vitro and in vivo using animal models.
Extracellular vesicles present in stored PRBC units are capable of activating coagulation pathways. However, it remains unclear whether this affects clinical outcomes in recipients of PRBC units. Further understanding of these pathways and their relationship to any adverse outcomes may yield novel strategies to mitigate complications of blood transfusion.
浓缩红细胞（PRBC）是最常输注的血液制品。PRBC 的制备需要从供体采集血液，进行处理，并在输注给受者之前储存。储存的红细胞（RBC）在储存过程中会发生结构和代谢变化，统称为储存损伤。RBC 细胞外囊泡（sREVs）在储存过程中从 PRBC 单位中释放出来，并与完整的 RBC 一起输注给受者。几十年来，细胞外囊泡一直是研究的焦点，发现了广泛的内源性生物学特性，可能影响许多生理和/或病理途径。
本研究综述了 PRBC 单位中存在的细胞外囊泡的特征，以及预储存和输血前处理以及储存条件对其生成的影响。重要的是，我们讨论了最近描述的 sREVs 与凝血途径的相互作用，以及使用动物模型在体外和体内与炎症途径的相互作用。
储存的 PRBC 单位中存在的细胞外囊泡能够激活凝血途径。然而，目前尚不清楚这是否会影响 PRBC 单位受者的临床结局。进一步了解这些途径及其与任何不良结局的关系，可能会产生减轻输血并发症的新策略。
