Rieger A, Saefkow M, Hass I, Spies C, Eyrich K
Klinik für Anaesthesiologie und operative Intensivmedizin, Universitätsklinikum Benjamin Franklin, Berlin, Germany.
Infusionsther Transfusionsmed. 1995 Dec;22(6):355-9. doi: 10.1159/000223160.
The study examines the feasibility and rate of leucocyte depletion with a single leucocyte depletion filter in combination with the Level 1 heat exchanging infusion/transfusion device H-500/H-25i during massive transfusions.
LeukoGuard-6 filters (LG-6) were manufactured to fit the infusion sets of the Level 1 H-500/H-25i. This modified device was used intraoperatively in six patients with severe haemorrhage. Following determination of the white cell counts (WCC) in each buffy coat poor red cell concentrate prior to administration, WCC were then obtained from blood sampled directly distal to the filter after the first and after the last red cell concentrate was given. Leucocytes were determined in the Nageotte chamber and then calculated to determine leucocytes/250 ml (therapeutic unit). Parameters of feasibility (time for preparation of the system, the amount of transfused red cell concentrates, time interval of transfusions) were recorded.
The mean volume of red cell concentrates which were transfused and filtered by a single filter was 2,708 ml (S.D. +/- 797 ml) within a mean time interval of 42.5 min (S.D. +/- 26 min). With a mean WCC of 1.17 +/- 0.68 x 10(9) leucocytes/250 ml in the red cell concentrate prior to filtration the LG-6 achieved a log-3 reduction of leucocyte counts. During the transfusion the WCC distal to the filter increased on average by a factor of 3 (from 0.9 x 10(6) leucocytes/250 ml following the first blood unit to 2.7 x 10(6) leucocytes/250 ml following the last), but remained below 5 x 10(6).
Modification of the Level 1 H-500/H-25i system by incorporating the LG-6 leucocyte depletion filter provides a significant reduction of the WCC in the transfused red cell concentrates during massive transfusion. The rate of leucocyte depletion by a single leucocyte depletion filter achieves low leucocyte counts which are documented to be of therapeutical value. As the significance of leucocyte-reduced blood products for patients with haemorrhagic shock following trauma or major surgery has still to be elucidated, the presented device may be useful in the performance of future studies related to this subject.
本研究探讨在大量输血期间，使用单个白细胞滤除器与一级热交换输液/输血装置H - 500/H - 25i联合进行白细胞滤除的可行性和效率。
制造了适配一级H - 500/H - 25i输液装置的LeukoGuard - 6滤器（LG - 6）。该改良装置在6例严重出血患者手术中使用。在输注前测定每份去白红细胞悬液中白细胞计数（WCC），然后在输注第一份和最后一份红细胞悬液后，从滤器远端直接采集的血液样本中获取WCC。在Nageotte计数室中测定白细胞，然后计算确定白细胞/250ml（治疗单位）。记录可行性参数（系统准备时间、输注的红细胞悬液量、输血时间间隔）。
单个滤器输注并滤过的红细胞悬液平均体积为2708ml（标准差±797ml），平均时间间隔为42.5分钟（标准差±26分钟）。滤过前红细胞悬液中白细胞平均计数为1.17±0.68×10⁹白细胞/250ml，LG - 6实现了白细胞计数对数降低3级。输血期间，滤器远端白细胞计数平均增加3倍（从第一单位血液后的0.9×10⁶白细胞/250ml增加到最后单位血液后的2.7×10⁶白细胞/250ml），但仍低于5×10⁶。
通过并入LG - 6白细胞滤除器对一级H - 500/H - 25i系统进行改良，可在大量输血期间显著降低输注的红细胞悬液中的白细胞计数。单个白细胞滤除器的白细胞滤除效率可实现低白细胞计数，已证明具有治疗价值。由于创伤或大手术后出血性休克患者使用白细胞减少血液制品的意义仍有待阐明，本装置可能有助于今后开展与此相关的研究。
