Leukodepleted versus nonleukodepleted red blood cell transfusion in septic patients: a microcirculatory vision

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• 作者：Sebastien Tanaka (1)
  Anatole Harrois (1)
  Jacques Duranteau (1)
  
  1. AP-HP ; Service d鈥橝nesth茅sie-R茅animation ; H么pitaux Universitaires Paris-Sud ; Universit茅 Paris-Sud ; H么pital de Bic锚tre ; Le Kremlin-Bic锚tre ; 94275 ; France
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：April 2014
• 年：2014
• 卷：18
• 期：2
• 全文大小：108 KB
• 参考文献：1. Donati, A, Damiani, E, Luchetti, MM, Domizi, R, Scorcella, C, Carsetti, A, Gabbanelli, V, Carletti, P, Bencivenga, R, Vink, H, Adrario, E, Piagnerelli, M, Gabrielli, A, Pelaia, P, Ince, C (2014) Microcirculatory effects of the transfusion of leukodepleted or nonleukodepleted red blood cells in septic patients 鈥?a pilot study. Crit Care 18: pp. R33 CrossRef
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  4. Chin-Yee, IH, Gray-Statchuk, L, Milkovich, S, Ellis, CG (2009) Transfusion of stored red blood cells adhere in the rat microvasculature. Transfusion 49: pp. 2304-2310 CrossRef
  5. Sakr, Y, Chierego, M, Piagnerelli, M, Verdant, C, Dubois, MJ, Koch, M, Creteur, J, Gullo, A, Vincent, JL, De Backer, D (2007) Microvascular response to red blood cell transfusion in patients with severe sepsis. Critical Care Med 35: pp. 1639-1644 CrossRef
  6. Ospina-Tascon, G, Neves, AP, Occhipinti, G, Donadello, K, Buchele, G, Simion, D, Chierego, ML, Silva, TO, Fonseca, A, Vincent, JL, De Backer, D (2010) Effects of fluids on microvascular perfusion in patients with severe sepsis. Intensive Care Med 36: pp. 949-955 CrossRef
  
• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Storage time and residual leukocytes in red blood cell (RBC) units may be deleterious by increasing the accumulation of leukocyte-derived cytokines and by raising the adhesion of RBCs to endothelium. Leukodepleted RBC transfusion may reduce the incidence of infection and organ dysfunction. However, the influence of leukodepletion on microcirculation remains not well defined in ICU patients. In this context, an original study in a previous issue of Critical Care emphasizes the microcirculatory effects of transfusion of leukodepleted RBCs (post-storage leukoreduction) or nonleukodepleted RBCs in septic patients. This study suggests a positive rheological impact of leukodepleted RBCs in septic patients with an increase in sublingual microvascular flow and perfused vessel density. Given the variability in the microvascular response to RBC transfusion in individual patients, there is a need for monitoring the microcirculation to guide transfusion in patients with sepsis rather than deciding to transfuse RBCs according to an arbitrary hemoglobin level. Further studies to identify the microvascular response to RBC transfusion in ICU patients are warranted.