tailieunhanh - Báo cáo y học: "New versus old blood – the debate continues"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: New versus old blood – the debate continues. | Laurie et al. Critical Care 2010 14 130 http content 14 2 130 CRITICAL CARE COMMENTARY L__ New versus old blood - the debate continues John Laurie1 Duncan Wyncoll2 and Claire Harrison 1 See related research by Ranucci etal. http content 13 6 R207 Abstract Since the inception of blood banking refinements in laboratory processes have allowed for progressively longer storage times of red blood cells. Whilst advantageous for the logistics of stock management the clinical impact of the duration of red blood cell storage prior to transfusion remains uncertain and a topic of growing interest. The current standard red blood cell RBC storage time of up to 42 days is not based upon a demonstrable therapeutic benefit but instead on the observed return of 70 of the viable transfused RBCs at 24 hours after storage for 42 days or less. The structural biochemical and immunological changes that RBCs undergo during storage are well described but what remains controversial is the evidence that this storage lesion translates into adverse clinical outcomes for patients receiving older blood. In a previous issue of Critical Care Ranucci and colleagues report an adverse outcome in infants receiving older blood during cardiopulmonary bypass CPB 1 . Effects of blood storage The effects of storage on RBCs include changes in potassium increased levels 2 3-diphosphoglycate decreased levels lactate increased levels pH decreased values glucose decreased levels adenosine triphosphate decreased levels methaemoglobin increased levels red cell structure from biconcave disc to echinocytes and then to spherocytes and therefore red cell deformability. Storage effects also include changes to the microenvironment with reduced levels of S-nitrosohaemoglobin and nitric oxide. Prolonged storage prior to transfusion also results in an immunomodulatory effect first described by Opelz and colleagues who demonstrated reduced Correspondence .