chapter 49. quiz 2 Biochemical Changes in Stored Blood

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Questions and Answers

What is the purpose of citrate in stored blood?

Serving as a buffer

Binding to Ca2+ to prevent clotting (correct)

Providing energy to RBCs

Increasing the survival of RBCs

Which component of blood storage preservatives acts as an energy source for red blood cells (RBCs)?

Adenine

Dextrose (correct)

Phosphate

Citrate

Which component of blood storage preservatives acts as buffer for red blood cells (RBCs)?

Adenine

Dextrose

Phosphate (correct)

Citrate

The addition of adenine to PRBC lead to

extends the storage time from 21 to 35 days Signup and view all the answers

What is the effect of storage at 1°C to 6°C on glycolysis in RBCs?

Reduces glycolysis rate Signup and view all the answers

Which blood storage preservative extends the shelf life of PRBCs to 42 days?

AS-1 (Adsol) Signup and view all the answers

Which blood storage preservative extends the shelf life of PRBCs to 56 days?

AS-7 Signup and view all the answers

What does AS-1 (Adsol) contain that helps prolong storage time?

Adenine, glucose, mannitol, and NaCl Signup and view all the answers

Which biochemical reaction occurs during storage that leads to a decrease in plasma pH?

Metabolism of glucose to lactate Signup and view all the answers

What is the hematocrit (Hct) of the transfused product when CPDA is used as the storage solution?

Greater than 65% Signup and view all the answers

What is the volume of the transfused product when CPDA is used as the storage solution?

250 mL Signup and view all the answers

What is the volume of the transfused product when AS-1 is used as the storage solution?

310 ml Signup and view all the answers

What happens to potassium ion (K+) concentrations in RBCs stored for 35 days?

elevated Signup and view all the answers

What is the purpose of considering both the 'age of blood storage' and 'amount' of blood given when transfusing blood?

To improve oxygen delivery by RBCs Signup and view all the answers

What do red cell storage lesions refer to?

biochemical reactions Signup and view all the answers

Why does the addition of adenine prolong the storage time of RBCs?

To allow RBCs to resynthesize ATP Signup and view all the answers

According to Frank and associates, what is associated with decreased RBC deformability during blood storage?

Prolonged storage duration Signup and view all the answers

What is the hematocrit (Hct) of the transfused product when AS-1 is used as the storage solution?

55% to 60% Signup and view all the answers

What does a left shift in the O2 dissociation curve indicate?

Increased affinity of Hb for O2 Signup and view all the answers

What is quantitated by the P50 in the O2 dissociation curve?

Partial pressure of O2 at which Hb is half saturated with O2 Signup and view all the answers

How is the O2 dissociation curve affected by a low P50 value?

Left shift in the curve Signup and view all the answers

What is reflected by the sigmoid shape of the O2 dissociation curve?

Increase in Hb affinity for O2 with higher saturation Signup and view all the answers

In what scenario is it more difficult for hemoglobin to release oxygen to tissues?

Low P50 value Signup and view all the answers

How does an increase in the circulating red cell mass affect oxygen delivery to tissues?

Decreases oxygen delivery due to impaired RBC function Signup and view all the answers

What factor most likely contributes to the leftward shift in the oxygen dissociation curve of stored RBCs?

Decreased levels of 2,3-DPG in stored RBCs Signup and view all the answers

What innovative method shows promise in decreasing hemolysis and preventing a decrease in pH during prolonged storage of blood?

Utilizing electrostatic field of 500 to 3000 V Signup and view all the answers

What is a potential benefit of rejuvenating stored red cells with inosine prior to administration?

Mitigating the potential for organ damage in recipients Signup and view all the answers

What has been associated with increased postoperative pneumonia in cardiac patients?

Older blood transfusion Signup and view all the answers

What was the result of Purdy and colleagues' study comparing patients who received 17-day-old blood versus 25-day-old blood?

Higher survival rates Signup and view all the answers

How did the prolonged storage of blood affect morbidity after cardiac surgery according to the text?

