Red Blood Cell Function and Blood Storage
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Abstract Red blood cells are ideal vehicles for delivering oxygen to tissues, but their functions deteriorate during liquid preservation. In this article, we review the role of red blood cells in oxygen delivery and methods to evaluate the effectiveness of red blood cell transfusion. Quantitative estimation of transfusion effects could avoid unnecessary transfusion and reduce the risk of transfusion‐associated disorders. We also describe the benefits of transfusion of red blood cells having a higher oxygen‐delivering capacity. Phosphoenolpyruvate is a promising component to prepare red blood cells having a higher oxygen‐delivering capacity.Keywords:
Red Cell
Oxygen delivery
Blood cell
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Filtration (mathematics)
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Blood cell
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Oxygen delivery
Red Cell
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Basis (linear algebra)
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The need for red blood cell transfusion is determined by the etiology, chronicity, and severity of anemia, the patient's ability to compensate for decreased oxygen carrying capacity, and tissue oxygen requirements. The compensatory mechanisms invoked by acute blood loss differ from the physiologic adaptations to chronic anemia. Factors such as myocardial depression and inadequate ventilation can also decrease oxygen delivery, but their occurrence cannot be reliably predicted, particularly in surgical patients. A margin of safety is therefore necessary to prevent inadequate oxygen delivery and potential morbidity and mortality in anemic patients. Appropriate use of pharmacologic agents can obviate the need for red blood cell administration in some chronically anemic patients. There is no single red blood cell transfusion trigger. The entire clinical picture not just the hemoglobin, must be considered in each patient.
Oxygen delivery
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Summary In the past years, our group has made several observations suggesting that blood cells behave differently and when stimulated, release different levels of cytokines, depending on which anticoagulant the blood has been drawn into. The aim of this study was therefore to compare the effect of the four anticoagulants EDTA, citrate, heparin and hirudin on monocyte, neutrophil (PMN), and platelet function in human whole blood. Human whole blood was employed as an ex vivo model of cytokine production and protein secretion, and lipopolysaccharide (LPS) induced tissue factor (TF) activity in monocytes and LPS induced tumor necrosis factor α (TNFα) release were chosen as parameters of monocyte activation. Platelet factor 4 (PF4) secretion and LPS induced lacto ferrin release were chosen as parameters of platelet and PMN activation, respectively. When human whole blood was stimulated with 5 ng/ml LPS for 2 h, TF activity in monocytes isolated from EDTA blood was found to be 2.9 mU/106 cells, whereas TF activity in monocytes isolated from citrated, heparinized and hirudinized blood was 14.7, 24.7 and 28.5 mU/106 cells, respectively. TNFα concentrations in platelet poor plasma (PPP) isolated from whole blood stimulated with 5 ng/ml LPS for 2 h was increased with 200,400 and 350% in citrated, heparinized and hirudinized blood respectively, as compared to EDTA blood. Next, the effect of the anticoagulant on PMN secretion was measured. PPP isolated from whole blood incubated with 5 ng/ml LPS for 90 min contained 1170 ng/ml (EDTA blood), 2880 ng/ml (citrated blood), 4220 ng/ml (heparinized blood), and 5520 ng/ml lactoferrin (hirudinized blood). When studying the platelet parameter PF4, whole blood was incubated without any stimuli for 60 min, and we found that heparin PPP contained 1180 ng/ml PF4, while hirudin PPP contained 469 ng/ml, citrate PPP 440 ng/ml, and EDTA PPP 217 ng/ml PF4, respectively. Finally, the low molecular weight heparin compound Fragmin had no enhancing effect on PF4 levels in whole blood. It is concluded that the anticoagulant used in in vitro experiments has a large influence on the parameters measured.
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Hirudin
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Platelet counts were measured before and after red cell transfusions in 30 patients with anaemia and severe thrombocytopenia resulting from haematological diseases. There was a mean reduction of 1.1 x 109/l (P = 0.43) in the platelet count after transfusions of 2-3 units of leucocyte-depleted red cell concentrates (20 patients). However, there was a mean reduction of 2.7 x 109/l (P = 0.03), approximately 10%, in the platelet count after transfusions of non-leucocyte-depleted red cell concentrates (10 patients). The findings suggest that the forthcoming introduction of universal leucocyte depletion of red cell concentrates will minimize the worsening of thrombocytopenia that occurs in severely thrombocytopenic patients receiving standard non-leucocyte-depleted red cell concentrates.
Red Cell
Blood cell
Platelet Transfusion
Hematology
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K562 cells
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Despite the publication of several consensus guidelines that set forth recommendations for the transfusion of red cells, actual clinical practice continues to vary widely. Animal data and studies in human volunteers and patients support a red cell transfusion threshold of 7 to 8 g/dl in most patients. However, conflicting data, particularly in cardiac patients and in the elderly, suggest that it may be impossible to define a single red cell "trigger" for all patients. A well-designed, randomized, controlled trial is still needed to establish a safe threshold for red cell transfusion in adults with coronary artery disease.
Red Cell
Transfusion Therapy
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