紫外线照射对储存血液红细胞的影响

紫外线照射血液在灭活血液病毒和减少细菌污染,降低免疫细胞抗原呈递作用,预防同种免疫,增加受血者免疫耐受性,减少移植物抗宿主病方面有重要意义[1～4];紫外线照射加充氧自血疗法在提高机体红细胞携氧功能,治疗多种疾病方面也得到公认[5、6].但也有材料报道,其对细胞造成一定损害,溶血率达2%.为此,笔者观察了库血经紫外线照射并保存不同时间后血浆游离血红蛋白和红细胞渗透脆性的变化,报道如下.     

Red Blood Cell Transfusion

A method used to increase the utilization of packed red blood cells and components is described. This required the staff of the blood center to visit hospital staff meetings and explain the use of platelet concentrates, cryoprecipitates, fresh frozen plasma, leukocyte‐poor blood, and packed red blood cells.     

保存前去除白细胞对浓缩红细胞保存质量影响研究

为了研究保存前去除白细胞对不同方法制备的浓缩红细胞 (RCC)保存质量的可能影响 ,分别取分离血浆后所得浓缩红细胞 (RCC1)和分离富含血小板血浆后所得含少量血浆的浓缩红细胞 (RCC2 )各 8袋 ,每袋等量分为两份 :过滤组和对照组。过滤组在保存当天用去白细胞滤器过滤 ,然后按常规方法 4℃保存 35天 ;对照组直接 4℃常规保存 5周。每周取样本测定平均红细胞体积 (MCV)、平均红细胞血红蛋白含量 (MCH)和平均红细胞血红蛋白浓度 (MCHC) ,血浆K+浓度和乳酸脱氢酶 (LDH) ,游离血红蛋白 (FHb)和红细胞ATP水平 ,同时做细菌培养污染监测。结果表明 :两种方法制备的RCC在过滤组与对照组中MCV ,MCH和MCHC无显著差别 ;红细胞ATP水平在保存第 0 ,1,2和 3周过滤组与对照组无显著差异 ,第 4和 5周过滤组红细胞ATP水平低于对照组 (P <0 .0 5 ) ;在保存过程中过滤组K+水平低于对照组 ,除了RCC1在保存第 0 ,1,2和 3周与对照组无显著差别外 ,均有显著差异 (P <0 .0 5 )。过滤组血浆LDH释放量显著低于对照组 (P <0 .0 1) ,在分离血小板后制备的RCC2这种差别更为明显。在保存期间RCC2组血浆的FHb水平过滤组显著低于对照组 (P <0 .0 5 ) ,而RCC1两组间FHb水平无显著差异。各组细菌培养均为无细菌生长。结论 :保存前去白细胞过     

The 24-hour posttransfusion survival of baboon red blood cells preserved in citrate phosphate dextrose/ ADSOL (CPD/AS-1) for 49 days.

The purpose of this study was to evaluate the baboon as an animal model for evaluating red blood cell (RBC) preservation by comparing the 24-h posttransfusion survival of baboon RBCs preserved in citrate phosphate dextrose/ADSOL (CPD/AS-1) solution at 4 degrees C for 49 days to that of human RBCs preserved under similar conditions. CPD/AS-1 originally was approved by the Food and Drug Administration for 49-day storage of RBCs, but this period subsequently was reduced to 42 days. Adult male baboons (Papio anubis and P. cynocephalus) were autotransfused with RBCs that had been harvested using CPD and that had been resuspended and stored in AS-1 solution at 4 degrees C for as long as 49 days. The 24-h posttransfusion survival was measured using the 51Cr/125I-albumin method. The 24-h posttransfusion survival (mean +/- standard deviation) was 74% +/- 7% for seven units of CPD/AS-1-treated RBCs stored for 35 days, 65% +/- 15% for 12 units stored for 42 days, and 43% +/- 16% for seven units stored for 49 days. The mean 24-h posttransfusion survival rate for autologous baboon RBCs stored in CPD/AS-1 at 4 degrees C for 35 days (74%) was similar to that for autologous human RBCs stored in a similar manner. Further storage for 42 and 49 days resulted in lower values for baboon RBCs compared with human RBCs.     

