Insufficient nitric oxide bioavailability: a hypothesis to explain adverse effects of red blood cell transfusion.
Insufficient nitric oxide bioavailability: a hypothesis to explain adverse effects of red blood cell transfusion.
复制标题
DOI：
10.1111/j.1537-2995.2011.03094.x
复制
发表时间：
2011-04
期刊：
影响因子：
2.9
通讯作者：
Sutliff R
中科院分区：
文献类型：
--
作者：
Roback JD;Neuman RB;Quyyumi A;Sutliff R
While transfusion of red blood cells (RBCs) is effective at preventing morbidity and mortality in anemic patients, studies have indicated that some RBC components have functional defects (“RBC storage lesions”) that may actually cause adverse events when transfused. For example, in some studies patients transfused with RBCs stored >14 days have had statistically worse outcomes than those receiving “fresher” RBC units. Recipient-specific factors may also contribute to the occurrence of these adverse events. Unfortunately, these events have been difficult to investigate because up to now they have existed primarily as “statistical occurrences” of increased morbidity and mortality in large data sets. There are currently no clinical or laboratory methods to detect or study them in individual transfusion recipients. Herein, we propose a unifying hypothesis, centered on Insufficient NO Bio-Availability (INOBA), to explain the increased morbidity and mortality observed in some patients following RBC transfusion. In this model, variables associated with RBC units (storage time; 2,3-DPG concentration) and transfusion recipients (endothelial dysfunction) collectively lead to changes in NO levels in vascular beds. Under certain circumstances, these variables are “aligned” such that NO concentrations are markedly reduced, leading to vasoconstriction, decreased local blood flow and insufficient O2 delivery to end organs. Under these circumstances, the likelihood of morbidity and mortality escalates. If the key tenets of the INOBA hypothesis are confirmed, it may lead to improved transfusion methodologies including altered RBC storage/processing conditions, novel transfusion recipient screening methods, and improved RBC/recipient matching.
