Decreased erythrocyte deformability after transfusion and the effects of erythrocyte storage duration.
Decreased erythrocyte deformability after transfusion and the effects of erythrocyte storage duration.
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DOI：
10.1213/ane.0b013e31828843e6
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发表时间：
2013-05
影响因子：
5.7
通讯作者：
Barodka VM
中科院分区：
文献类型：
--
作者：
Frank SM;Abazyan B;Ono M;Hogue CW;Cohen DB;Berkowitz DE;Ness PM;Barodka VM
红细胞膜在储存过程中会发生形态变化，但目前尚不清楚这些变化是否可逆。我们评估了患者在输血前后红细胞膜的变形性，以确定储存时间的影响以及输血后红细胞膜变形性的变化是否可逆。对16例后路脊柱融合术患者进行了研究。比较中度输血组(≥5单位红细胞)和微量输血组(0-4单位红细胞)的红细胞变形性。在输血前直接从储血袋中抽取样本，以及从患者输血前和输血后(术后3天以上)抽取样本，测量其变形性。在从血液储存袋中取出的样本中，我们比较了长期储存的红细胞(≥21天)、短期储存的红细胞(21天)和回收红细胞的变形性。变形能力的定量评估使用伸长指数(EI)测量的EI，这是一种确定细胞在剪应力下伸长能力的方法。适量输血后红细胞变形性较术前显著降低(EI下降12±4~20±6%)(P=0.03)，微量输血后红细胞变形性无明显变化(EI下降3±1~4±1%)(P=0.68)。这些变化在术后3天内并未逆转。≥保存21天的红细胞变形性(EI=0.28±0.02)显著低于保存21天的红细胞(EI=0.33±0.02)(P=0.001)和术前采集的红细胞(EI=0.33±0.02)(P=0.001)。回收红细胞的中等变形性(EI=0.30±0.03)大于≥保存21天的红细胞(P=0.047)，但小于保存21天的红细胞(P=0.03)。结果表明，红细胞储存时间的延长与细胞膜变形性的降低有关，而且这些变化在输血后不易逆转。
Erythrocyte cell membranes undergo morphologic changes during storage, but it is unclear whether these changes are reversible. We assessed erythrocyte cell membrane deformability in patients before and after transfusion to determine the effects of storage duration and whether changes in deformability are reversible after transfusion. Sixteen patients undergoing posterior spinal fusion surgery were studied. Erythrocyte deformability was compared between those who required moderate transfusion (≥5 units erythrocytes) and those who received minimal transfusion (0–4 units erythrocytes). Deformability was measured in samples drawn directly from the blood storage bags before transfusion, and in samples drawn from patients before and after transfusion (over 3 postoperative days). In samples taken from the blood storage bags, we compared deformability of erythrocytes stored for a long duration (≥21 days), those stored for a shorter duration (<21 days), and cell-salvaged erythrocytes. Deformability was assessed quantitatively using the elongation index (EI) measured by ektacytometry, a method which determines the ability for the cell to elongate when exposed to shear stress. Erythrocyte deformability was significantly decreased from the preoperative baseline in patients after moderate transfusion (EI decreased by 12±4 to 20±6 %) (P = 0.03) but not after minimal transfusion (EI decreased by 3±1 to 4±1 %) (P = 0.68). These changes did not reverse over 3 postoperative days. Deformability was significantly less in erythrocytes stored for ≥21 days (EI = 0.28±0.02) than in those stored for <21 days (EI = 0.33±0.02) (P = 0.001) or those drawn from patients preoperatively (EI = 0.33±0.02) (P = 0.001). Cell-salvaged erythrocytes had intermediate deformability (EI = 0.30±0.03) that was greater than that of erythrocytes stored ≥21 days (P = 0.047), but less than that of erythrocytes stored <21 days (P = 0.03). The findings demonstrate that increased duration of erythrocyte storage is associated with decreased cell membrane deformability and that these changes are not readily reversible after transfusion.