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[Metabolic disorders caused by blood transfusions]
1Institut für Anaesthesiologie, Städtische Kliniken Darmstadt.
Insights
Stored blood transfusions can cause metabolic changes like low 2,3-diphosphoglycerate (2,3-DPG), acidosis, and hyperkalemia. These can impair heart function in patients with coronary artery disease, especially under hypothermia or shock.
Area of Science:
- Transfusion Medicine
- Physiology
- Biochemistry
Background:
- Stored blood undergoes metabolic alterations over time, including 2,3-diphosphoglycerate (2,3-DPG) depletion, acidosis, and hyperkalemia.
- Citrate in preservatives binds ionized calcium, potentially leading to hypocalcemia.
- These storage-related changes can manifest in recipients following massive transfusions.
Purpose of the Study:
- To investigate the physiological consequences of metabolic changes in stored blood following massive transfusions.
- To assess the impact of these changes on recipient cardiovascular function, particularly in patients with coronary artery disease.
Main Methods:
- Analysis of metabolic changes in stored erythrocytes, including 2,3-DPG levels and oxygen affinity.
- Monitoring of recipient electrolyte and acid-base balance (acidosis, hypocalcemia, hyperkalemia) post-transfusion.
- Evaluation of cardiac function in patients with coronary artery disease receiving massive transfusions.
Main Results:
- Depletion of 2,3-DPG in stored erythrocytes leads to increased oxygen affinity.
- Massive transfusions can induce acidosis, hypocalcemia, and hyperkalemia in recipients.
- Patients with coronary artery disease exhibit impaired heart function under these transfusion-induced metabolic conditions.
Conclusions:
- Metabolic derangements from stored blood transfusions, such as 2,3-DPG depletion and electrolyte imbalances, pose risks to recipients.
- Impaired compensatory mechanisms in hypothermia or shock can exacerbate transfusion-related metabolic disturbances.
- Regular monitoring via ECG and acid-base analysis is crucial for detecting and managing these critical changes.
Abstract:
Preserved stored blood undergoes metabolic changes depending on the duration of storage. These metabolic changes include a deprivation of 2,3-diphosphoglycerate (2,3-DPG), acidosis and hyperkalemia. The preservative contains citrate as an anticoagulant which binds the ionised serum calcium. 2,3-DPG depleted erythrocytes show a clearly elevated oxygen affinity. Following massive transfusion, these changes can also occur in the recipient. Under these conditions, patients with coronary artery disease show impaired heart function. Prejudicial changes concerning other vital systems have not yet been definitely proved. Acidosis, hypocalcemia and hyperkalemia can take place under massive transfusion. Normally the body's own compensatory mechanisms ensure sufficient recompensation; however, under hypothermia or shock these mechanisms can be impaired. Disturbances of the electrolyte and acid base system are safely detected by ECG and regularly performed acid base analysis.