Estimation of Achievable Oxygen Consumption Following Transfusion With Rejuvenated Red Blood Cells.

Autor: Srinivasan AJ; Duke University School of Medicine, Durham, North Carolina. Electronic address: amudan.srinivasan@duke.edu., Kausch K; Zimmer Biomet, Warsaw, Indiana., Inglut C; Zimmer Biomet, Warsaw, Indiana., Gray A; Citra Labs. LLC (a Zimmer Biomet company), Braintree, Massachusetts., Landrigan M; Zimmer Biomet, Warsaw, Indiana., Poisson JL; Duke University Transfusion Service, Department of Pathology, Duke University School of Medicine, Durham, North Carolina., Schroder JN; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina., Welsby IJ; Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina.
Jazyk: angličtina
Zdroj: Seminars in thoracic and cardiovascular surgery [Semin Thorac Cardiovasc Surg] 2018 Summer; Vol. 30 (2), pp. 134-141. Date of Electronic Publication: 2018 Feb 09.
DOI: 10.1053/j.semtcvs.2018.02.009
Abstrakt: Erythrocyte storage induces a nonphysiological increase in hemoglobin-oxygen affinity (quantified by low p50, the oxygen tension at 50% hemoglobin saturation), which can be restored through biochemical rejuvenation. The objective was to mathematically model the impact of transfusing up to 3 standard allogeneic units or rejuvenated units on oxygen delivery (DO 2 ) and oxygen consumption (VO 2 ). Oxygen dissociation curves were generated from additive solution-1 red blood cell (RBC) leukoreduced units (n = 7) before and after rejuvenation following manufacturer's instructions. Two of these units were used to prepare standard or rejuvenated donor RBC and added to samples of fresh whole blood. These admixtures were used to construct an in vitro transfusion model of postoperative anemia and determine a linear equation for calculating the sample p50, which was subsequently used to calculate DO 2 and VO 2 after simulated transfusions. Whole blood-packed red blood cell unit admixture p50s could be predicted from a linear model including the p50 of its components, the mass fraction of the transfused component, and interaction terms (R 2  = .99, P < 0.001). Transfusion with standard units slightly, but significantly, increased projected DO 2 compared with rejuvenated units (P = 0.03), but rejuvenated units markedly increased projected VO 2 (P = 0.03). Standard units did not significantly change VO 2 relative to pre-transfusion levels (P > 0.1). Using high-p50, rejuvenated RBC in simulated transfusions greatly improved projected VO 2 , indicating the potential for increased end-organ oxygen availability compared with standard transfusion. Patient capacity to increase cardiac output after cardiac surgery may be limited. Transfusing high-p50 RBC in this setting may improve the perioperative care of these patients.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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