EFFICACY OF RESUSCITATIVE TRANSFUSION WITH HEMOGLOBIN VESICLES IN THE TREATMENT OF MASSIVE HEMORRHAGE IN RABBITS WITH THROMBOCYTOPENIC COAGULOPATHY AND ITS EFFECT ON HEMOSTASIS BY PLATELET TRANSFUSION
EFFICACY OF RESUSCITATIVE TRANSFUSION WITH HEMOGLOBIN VESICLES IN THE TREATMENT OF MASSIVE HEMORRHAGE IN RABBITS WITH THROMBOCYTOPENIC COAGULOPATHY AND ITS EFFECT ON HEMOSTASIS BY PLATELET TRANSFUSION
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DOI：
10.1097/shk.0000000000001042
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发表时间：
2018-09-01
期刊：
影响因子：
3.1
通讯作者：
Sakai, Hiromi
中科院分区：
文献类型：
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作者：
Hagisawa, Kohsuke;Kinoshita, Manabu;Sakai, Hiromi
简介：我们已经开发了血红蛋白囊泡（HbVs）作为红细胞（RBC）的替代品。我们研究了HbV输注在治疗家兔血小板减少性凝血病大出血中的疗效，重点是随后输注血小板的止血疗效。研究方法：通过反复抽血和自体红细胞等容回输（血小板计数<45，000/mL）诱导家兔血小板减少性凝血病。然后造成穿透性肝损伤。在30分钟内，每10分钟测量一次出血量，之后向受试者输注等量储存的RBC、HbV或贫血小板血浆（PPP）以补偿失血，模拟最初的院前复苏。此后，我们输注富血小板血浆（PRP）止血，模拟院内复苏。结果如下：在初始复苏期间，HbV组在其血液动力学和组织循环/氧合方面与RBC组（但不是PPP组）相似，如通过血浆乳酸水平评估的。在此期间，所有家兔的出血量相似（20-30 mL）。与输注RBC的兔相比，输注HBV的兔维持血红蛋白水平，但表现出较低的红细胞压积水平。随后输注PRP可有效止血，所有输注RBC的家兔（6/6）和大多数输注HbV的家兔（7/8）均有效止血，但输注PPP的家兔（2/8）无效。此外，83%的RBC输注兔和75%的HbV输注兔存活24小时，但没有PPP输注兔存活。在家兔中，输注乙型肝炎病毒不增加一氧化氮。结论：HbV输注有效地挽救了家兔的严重出血与凝血功能障碍，而不会干扰血小板输注后的止血。HbV输注在院前复苏中可能是实用和有用的。
Introduction: We have developed hemoglobin vesicles (HbVs) as a substitute for red blood cells (RBCs). We investigated the efficacy of HbV transfusion in the treatment of massive hemorrhage in rabbits in the setting of thrombocytopenic coagulopathy, focusing on the efficacy of hemostasis by subsequent platelet transfusion. Methods: Thrombocytopenic coagulopathy was induced in rabbits by repeated blood withdrawal and isovolemic retransfusion of autologous RBC (platelet counts < 45,000/mL). A penetrating liver injury was then made. For 30 min, bleeding volume was measured every 10 min, after which subjectswere transfused with an equivalent volume of stored RBC, HbV, or platelet poor plasma (PPP) to compensate for blood loss, simulating initial prehospital resuscitation. Thereafter, we transfused platelet rich plasma (PRP) to stop bleeding, which simulated inhospital resuscitation. Results: During the initial resuscitation, the HbV group was similar to the RBC group (but not the PPP group) in their hemodynamics and tissue circulation/ oxygenation as assessed by plasma lactate levels. All rabbits showed similar bleeding volumes (20-30 mL) in this period. HbV-transfused rabbits sustained hemoglobin levels, but showed lower hematocrit levels compared with RBC-transfused rabbits. Subsequent PRP transfusion effectively stopped bleeding in all RBC-transfused rabbits (6/6) and most HbVtransfused rabbits (7/8) but not PPP-transfused rabbits (2/8). In addition, 83% of RBC-transfused rabbits and 75% of HbVtransfused rabbits survived for 24 h, although no PPP-transfused rabbits survived. HbV transfusion did not scavenge nitric oxide in rabbits. Conclusions: HbV transfusion effectively rescued rabbits from severe hemorrhage with coagulopathy, without disturbing hemostasis after the platelet transfusion. HbV transfusion may be practical and useful in prehospital resuscitation.