Red blood cells donated by smokers: A pilot investigation of recipient transfusion outcomes
Red blood cells donated by smokers: A pilot investigation of recipient transfusion outcomes
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DOI：
10.1111/trf.15339
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发表时间：
2019-08-01
期刊：
影响因子：
2.9
通讯作者：
Cushing, Melissa M.
中科院分区：
文献类型：
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作者：
DeSimone, Robert A.;Hayden, Joshua A.;Cushing, Melissa M.
背景目前的法规没有要求采血机构询问献血者吸烟的情况，而且血液产品中尼古丁及其代谢物的流行率也没有得到很好的证实。虽然吸烟者的血红蛋白(Hb)水平较高，但吸烟可能会通过较高的碳氧血红蛋白(COHb)含量和过早溶血而对捐献红细胞的质量产生不利影响。研究设计与方法用质谱仪和分光光度法检测100例不同献血者的红细胞单位片段中尼古丁及其代谢产物可替宁和COHb的含量。对接受单一红细胞单位治疗的成年无出血患者的结果进行了回顾性评估。结果100个RBC片段中13个(13%)可替宁阳性，与当前吸烟水平(>；10 ng/m L)一致。可替宁阳性红细胞的COHb含量显著高于可替宁阴性单位(中位数3.0%对0.8%，p=0.007)。对于输注可替宁阳性单位的患者，他们的生命体征在输血后没有明显变化，也没有观察到输血反应。然而，输注可替宁阳性单位的患者在输血后的红细胞压积和血红蛋白增量(中位数+1.2%和+0.4g/dL)显著低于接受可替宁阴性单位的患者(中位数+3.6%和+1.4g/dL)(p=0.014)。结论13%的红细胞单位可替宁检测阳性，符合主动吸烟的水平，与全国吸烟率15.5%的估计值一致。可替宁阳性的红细胞单位在输血后COHb含量更高，红细胞压积和血红蛋白增量降低。这些初步结果应该在更大的队列中得到验证。
BACKGROUND Current regulations do not require blood collection facilities to ask donors about cigarette smoking, and the prevalence of nicotine and its metabolites in blood products is not well established. Although smokers have higher hemoglobin (Hb) levels, smoking may adversely affect the quality of donated red blood cells through higher carboxyhemoglobin (COHb) content and premature hemolysis. STUDY DESIGN AND METHODS Red blood cell (RBC) unit segments from 100 unique donors were tested for nicotine and its metabolite cotinine by mass spectrometry and for COHb spectrophotometrically. Outcomes were evaluated retrospectively in adult non-bleeding patients receiving single RBC units. RESULTS Thirteen of 100 RBC segments (13%) were positive for cotinine at levels consistent with current smoking (> 10 ng/mL). The cotinine positive RBCs showed significantly greater COHb content compared to cotinine negative units (median 3.0% vs. 0.8%, p = 0.007). For patients transfused cotinine-positive units, there was no significant change in their vital signs following transfusion and no transfusion reactions were observed. However, patients transfused cotinine-positive units showed significantly reduced hematocrit and hemoglobin increments (median +1.2% and +0.4 g/dL) following transfusion compared to patients receiving cotinine negative units (median +3.6% and +1.4 g/dL) (p = 0.014). CONCLUSION Thirteen percent of RBC units tested positive for cotinine at levels consistent with active smoking, accordant with the estimated national smoking rate of 15.5%. Cotinine-positive RBC units had greater COHb content and showed reduced hematocrit and hemoglobin increments following transfusion. These preliminary results should be validated in a larger cohort.