Transfusion-related leukocytosis in critically ill patients
Transfusion-related leukocytosis in critically ill patients
复制标题
DOI：
10.1097/01.ccm.0000104951.94820.a9
复制
发表时间：
2004-02-01
影响因子：
8.8
通讯作者：
Hersch, M
中科院分区：
文献类型：
--
作者：
Izbicki, G;Rudensky, B;Hersch, M
目的：我们观察到许多危重患者在输血后出现白细胞增多。为了验证这一观察结果并探索可能的机制，设计了一项前瞻性研究。设计：前瞻性、非干预性研究。设置：大学附属社区医院的外科/医疗重症监护病房。患者：需要输注浓缩红细胞的连续患者。干预措施：白细胞计数（平均值+/-SD）x10(9)/L之前和之后2、4、6、12和24小时 对 96 名患者输注未经过滤的浓缩红细胞进行了测量。测量和主要结果：20 名患者在输血时出现败血症，而 76 名患者则没有。脓毒症患者和非脓毒症患者的输血后白细胞增多的发生率分别为 15% 和 76% (p < .001)。非脓毒症患者的白细胞计数从输血前的 14.3 +/- 4.8 增加到输血后 2 小时的 19.5 +/- 7.0 (p < .001)，并在 24 小时内恢复到基线。在脓毒症组中，没有发生明显的输血后白细胞增多。在 11 名需要超过 1 个单位的浓缩红细胞的非脓毒症患者中，输注未过滤的浓缩红细胞后 2 小时，平均白细胞计数显着增加，而输注预储存过滤的浓缩红细胞则不会导致这种增加。储存 4 周后，储存的未过滤浓缩红细胞中的白细胞介素 8 浓度 (pg/mL) (745.5 +/- 710，p = 0.02) 显着高于第 1 周 (61.2 +/- 21.6) 和第 2 周 (59.3 +/- 29)。在最后 16 名非脓毒症患者中，在输血前立即对未过滤的浓缩红细胞单位进行了白细胞介素 8 检测。与未导致受者白细胞增多的单位相比，导致受者白细胞增多的单位中白细胞介素 8 的浓度较高（408.4 +/- 202 与 65.1 +/- 49，p = .02）。结论：输注未过滤的浓缩红细胞（而非预储存过滤的浓缩红细胞）可能经常导致危重非脓毒症患者出现急性和短暂的白细胞增多。 患者。 Interleukin-8 在储存的未经过滤的浓缩红细胞中积聚可能在这一现象中发挥了作用。识别红细胞输注后白细胞增多可以避免误诊败血症而进行不必要的检查和治疗。
Objective: We observed that many critically ill patients developed leukocytosis following blood transfusions. To validate this observation and to explore a possible mechanism, a prospective study was designed.Design: Prospective, noninterventional study.Setting: Surgical/medical intensive care unit in a university-affiliated community hospital.Patients: Consecutive patients who required packed red blood cells transfusion.Interventions: White blood cell count (mean +/- SD) x10(9)/L before and 2, 4, 6, 12, and 24 hrs following transfusion of nonfiltered packed red cells was measured in 96 patients.Measurements and Main Results: Twenty patients were septic at the time of transfusion, whereas 76 were not. The incidence of post-transfusion leukocytosis in septic vs. nonseptic patients was 15% vs. 76%, respectively (p < .001). The white blood cell count in nonseptic patients increased from 14.3 +/- 4.8 before transfusion to 19.5 +/- 7.0 2 hrs following transfusion (p < .001) and returned to baseline in 24 hrs. In the septic group, no significant post-transfusion leukocytosis occurred. In 11 nonseptic patients requiring more than one unit of packed red cells, a significant increase in mean white blood cell count occurred 2 hrs after transfusion with nonfiltered packed red cells, whereas transfusion with prestorage-filtered packed red cells did not result in such an increase. Interleukin-8 concentrations (pg/mL) in stored nonfiltered packed red cells were significantly higher after 4 wks of storage (745.5 +/- 710, p = .02) than at weeks 1 (61.2 +/- 21.6) and 2 (59.3 +/- 29). in the last 16 nonseptic patients, the units of nonfiltered packed red cells were assayed for interleukin-8 immediately before transfusion. Interleukin-8 concentrations were higher in units that caused leukocytosis in the recipients compared with those that did not (408.4 +/- 202 vs. 65.1 +/- 49, p = .02).Conclusions: Transfusion of nonfiltered packed red cells, but not of prestorage-filtered packed red cells, may frequently cause an acute and transient leukocytosis in critically ill nonseptic patients. Interleukin-8 accumulating in stored nonfiltered packed red cells may play a role in this phenomenon. Recognition of post packed red cell transfusion leukocytosis may avoid unnecessary investigations and therapies in false suspicion of sepsis.