FILTERABILITY OF MIXTURES OF SICKLE AND NORMAL ERYTHROCYTES FOR TRANSFUSION

红细胞输注长期以来一直是，目前仍然是 镰状细胞病的治疗。明智地使用血液 在各种临床中既能救命又能延长生命 设置。SCD的输血有两个广泛的适应症， 维持血液的携氧能力和稀释 血液循环中含有HBs的细胞。后者是可以实现的 既有输血的直接稀释作用，也有 其次是骨髓抑制和生产减少 能够镰刀状生长的细胞。 与简单的红细胞交换相比，红细胞交换具有许多潜在的优势 输血治疗SCD的某些并发症， 特别是如果担心会导致循环超负荷或 导致高粘滞状态，这实际上可能会加剧 通过延缓毛细血管运输而产生镰刀倾向。指导方针： 交换输血疗法应源于对 镰状细胞的流变性。微血管闭塞 红细胞变形性差被认为是主要的病理生理机制。 SCD中的事件。因此，我们研究了材料的变形性 镰状(SS)细胞及其与正常(AA)细胞的混合物 可通过镍网过滤。我们还研究了Density的作用 SS细胞和致密的SS网织红细胞总体可变形。在这 研究发现，SS和AA混合红细胞的过滤 以近乎线性的方式受到%SS红细胞和 %的致密细胞，致密细胞损害了这些细胞的过滤 混合物大约是SS红细胞的25倍，没有稠密 细胞做到了。没有致密细胞的SS细胞混合物的过滤和 60%以上的AA细胞与正常细胞基本相同 红血球。这些结果表明，交换输血疗法 应以尽可能减少密集单元格为目标，以及 将SS细胞占细胞总数的比例控制在40%以下。我们的结果 也表明致密的SS网织红细胞可能参与了 可变形性降低。我们的数据，使用自动网织红细胞 分析仪显示，高荧光网织红细胞的比例 在SCD患者中升高，这表明 未成熟网织红细胞的再生。互换的好处 因此，输血不仅可以由于直接稀释效应， 但也与SS网织红细胞的抑制有关。这些研究可以 为临床实施换血方案提供实用指导 关于镰状细胞的流变性。

RBC transfusion has long been and currently remains an integral part of the management of sickle cell disease (SCD). The judicious use of blood can be both life-saving and life-prolonging in a variety of clinical settings. There are two broad indications for blood transfusion in SCD, maintenance of the oxygen-carrying capacity of the blood and dilution of the circulating, HbS containing cells. The latter may be accomplished both by the direct dilutional effect of transfused blood but also secondarily by suppression of the bone marrow and decreased production of cells capable of sickling. Erythrocyte exchange offers numerous potential advantages over simple transfusion for the management of certain complications of SCD, especially if there is concern of causing circulatory overload or inducing a hyperviscosity state, which may actually exacerbate the propensity to sickle by retarding capillary transit. Guidelines for exchange transfusion therapy should be derived from an understanding of the rheological behavior of sickle cells. Microvascular occlusion by poorly deformable erythrocytes is believed to be the key pathophysiologic event in SCD. We, therefore, investigated the deformability of sickle(SS) cells and their mixture with normal(AA) cells in terms of filterability through nickel mesh. We also examined the role of dense SS cells and dense SS reticulocytes in overall deformability. In this study, we found that the filtration of mixtures of SS and AA erythrocytes was affected in almost linear fashion by both the %SS erythrocytes and %dense cells, and that dense cells impaired the filtration of these mixtures about 25 times as much as that of SS erythrocytes with no dense cells did. Filtration of mixtures of SS cells with no dense cells and AA cells of more than 60% was almost the same as that of normal erythrocytes. These results suggest that exchange transfusion therapy should aim at decreasing dense cells as much as possible, as well as at keeping the level of SS cells to the total cells below 40%. Our results also indicate the possibility that dense SS reticulocytes involved in reduced deformability. Our data, using an automated reticulocyte analyzer, showed that the proportion of high fluorescence-reticulocytes was elevated in the patients with SCD, which indicated the increased regeneration of immature reticulocytes. The benefit of exchange transfusion, therefore, can be not only due to direct dilution effect, but also due to suppression of SS reticulocytes. These studies can provide the practical guideline for exchange transfusion program based on the rheological behavior of sickle cells.