Plasma Free Hemoglobin and Microcirculatory Response to Fresh or Old Blood Transfusions in Sepsis

被引:24
作者
Damiani, Elisa [1 ]
Adrario, Erica [1 ,2 ]
Luchetti, Michele Maria [3 ]
Scorcella, Claudia [1 ]
Carsetti, Andrea [1 ]
Mininno, Nicoletta [1 ]
Pierantozzi, Silvia [1 ]
Principi, Tiziana [2 ]
Strovegli, Daniele [2 ]
Bencivenga, Rosella [4 ]
Gabrielli, Armando [3 ]
Romano, Rocco [1 ]
Pelaia, Paolo [1 ,2 ]
Ince, Can [5 ]
Donati, Abele [1 ,2 ,5 ]
机构
[1] Univ Politecn Marche, Dept Biomed Sci & Publ Hlth, Torrette Di Ancona, Italy
[2] Azienda Osped Univ Osped Riuniti, Anesthesia & Intens Care Unit, Torrette Di Ancona, Italy
[3] Univ Politecn Marche, Dept Clin & Mol Sci, Med Clin, Torrette Di Ancona, Italy
[4] AOU Osped Riuniti, Immunohematol & Transfus Med, Torrette Di Ancona, Italy
[5] Univ Amsterdam, Acad Med Ctr, Dept Translat Physiol, NL-1105 AZ Amsterdam, Netherlands
关键词
CELL-FREE HEMOGLOBIN; NITRIC-OXIDE BIOAVAILABILITY; NEAR-INFRARED SPECTROSCOPY; CRITICALLY-ILL; MICROVASCULAR RESPONSE; OXYGEN-SATURATION; SEPTIC PATIENTS; ORGAN FAILURE; STORAGE TIME; RED-CELLS;
D O I
10.1371/journal.pone.0122655
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background Free hemoglobin (fHb) may induce vasoconstriction by scavenging nitric oxide. It may increase in older blood units due to storage lesions. This study evaluated whether old red blood cell transfusion increases plasma fHb in sepsis and how the microvascular response may be affected. Methods This is a secondary analysis of a randomized study. Twenty adult septic patients received either fresh or old (<10 or >15 days storage, respectively) RBC transfusions. fHb was measured in RBC units and in the plasma before and 1 hour after transfusion. Simultaneously, the sublingual microcirculation was assessed with sidestream-dark field imaging. The perfused boundary region was calculated as an index of glycocalyx damage. Tissue oxygen saturation (StO(2)) and Hb index (THI) were measured with near-infrared spectroscopy and a vascular occlusion test was performed. Results Similar fHb levels were found in the supernatant of fresh and old RBC units. Despite this, plasma fHb increased in the old RBC group after transfusion (from 0.125 [0.098-0.219] mg/mL to 0.238 [0.163-0.369] mg/mL, p = 0.006). The sublingual microcirculation was unaltered in both groups, while THI increased. The change in plasma fHb was inversely correlated with the changes in total vessel density (r = -0.57 [95% confidence interval -0.82, -0.16], p = 0.008), De Backer score (r = -0.63 [95% confidence interval -0.84, -0.25], p = 0.003) and THI (r = -0.72 [95% confidence interval -0.88, -0.39], p = 0.0003). Conclusions Old RBC transfusion was associated with an increase in plasma fHb in septic patients. Increasing plasma fHb levels were associated with decreased microvascular density.
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页数:15
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