Red blood cell transfusion and skeletal muscle tissue oxygenation in anaemic haematologic outpatients - PubMed (original) (raw)

Red blood cell transfusion and skeletal muscle tissue oxygenation in anaemic haematologic outpatients

Matej Podbregar et al. Radiol Oncol. 2016.

Abstract

Background: Stored red blood cells (RBCs) accumulate biochemical and biophysical changes, known as storage lesion. The aim of this study was to re-challenge current data that anaemia in chronically anaemic haematology patients is not associated with low skeletal muscle tissue oxygen (StO2), and that RBC storage age does not influence the tissue response after ischaemic provocation, using near-infrared spectroscopy.

Patients and methods: Twenty-four chronic anaemic haematology patients were included. Thenar skeletal muscle StO2 was measured at rest (basal StO2), with vascular occlusion testing (upslope StO2, maximum StO2) before and after transfusion.

Results: Basal StO2 was low (53% ± 7%). Average RBC storage time was 10.5 ± 3.9 days. Effects of RBC transfusions were as follows: basal StO2 and upslope StO2 did not change significantly; maximum StO2 increased compared to baseline (64 ± 14% vs. 59 ± 10%, p = 0.049). Change of basal StO2, upslope StO2 and maximum StO2 was negatively related to age of RBCs. The decrease of maximum StO2 was predicted (sensitivity 70%, specificity 100%), after receiving RBCs ≥ 10days old.

Discussion: Resting skeletal muscle StO2 in chronic anaemic patients is low. RBC storage time affects skeletal muscle StO2 in the resting period and after ischaemic provocation.

Keywords: red blood cells; skeletal muscle; storage lesion; tissue oxygenation; transfusion.

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Figures

Figure 1

Figure 1

Schematic presentation of thenar skeletal muscle StO2 before, during and after the vascular occlusion tests. Before the vascular occlusion, the StO2 is measured in the resting period (1, basal StO2). During the vascular occlusion, the StO2 gradually decreases. The rate of this decrease is determined from the curve as the downslope StO2 (2; %/min), as a surrogate of the tissue oxygen consumption. After reaching the predetermined minimum StO2, present here as 40% StO2 (3), the vascular occlusion is released, and the StO2 begins to rise again. The rate of this increase is determined from the curve as the upslope StO2 (4; %/min), as a surrogate marker of the microcirculatory reactivity. After the release of the occlusion, the StO2 increases to higher values compared to the basal StO2 due to post-ischaemic vasodilatation (5, maximum StO2). The StO2 then slowly returns to the basal StO2.

Figure 2

Figure 2

Effects of the age of the RBCs for the transfusions on the basal StO2. (A) Regression/analysis of variance. (B) Roc analysis, interactive dot diagram for optimal effect separation. Prediction line (solid lines); 95% confidence line (dashed lines)

Figure 3

Figure 3

Effects of the age of the RBCs for the transfusions on the upslope StO2. (A) Regression/analysis of variance. (B) ROC analysis, interactive dot diagram for optimal effect separation. Prediction line (solid lines); 95% confidence line (dashed lines

Figure 4

Figure 4

Effects of the age of the RBCs for the transfusions on the maximum StO2. (A) Regression/analysis of variance. (B) ROC analysis, interactive dot diagram for optimal effect separation Prediction line (solid lines); 95% confidence line (dashed lines)

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