Bull B S, Bull M H
Department of Pathology and Human Anatomy, Loma Linda University, School of Medicine, CA 92354.
Proc Natl Acad Sci U S A. 1994 Aug 16;91(17):8190-4. doi: 10.1073/pnas.91.17.8190.
We have identified a leukocyte activation syndrome that is occasionally associated with the transfusion of intraoperatively recovered erythrocytes. This syndrome appears to result from intravascular damage caused by leukocytes activated during the erythrocyte salvage process. We hypothesize that this syndrome is part of a larger disease grouping: disseminated intravascular inflammation (DII). DII is the analog of the coagulation disorder disseminated intravascular coagulation. In disseminated intravascular coagulation, the organ damage results from uncontrolled activation of the clotting pathway; in DII the damage is caused by leukocytes that have become activated by direct contact with bacteria or in rare instances--such as erythrocyte salvage--in the absence of bacteria and bacterial products. Recent studies of the hazards associated with intraoperative blood salvage indicate that activation of leukocytes can be achieved by exposure to activated platelets alone. If such activated leukocytes are reinfused along with the washed erythrocytes, widespread organ damage may result. The lung is the organ most severely affected by activated leukocytes. Adult respiratory distress syndrome is one outcome. It is likely that DII is a presently unrecognized pathophysiological process that complicates a variety of primary disease states and increases their lethality.
我们已经识别出一种白细胞活化综合征，它偶尔与术中回收红细胞的输血有关。这种综合征似乎是由红细胞回收过程中被激活的白细胞引起的血管内损伤所致。我们推测这种综合征是一种更大疾病分类的一部分：弥散性血管内炎症（DII）。DII是凝血障碍弥散性血管内凝血的类似物。在弥散性血管内凝血中，器官损伤是由凝血途径的失控激活导致的；在DII中，损伤是由直接接触细菌而被激活的白细胞引起的，或者在罕见情况下，如红细胞回收时，在没有细菌和细菌产物的情况下被激活。最近对术中血液回收相关危害的研究表明，仅通过接触活化血小板就能激活白细胞。如果这种活化的白细胞与洗涤后的红细胞一起回输，可能会导致广泛的器官损伤。肺是受活化白细胞影响最严重的器官。成人呼吸窘迫综合征就是一种后果。DII很可能是一种目前未被认识的病理生理过程，它使多种原发性疾病状态复杂化并增加其致死率。
