Stationary versus agitated storage of whole blood during acute normovolemic hemodilution.
Stationary versus agitated storage of whole blood during acute normovolemic hemodilution.
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DOI：
10.1213/ane.0000000000000046
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发表时间：
2014-02
影响因子：
5.7
通讯作者：
Waters JH
中科院分区：
文献类型：
--
作者：
Lu SY;Konig G;Yazer MH;Brooks JP;Chen YF;Jeong JH;Waters JH
急性等容血液稀释是一种术中技术，用于减少手术期间流出血液中丢失的红细胞数量。储存血小板的标准指南建议持续温和搅拌以维持代谢活性血小板的气体交换。采集的用于急性等容血液稀释的全血（WB）在回输前保持静止长达8小时。我们假设，在整个储存过程中轻轻搅拌WB将改善WB在再输注时的凝血性能。从10名志愿者供体中采集WB，并采集对照样品。将装置分为两个储存组：搅拌（摇动）和静止（未摇动）。在室温下摇动或不摇动储存8小时后，对对照样品和供试样品进行细胞计数和纤维蛋白原水平以及血栓弹力图（TEG®）测量，包括TEG® PlateletMapping®测定。测试了来自9名不同健康志愿者的9个WB单位。对照样本与摇动和未摇动WB样本之间的红细胞压积、血红蛋白、红细胞计数、血小板计数或纤维蛋白原水平无显著差异。如通过TEG®测量的WB凝固在摇动和未摇动的样品两者中在8小时储存期期间得以保存。对照、摇动和未摇动样本之间在开始凝血的时间、凝块形成时间、凝块形成速率或凝块最大强度值方面无显著差异。对照组、摇动组和未摇动组之间的纤维蛋白对凝块强度的贡献也无显著差异，三组中任何一组的二磷酸腺苷或花生四烯酸的血小板活化之间也无显著差异。鉴于样本量较小，没有统计学证据可拒绝零假设，即搅拌或静止8小时的WB之间通过TEG®测量的凝血功能相对于基线的变化无差异。这些发现需要在更大规模的研究中得到证实。
Acute normovolemic hemodilution is an intraoperative technique to reduce the number of red blood cells lost in shed blood during surgery. Standard guidelines for storage of platelets recommend constant gentle agitation to maintain gas exchange for the metabolically active platelets. The collected whole blood (WB) for acute normovolemic hemodilution remains stationary for as long as 8 hours before reinfusion. We hypothesized that gentle agitation of WB throughout storage would improve the coagulation properties of the WB at the time of reinfusion. WB was collected from 10 volunteer donors and control samples taken. The units were split into two storage groups: agitated (rocked), and stationary (unrocked). Cell counts and fibrinogen levels, as well as thromboelastography (TEG®) measurements, including TEG® PlateletMapping® assays, were performed on the control sample and the test samples after 8 hours of rocked or unrocked storage at room temperature. Nine units of WB from 9 different healthy volunteers were tested. There were no significant differences in hematocrit, hemoglobin, red blood cells counts, platelet counts, or fibrinogen levels between the control samples and the rocked and unrocked WB samples. WB coagulation as measured by TEG® was preserved during the 8-hour storage period in both the rocked and unrocked samples. There were no significant differences between the control, rocked, and unrocked samples in time to initiate clotting, time of clot formation, rate of clot formation, or maximum strength of clot values. There were also no significant differences in the fibrin contribution to clot strength between the control, rocked, and unrocked samples, and no significant difference between the platelet activation from adenosine diphosphate or arachidonic acid among any of the three groups. Given the small sample size, there is no statistical evidence on which to reject the null hypothesis of there being no difference in the changes from the baseline between coagulation function as measured by TEG® between WB that is either agitated or kept stationary for 8 hours. These findings need to be confirmed in a larger study.