Low-shear red blood cell oxygen transport effectiveness is adversely affected by transfusion and further worsened by deoxygenation in sickle cell disease patients on chronic transfusion therapy.
Low-shear red blood cell oxygen transport effectiveness is adversely affected by transfusion and further worsened by deoxygenation in sickle cell disease patients on chronic transfusion therapy.
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DOI：
10.1111/j.1537-2995.2012.03822.x
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发表时间：
2013-02
期刊：
影响因子：
2.9
通讯作者：
Meiselman H
中科院分区：
文献类型：
--
作者：
Detterich J;Alexy T;Rabai M;Wenby R;Dongelyan A;Coates T;Wood J;Meiselman H
简单慢性输血疗法（CTT）是镰状细胞性贫血中风预防的主要手段，但其对血流动力学的影响尚不清楚。输血可提高携氧能力，减少对高心输出量的需求。虽然输血会减少与血管闭塞相关的因素，包括血红蛋白百分比、网织红细胞计数和循环无细胞血红蛋白，但它会增加血液粘度，从而减少微血管流量。血细胞比容与粘度之比 (HVR) 是红细胞氧运输有效性的指数，它随剪切应力而变化，并平衡改善氧容量与粘度介导的微血管血流损伤的益处。我们假设，尽管血液粘度增加，但输血会改善高剪切力下的 HVR，但会降低低剪切力下的 HVR。为了检验这一假设，我们在输血前立即进行 CTT 检查，并在输血后 12-120 小时再次检查了 15 名镰状细胞病患者的含氧和脱氧血液样本。所有受试者的血红蛋白、血细胞比容、网织红细胞计数和血红蛋白 S 随输血发生的变化均相似。粘度、血细胞比容和高剪切 HVR 随着输血而增加，而低剪切 HVR 显着降低。低剪切 HVR 降低表明向低流量区域的氧气输送受损，并且可以解释为什么镰状细胞性贫血的一些并发症可以通过长期输血治疗得到改善，而其他并发症可能会变得更糟。
Simple chronic transfusion therapy (CTT) is a mainstay for stroke prophylaxis in sickle cell anemia, but its effects on hemodynamics are poorly characterized. Transfusion improves oxygen carrying capacity, reducing demands for high cardiac output. While transfusion decreases factors associated with vaso-occlusion, including percent HbS, reticulocyte count and circulating cell-free hemoglobin, it increases blood viscosity, which reduces microvascular flow. The hematocrit to viscosity ratio (HVR) is an index of red cell oxygen transport effectiveness that varies with shear stress and balances the benefits of improved oxygen capacity to viscosity-mediated impairment of microvascular flow. We hypothesized that transfusion would improve HVR at high shear despite increased blood viscosity, but would decrease HVR at low shear. To test this hypothesis, we examined oxygenated and deoxygenated blood samples from 15 sickle cell patients on CTT immediately pre-transfusion and again 12–120 hours post-transfusion. Comparable changes in hemoglobin, hematocrit, reticulocyte count and hemoglobin S with transfusion were observed in all subjects. Viscosity, hematocrit and high-shear HVR increased with transfusion while low shear HVR decreased significantly. Decreased low-shear HVR suggests impaired oxygen transport to low-flow regions and may explain why some complications of sickle cell anemia are ameliorated by chronic transfusion therapy and others may be made worse.
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影响因子：
2.1
作者：
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影响因子：
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DOI：
10.1111/j.1365-2362.2005.01562.x
发表时间：
2005-11-01
影响因子：
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作者：
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影响因子：
2.9
作者：
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