Oxygen dissociation after transfusion of blood stored in ACD or CPD solution.

In 20 patients undergoing open-heart surgery, 2,3-diphosphoglycerate (2,3-DPG) concentrations, oxygen affinity of hemoglobin (Po2 at half saturation of hemoglobin with oxygen [P50]), hemoglobin concentration, and pH were measured repeatedly. Measurements were made before and at various times after open-heart surgery and replacement of blood loss with blood stored in acid-citrate-dextrose (ACD) or citrate-phosphate-dextrose (CPD) solutions for less than 72 hours (10 cases per group). Infusion of ACD blood caused P50 and 2,3-DPG concentration to decrease significantly after the operation. The infusion of blood stored in CPD did not significantly increase the oxygen affinity. No significant changes in hemoglobin concentration or pH were observed immediately after the operation in either group. To compensate for the increased oxygen affinity, there must be a rise in cardiac output or more likely a decrease in venous Po2. The transfusion of CPD blood, therefore, is more favorable in terms of oxygen supply, particularly in patients who have had cardiac surgery.     

输注自体血与库存血对患者术后炎症反应的影响

目的探讨输注自体回输血与保存时间短于2周的库存血对患者术后炎症反应的影响。方法选择择期行腰椎滑脱椎弓根内固定植骨融合术手术,估计出血量多于500ml的骨科患者40例。其中20例患者应用自体血回输装置即为回收血组(A组),20例患者单独输注短于2周的库存血即为库存血组(B组)。检测两组患者Hb、Hct、pH、K+、ATP含量和2,3-二磷酸甘油酸(2,3-DPG)及输血后患者的WBC、C-反应蛋白(CRP)、血沉(ESR)。结果 A组患者的pH值、K+、Hct、ATP、2,3-DPG均明显高于B组(P0.05);两组术后1、3dWBC,术后1、3、5dCRP、ESR均明显高于术前(P0.05);术后1、3、5dB组的CRP、ESR均明显高于A组(P0.05)。结论自体血的质量明显优于库存血,输注自体血的患者术后CRP、ESR明显低于输注库存血的患者,提示输注自体血的炎症反应发生率较库存血低。     

Fresh versus stored blood in donor specific transfusion

Haploidentical, MLC responsive recipients were randomized to receive either fresh (less than 48 hours old) or stored donor specific transfusions (DST). In the stored DST group, one donor unit obtained with CPD-Adenine anticoagulant was split into three aliquots and administered as packed cells after 1, 3, and 5 weeks of storage. While 3/6 fresh DST recipients became sensitized to their donors, 0/12 receiving stored DSTs developed positive donor crossmatches. Eleven patients (three fresh, eight stored) have been transplanted and have had similar posttransplant courses. None of the stored DST recipients has rejected his transplant. Four recipients of stored DSTs are awaiting transplantation. Leukocyte enumeration and FACS analysis of aliquots of stored blood shown that cells bearing HLA-ABC antigens disappear with time while B cells and monocytes persist. Taken in concert, the observations suggest that favorable recipient conditioning for transplantation can take place without sensitization to HLA antigens by simply storing the blood prior to transfusion.     

Gas exchange after pulmonary fat embolism in dogs.

Gas exchange following moderately severe experimental pulmonary fat embolism was studied in nine dogs. A new method designed to describe the distribution of ventilation-perfusion ratios in the lung was applied before and after intravenous injection of homologous neutral fat. The dose of fat (0.75 ml/kg) was low enough to produce a small but significant decrease in arterial PO2 (mean change of 10 mm Hg) in the first 15 minutes after the embolism but high enough to result in the death of two of the four dogs that were allowed to survive the initial postembolism period. Pulmonary artery pressure and pulmonary vascular resistance both rose significantly within 5 minutes of the fat injection and remained elevated for the 2 hour experimental period. Immediately after the embolism there was an increase in the percentage of the total ventilation going to areas of the lung with ventilation-perfusion ratios between 10 and 100, which usually appeared as a discrete mode in the ventilation distribution. This mismatching of ventilation and perfusion partially resolved within 2 hours after the embolism, as indicated by the gradual disappearance of this population of gas exchanging units with relatively decreased blood flow. At no time within 2 hours after the embolism was there a significant increase in shunt or in ventilation to totally unperfused lung. The gas exchange pattern in the two dogs that subsequently died was indistinguishable from that of the other seven in the immediate postembolism period.     

Systemic responses to hemodilution after transfusion with stored blood and with a hemoglobin-based oxygen carrier

We assessed the systemic effects of exchanges with blood or hemoglobin (Hb) raffimer under conditions of critical oxygen delivery (Do(2)crit). We compared Do(2)crit in animals receiving Hb-based oxygen carrier (HBOC; Hemolink), fresh blood (collected <24 h), or stored blood (10 days) before hemodilution. Rats were randomized to control, blood, or HBOC isovolemic exchange. Oxygen consumption was measured by using expired gas (o(2)a) and blood (o(2)b) samples, whereas whole-body oxygen delivery (Do(2)) was calculated from cardiac output and arterial oxygen content. After exchange, rats were subjected to stepwise isovolemic hemodilution. Blood pressure, gases, acid-base status, glucose, Hb oxygen saturation, heart rate, and total peripheral resistance were also measured. We found that 1) HBOC-treated rats showed an increased mean arterial blood pressure and total peripheral resistance throughout the hemodilution, 2) Do(2)crit calculated with o(2)a or o(2)b gave identical results, 3) Do(2)crit was not different between animals receiving blood and those receiving HBOC, 4) the terminal Hb concentration (1.8 +/- 0.1 g/dL) and Do(2) (5 +/- 1 mL . min(-1) . kg(-1)) were similar for all animals, and 5) most oxygen transport and biochemical variables changed similarly during hemodilution. The data suggest that tolerance to Do(2)crit is not altered by 50% replacement of native Hb by stored blood or Hb raffimer.     

Laryngospasm after autologous blood transfusion

Although perioperative autologous blood transfusions are associated with few side effects, transfusion reactions can occur and can be life-threatening. We report the occurrence of postoperative laryngospasm in a patient who underwent spinal anesthesia for hip surgery. The laryngospasm could not be attributed to any cause other than the autologous blood transfusion and recurred when the transfusion was restarted. Laryngospasm was successfully treated both times with positive pressure ventilation. Autologous transfusions can trigger febrile nonhemolytic transfusion reactions, which may result in airway compromise.