Transfusion of stored red blood cells adhere in the rat microvasculature
Transfusion of stored red blood cells adhere in the rat microvasculature
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DOI：
10.1111/j.1537-2995.2009.02315.x
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发表时间：
2009-11-01
期刊：
影响因子：
2.9
通讯作者：
Ellis, Christopher G.
中科院分区：
文献类型：
--
作者：
Chin-Yee, Ian H.;Gray-Statchuk, Leslie;Ellis, Christopher G.
背景：用于输血的红细胞(RBC)的体外储存与“储存损伤”有关，这种损伤降低了红细胞的变形性，增加了红细胞与血管内皮细胞的粘附性。这可能会损害微循环，对输血后的氧气输送产生有害影响。以往的研究表明，人红细胞在体外可长时间与内皮单分子层黏附，保存前降白细胞(LR)可使其减少。本研究的目的是确定RBC的保存时间和LR是否会影响RBC在体内的黏附。研究设计与方法：在标准血库条件下收集大鼠RBC并保存在CPDA-1中。比较了3种RBC产品：1)新鲜RBC，保存少于24小时(n=6)；2)非去白细胞(NLR)保存7天(n=6)；3)保存前LR RBC(n=6)。在输血前24小时用异硫氰酸荧光素(FITC)标记红细胞，然后等容回注给健康大鼠。在活体视频显微镜下(放大20倍)，FITC标记的红细胞在趾长伸肌内可见。在10个随机区域中，于输血后1h计数毛细血管内红细胞的黏附数量，并用单因素方差分析比较中位数。结果：储存的红细胞在毛细血管内的黏附水平高于新鲜红细胞(p<；0.05)。保存前LR可将RBC的粘附率降低到与新鲜RBC相当的水平(保存LR与保存NLR相比，P<；0.05)。结论：在模拟临床输血的条件下保存的大鼠RBC黏附在毛细血管中。RBC与LR的粘附性降低提示白细胞或其副产物对RBC的变形性和/或与微血管内皮细胞的粘附性有直接影响。进一步的研究将检查黏附的机制以及它对危重宿主的微循环流动和氧气输送的影响。
BACKGROUND:Ex vivo storage of red blood cells (RBCS) for transfusions is associated with a "storage lesion," which decreases RBC deformability and increases RBC adhesiveness to vascular endothelium. This may impair microcirculatory flow with deleterious effects on oxygen delivery after transfusion. Previous studies have shown that human RBCs adhere to endothelial monolayers in vitro with prolonged storage and is reduced by prestorage leukoreduction (LR). The objective of this study was to determine whether duration of RBC storage and LR influence RBC adhesion in vivo in capillaries.STUDY DESIGN AND METHODS:Rat RBCs were collected and stored in CPDA-1 under standard blood bank conditions. Three RBC products were compared: 1) fresh RBCs, less than 24 hours of storage (n = 6); 2) nonleukoreduced (NLR) RBCs stored for 7 days (n = 6); and 3) prestorage LR RBCs stored for 7 days (n = 6). RBCs were labeled with fluorescein isothiocyanate (FITC) 24 hours before transfusion and reinjected in an isovolemic manner into healthy rats. The FITC-labeled RBCs were visualized in the extensor digitorum longus muscle using intravital video microscopy (20x magnification). The number of RBCs adherent in capillaries was counted 1 hour after transfusion in 10 random fields and the median values were compared with one-way analysis of variance.RESULTS:Stored RBCs showed increased levels of adherence in capillaries compared to their fresh counterparts (p < 0.05). Prestorage LR decreased RBC adherence to levels equivalent to those of fresh RBCs (p < 0.05 for stored LR vs. stored NLR).CONCLUSION:Rat RBCs stored under conditions that closely mimicked clinical transfusion adhere in capillaries. The decreased RBC adherence with LR suggest a direct effect of white blood cells or their byproducts on RBC deformability and/or adhesiveness to microvascular endothelium. Further study will examine the mechanism of adherence and the impact it has on microcirculatory flow and oxygen delivery in the critically ill host.