Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta.
Division of Hematology/Oncology, Department of Pediatrics, Emory University School of Medicine.
Curr Opin Hematol. 2023 Nov 1;30(6):230-236. doi: 10.1097/MOH.0000000000000783. Epub 2023 Aug 18.
This review encompasses different considerations of transfusion effectiveness based upon clinical scenario and transfusion indication. Tissue oxygenation, cerebral metabolic oxygen use, and red blood cell (RBC) survival are important elements of transfusion effectiveness in individuals with acute and chronic transfusion requirements.
Noninvasive measures of tissue and cerebral oxygen extraction include near-infrared spectroscopy (NIRS) and specialized MRI sequences. RBC survival timepoints including 24 h posttransfusion recovery, 50% recovery timepoint, and mean potential lifespan may be accurately measured with biotin-labeling of RBC prior to transfusion. Labeling at different cell surface densities allows survival of multiple RBC populations to be determined.
Although past trials of optimal transfusion thresholds have focused on Hb as a singular marker for transfusion needs, measures of oxygenation (via NIRS or specialized MRI) and RBC survival (via biotin labeling) provide the opportunity to personalize transfusion decisions to individual patient's acute health needs or chronic transfusion goals.
本综述涵盖了基于临床情况和输血适应证的不同输血效果考虑因素。组织氧合、脑代谢氧利用和红细胞（RBC）存活是急性和慢性输血需求个体输血效果的重要因素。
组织和脑氧提取的非侵入性测量包括近红外光谱（NIRS）和特殊的 MRI 序列。RBC 存活时间点，包括输血后 24 小时恢复、50%恢复时间点和平均潜在寿命，可以通过输血前 RBC 的生物素标记来准确测量。在不同的细胞表面密度下进行标记，可以确定多个 RBC 群体的存活情况。
尽管过去关于最佳输血阈值的试验主要关注 Hb 作为输血需求的单一标志物，但氧合（通过 NIRS 或特殊的 MRI）和 RBC 存活（通过生物素标记）的测量为根据个体患者的急性健康需求或慢性输血目标来个性化输血决策提供了机会。