Electrophoretic Analyses of Red Cell Hemolysates Before and During Storage of Blood from Diseased Individuals

The bloods of six healthy young male students were stored anaerobically in the cold and at intervals the stroma-free red cell hemolysates were analyzed in a cacodylate buffer at p H 6.5 and .05M concentration. From these data, a control range was established.
Results are presented which show the effect of anaerobic storage on the B/2 values of red cell hemolysates of the bloods of 23 patients with a variety of diseases. In 21 cases, the B/2 values decreased rapidly or showed an initial increase followed by a decrease. Attempts to relate the type of storage curve to specific diseases were unsuccessful. It is concluded that water-soluble protein components of the red cells may be altered by disease.     

Red Blood Cell Clearance in Inflammation

Summary

Anemia is a frequently encountered problem in the critically ill patient. The inability to compensate for anemia includes several mechanisms, collectively referred to as anemia of inflammation: reduced production of erythropoietin, impaired bone marrow response to erythropoietin, reduced iron availability, and increased red blood cell (RBC) clearance. This review focuses on mechanisms of RBC clearance during inflammation. We state that phosphatidylserine (PS) expression in inflammation is mainly enhanced due to an increase in ceramide, caused by an increase in sphingomyelinase activity due to either platelet activating factor, tumor necrosis factor-α, or direct production by bacteria. Phagocytosis of RBCs during inflammation is mediated via RBC membrane protein band 3. Reduced deformability of RBCs seems an important feature in inflammation, also mediated by band 3 as well as by nitric oxide, reactive oxygen species, and sialic acid residues. Also, adherence of RBCs to the endothelium is increased during inflammation, most likely due to increased expression of endothelial adhesion molecules as well as PS on the RBC membrane, in combination with decreased capillary blood flow. Thereby, clearance of RBCs during inflammation shows similarities to clearance of senescent RBCs, but also has distinct entities, including increased adhesion to the endothelium.KeyWords: Erythrocyte clearance, Senescence, Inflammation     

Red Blood Cell Alloimmunization Mitigation Strategies

Hemolytic transfusion reactions due to red blood cell (RBC) alloantibodies are a leading cause of transfusion-associated death. In addition to reported deaths, RBC alloantibodies also cause significant morbidity in the form of delayed hemolytic transfusion reactions. These alloantibodies may also cause morbidity in the form of anemia, with compatible RBC units at times being unable to be located for highly alloimmunized patients, or in the form of hemolytic disease of the newborn. Thus, preventing RBC alloantibodies from developing in the first place, or mitigating the dangers of existing RBC alloantibodies, would decrease transfusion-associated morbidity and mortality. A number of human studies have evaluated the impact on RBC alloimmunization rates of providing partially phenotypically or genotypically matched RBCs for transfusion, and a number of animal studies have evaluated the impact of single variables on RBC alloimmunization. The goal of this review is to take a comprehensive look at existing human and animal data on RBC alloimmunization, focusing on strategies that may mitigate this serious hazard of transfusion. Potential factors that impact initial RBC alloimmunization, on both the donor and recipient sides, will be discussed. These factors include, but are not limited to, exposure to the antigen and an ability of the recipient's immune system to present that antigen. Beyond these basic factors, coexisting “danger signals,” which may come from the donor unit itself or which may be present in the recipient, also likely play a role in determining which transfusion recipients may become alloimmunized after RBC antigen exposure. In addition, to better understanding factors that influence the development of RBC alloantibodies, this review will also briefly discuss strategies to decrease the dangers of existing RBC alloantibodies.     

Polybrene-induced Red Blood Cell Aggregation In Vitro

Human erythrocytes, aggregated by non-immunological means, were studied by both scanning and transmission electron microscopy. Cells within the Polybrene®-induced aggregates appeared spheroidal at their free surfaces and flattened at their interfaces. The outer leaflets of apposing plasma membranes were found to approach each other very closely at several points so that no measurable intervening extracellular space was discernible. This finding is consistent with the concept that Polybrene acts by diminishing intercellular distances.     

Red Blood Cell Microparticles: Clinical Relevance

Summary

Microparticles are small phospholipid vesicles of less than 1 µm released into the blood flow by various types of cells such as endothelial, platelet, white or red blood cells. They are involved in many biological and physiological processes including hemostasis. In addition, an elevated number of microparticles in the blood is observed in various pathological situations. In the context of transfusion, erythrocyte-derived microparticles are found in red blood cell concentrates. Their role is not elucidated, and they are considered as a type of storage lesion. The purpose of this review is to present recent data showing that erythrocyte-derived microparticles most likely play a role in transfusion medicine and could cause transfusion complications.KeyWords: Ageing, Microparticles, Red blood cells, Red blood cell concentrates, Transfusion     