Not associated with increased morbidity Signup and view all the answers

What did the accompanying editorial suggest regarding the use of newer blood in clinical situations?

It should be used whenever possible in situations that require it. Signup and view all the answers

Based on the text, what did Weiskopf and associates conclude about the efficacy of erythrocytes stored for different durations?

There is no difference in efficacy between erythrocytes stored for 3 weeks and those stored for 3.5 hours. Signup and view all the answers

What did Spahn postulate about the key factor in determining the delivery of oxygen in blood?

2,3-DPG levels are reduced in older blood but do not affect oxygen delivery. Signup and view all the answers

What was the conclusion reached by Cata and associates regarding the outcome of patients receiving older blood during radical prostatectomy?

There was no change in outcome compared to patients receiving newer blood. Signup and view all the answers

What was the major finding of the INFOMR trial published by Heddle and colleagues in 2016?

No significant differences in mortality were noted between blood stored for different durations. Signup and view all the answers

What did the RECESS trial reveal about mortality rates among patients transfused with blood stored for different durations?

Mortality rates were similar regardless of the duration of blood storage. Signup and view all the answers

What was a notable observation from two randomized controlled trials evaluating the age of transfused blood on outcomes?

No differences were found between fresher and older blood transfusions. Signup and view all the answers

Study Notes

Blood Storage and Transfusion

In Europe, a solution similar to AS-1 is used, which contains saline, adenine, glucose, and mannitol.
AS-7, a new additive solution, has been approved by the FDA, increasing storage time to at least 56 days, but it is not yet commercially available in the US.

Hematocrit and Storage Volume

When CPDA is used as the anticoagulant, the hematocrit (Hct) is greater than 65%, and the volume is approximately 250 mL.
When AS-1 is used, the Hct is 55% to 60%, and the volume is 310 mL.

Red Cell Storage Lesions

During storage, red blood cells (RBCs) metabolize glucose to lactate, resulting in a decrease in plasma pH and an increase in oxidative damage to lipids and proteins.
The storage temperature of 1°C to 6°C inhibits the sodium-potassium pump, leading to a loss of potassium ions from the cells and a gain of intracellular sodium.

Biochemical Changes in Stored Blood

There are progressive decreases in RBC concentrations of ATP, nitric oxide, and 2,3-diphosphoglycerate during storage.
The osmotic fragility of RBCs increases, and some cells undergo lysis, resulting in increased plasma Hb levels.
Deformability of RBCs appears impaired in patients who receive allogenic blood cell transfusion, potentially resulting in micro-occlusive events.

Anticoagulant Preservative

Citrate phosphate dextrose adenine-1 (CPDA-1) is an anticoagulant preservative that is used for blood stored at 1°C to 6°C.
Citrate prevents clotting by binding Ca2+, phosphate serves as a buffer, and dextrose is a red cell energy source.

Shelf Life of PRBCs

The shelf life of PRBCs can be extended to 42 days when AS-1 (Adsol), AS-3 (Nutricel), or AS-5 (Optisol) is used.
Adsol contains adenine, glucose, mannitol, and sodium chloride, while Nutricel contains glucose, adenine, citrate, phosphate, and NaCl.

Changes in Oxygen Transport

RBCs are transfused primarily to increase oxygen transport to tissues.
The oxygen dissociation curve is determined by plotting the partial pressure of oxygen (Po2) in blood against the percentage of Hb saturated with oxygen.
A low P50 indicates a left shift in the oxygen-dissociation curve, making it more difficult for Hb to release oxygen to hypoxic tissues.

Clinical Implications

The duration of blood storage has been associated with an increased risk for death, but the evidence is not consistent.
Recent randomized controlled trials have demonstrated the safety and noninferiority of "older" versus "younger" blood, but the complete answer may still need further data.

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Description

Explore the biochemical changes that occur in stored blood, including the use of anticoagulant preservatives and the roles of citrate, phosphate, and dextrose in maintaining blood components. Learn about the mechanisms behind preventing clotting and supporting red blood cell energy.