Evolution of adverse changes in stored RBCs
Evolution of adverse changes in stored RBCs
复制标题
DOI：
10.1073/pnas.0708160104
复制
发表时间：
2007-10-23
影响因子：
11.1
通讯作者：
McMahon, Timothy J.
中科院分区：
文献类型：
--
作者：
Bennett-Guerrero, Elliott;Veldman, Tim H.;McMahon, Timothy J.
最近的研究强调了关于红细胞输注的风险和益处平衡的问题。更好地了解储存的红细胞中分子和功能变化的性质和时间，可以提供改善红细胞输注获益和风险平衡的策略。我们分析了红细胞储存过程中发生的变化，重点是红细胞的可清除性，红细胞依赖性血管调节功能，和S-亚硝基血红蛋白（SNO-Hb），通过血红蛋白（Hb）O-2去饱和耦合到局部增加体内血流量（缺氧血管舒张）。将来自15名健康志愿者中的每一个的500 ml血液处理成白细胞过滤的、添加剂溶液3暴露的RBC，并根据AABB标准储存在1-6 ℃下。在0、3、8、24和96 h以及1、2、3、4和6周时对血液进行26次测定。RBC SNO-Hb迅速下降（3 h时为1.2 x 10 - 4，而新鲜S-亚硝基硫醇（SNO）/mol Hb四聚体为6.5 x 10 - 4）（P = 0.032，汞置换光解-化学发光测定），并在42天内保持较低水平。通过使用一氧化碳饱和铜-半胱氨酸测定[3 h时3.0 x 10（-5）vs. 9.0 x 10（-5）（新鲜）mol SNO/mol Hb]证实了这种下降。与此同时，储存的红细胞的血管收缩作用也被显著抑制。在生理切应力下测定的红细胞变形能力在42天内逐渐下降（P < 0.001）。几种储存引起的缺陷的时间过程各不相同，这可能是最近观察到的输血与不良结局有关的原因。临床关注的是，SNO水平及其生理相关性，RBC依赖性血管舒张，在收集后不久变得沮丧，这表明即使是“新鲜”血液也可能具有不良的生物学特性。
Recent studies have underscored questions about the balance of risk and benefit of RBC transfusion. A better understanding of the nature and timing of molecular and functional changes in stored RBCs may provide strategies to improve the balance of benefit and risk of RBC transfusion. We analyzed changes occurring during RBC storage focusing on RBC cleformability, RBC-dependent vasoregulatory function, and S-nitrosohemoglobin (SNO-Hb), through which hemoglobin (Hb) O-2 desaturation is coupled to regional increases in blood flow in vivo (hypoxic vasodilation). Five hundred ml of blood from each of 15 healthy volunteers was processed into leukofiltered, additive solution 3-exposed RBCs and stored at 1-6 degrees C according to AABB standards. Blood was subjected to 26 assays at 0, 3, 8, 24 and 96 h, and at 1, 2, 3, 4, and 6 weeks. RBC SNO-Hb decreased rapidly (1.2 x 10(-4) at 3 h vs. 6.5 x 10(-4) (fresh) mol S-nitrosothiol (SNO)/mol Hb tetramer (P = 0.032, mercuric-displaced photolysis-chemiluminescence assay), and remained low over the 42-day period. The decline was corroborated by using the carbon monoxide-saturated copper-cysteine assay [3.0 x 10(-5) at 3 h vs. 9.0 x 10(-5) (fresh) mol SNO/mol Hb]. in parallel, vasoclilation by stored RBCs was significantly depressed. RBC deform-ability assayed at a physiological shear stress decreased gradually over the 42-day period (P < 0.001). Time courses vary for several storage-induced defects that might account for recent observations linking blood transfusion with adverse outcomes. Of clinical concern is that SNO levels, and their physiological correlate, RBC-dependent vasodilation, become depressed soon after collection, suggesting that even '' fresh '' blood may have developed adverse biological characteristics.