Schenkman Kenneth A, Ciesielski Wayne A, Gernsheimer Terry B, Arakaki Lorilee S L
Departments of Pediatrics, Bioengineering, and Anesthesiology, University of Washington, Seattle, Washington, USA.
Department of Pediatrics, University of Washington, Seattle, Washington, USA.
Transfus Med. 2025 Feb;35(1):68-74. doi: 10.1111/tme.13090. Epub 2024 Aug 27.
This study aims to demonstrate the potential of myoglobin saturation as an indicator of oxygen delivery adequacy to help determine the need for red cell transfusion.
Modern blood management approaches have been established to optimise use of red blood cells for transfusions in patients with anaemia. However, most approaches make recommendations to transfuse based on haemoglobin or haematocrit levels and do not directly address adequacy of oxygen delivery. Intracellular oxygen determined by myoglobin saturation directly measures oxygen delivery at the tissue level.
METHODS/MATERIALS: A custom built spectrometer system with an optical fibre probe was used in this pilot study to measure muscle cell myoglobin saturation noninvasively from the first digital interosseous muscles in patients undergoing planned red blood cell transfusion. Patients were recruited from both the in-patient and out-patient oncology service at a major university medical centre. Measurements were made immediately before, immediately after, and 24 h following transfusion. Clinical data and tissue oxygen values from the Somanetics INVOS system were also collected.
Myoglobin saturation, and thus cellular oxygen increased in some, but not all patients receiving a transfusion, and was most pronounced in patients who initially had low myoglobin saturation compared with the group as a whole.
Clinical decisions to transfuse based on haemoglobin or haematocrit thresholds alone are likely insufficient to optimise use of red blood cell transfusions. The combination of haemoglobin or haematocrit with myoglobin saturation may optimally determine who will benefit physiologically from a transfusion.
本研究旨在证明肌红蛋白饱和度作为氧输送充足指标的潜力，以帮助确定红细胞输血的必要性。
现代血液管理方法已确立，以优化贫血患者输血时红细胞的使用。然而，大多数方法根据血红蛋白或血细胞比容水平建议输血，并未直接解决氧输送是否充足的问题。由肌红蛋白饱和度所决定的细胞内氧直接在组织水平上测量氧输送情况。
方法/材料：在这项初步研究中，使用了一个带有光纤探头的定制光谱仪系统，以无创方式测量计划接受红细胞输血患者第一骨间肌的肌肉细胞肌红蛋白饱和度。患者从一所大型大学医学中心的住院和门诊肿瘤服务部门招募。在输血前、输血后即刻以及输血后24小时进行测量。还收集了来自Somanetics INVOS系统的临床数据和组织氧值。
在一些但并非所有接受输血的患者中，肌红蛋白饱和度以及细胞内氧增加，与总体组相比，最初肌红蛋白饱和度较低的患者中这种情况最为明显。
仅基于血红蛋白或血细胞比容阈值做出输血的临床决策可能不足以优化红细胞输血的使用。血红蛋白或血细胞比容与肌红蛋白饱和度相结合可能最优化地确定谁将从输血中在生理上获益。