Rejuvenation of Human Red Blood Cells During Liquid Storage

Blood in ACD was stored under blood banking conditions. At 21 days of storage, aliquots of blood were rejuvenated by incubation at 37 C for one hour, with a solution containing pyruvate, inosine, phosphate, glucose, and adenine, at pH 7.2. The rejuvenated erythrocytes were washed with a solution of NaCl-Na phosphate and resuspended in an artificial medium or in the freshly drawn plasma from the same donor. These suspensions were stored in liquid form and analyzed at predetermined intervals. The cellular ATP and 2,3-DPG levels of rejuvenated cells were higher than those in the control cells and were maintained higher throughout the storage intervals investigated. The metabolic integrity of the rejuvenated cells was also improved, as evidenced by greater osmotic resistance, decreased spontaneous lysis, and greater uptake of methylene blue when compared to control cells.     

Influence of Red Blood Cell Storage Time on Clinical Course and Cytokine Profile in Septic Shock Patients

Background

Previous investigations have suggested beneficial effects of fresh versus stored red blood cell transfusion in critically ill patients. The present study investigates the effects of red blood cell storage time on the clinical course and hemodynamic and laboratory parameters in patients with septic shock.

Patients and Methods

18 patients with septic shock received 2 erythrocyte units stored for ? 7 days (n = 8) or > 7 days (n = 10). The sequential organ failure assessment (SOFA) score was calculated for 7 days. Hemodynamic parameters (cardiac index, extravascular lung water) were determined using transpulmonary thermodilution. Laboratory parameters (lactate, base excess, C-reactive protein, procalcitonin, IL-1Β, IL-6, TNF-α, sVCAM-1, sICAM-1) were monitored before and 1, 3, 6, 12, 24, and 48 h after transfusion. The Mann-Whitney-U test and Neumann test were used for group comparison and trend assessment, respectively.

Results

We failed to observe significant differences with respect to SOFA scores between patients receiving fresh or stored erythrocytes. However, a significant trend towards an improvement in the SOFA score was found in the group receiving fresh erythrocytes (p < 0.01). No significant differences in hemodynamic or laboratory parameters were found between both groups. Conclusion: While the present findings do not provide clear-cut evidence supporting beneficial effects of fresh red blood cells in septic shock, they warrant larger randomized studies to confirm or refute such effects.     

海藻糖负载对人红细胞膜的影响

本研究通过对海藻糖负载后红细胞膜各项理化指标检测,评价海藻糖对红细胞膜的保护作用。以海藻糖负载红细胞为实验组,未负载海藻糖红细胞为对照组,在不同渗透压的NaCl溶液中,检测2组红细胞膜渗透脆性变化,流式细胞术和红细胞变形仪分别检测2组红细胞膜的完整性和变形性。结果显示:对照组红细胞在渗透压为160 mOsm的NaCl溶液中溶血率为50%,而实验组红细胞出现50%溶血率的NaCl溶液渗透压为121.4 mOsm。流式细胞术检测结果显示,红细胞负载海藻糖后,细胞膜结合的AnnexinⅤ-FITC量很少,并且通过300 mOsm磷酸盐缓冲液的洗涤,破损细胞能被有效清除。负载后红细胞变形能力有所下降,2组之间存在显著差异(P<0.01)。结论:红细胞摄取海藻糖后能够在高渗环境中保持细胞膜稳定性和结构完整性。     

干化学法对尿液红细胞和白细胞筛查作用的分析

目的探讨干化学法对尿液中红细胞（RBC）和白细胞（WBC）检测的筛查作用。方法通过干化学法和显微镜法检测257份尿液,对两种方法测得尿液细胞成分的结果进行分析。结果257份尿液经RBC干化学法检测阳性96份,再经显微镜检查法检测20份阳性,76份阴性;RBC干化学法阴性161例,经显微镜检查法检测均为阴性;两法阳性符合率为20.8%,阴性结果符合率为100.0%。经WBC干化学法检测阳性60例,再经显微镜检查法检测阳性45例,阴性15份;WBC干化学法检测阴性197份,经显微镜法检测阴性185份,阳性12份;两法阳性符合率为75.0%,阴性符合率为93.9%。结论尿干化学法结果均为阴性,且排除肾脏病、溶血和泌尿系统疾病时,RBC过筛结果准确,RBC干化学法阳性结果须镜检;干化学法检测尿WBC为阴性不可免去镜检,阳性结果必须镜检。