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Comparative Study
. 2016 Mar;122(3):616-623.
doi: 10.1213/ANE.0000000000001071.

2,3-Diphosphoglycerate Concentrations in Autologous Salvaged Versus Stored Red Blood Cells and in Surgical Patients After Transfusion

Andrew V Scott  1 , Enika Nagababu, Daniel J Johnson, Khaled M Kebaish, Joshua A Lipsitz, Ian M Dwyer, Gabriel S Zuckerberg, Viachaslau M Barodka, Dan E Berkowitz, Steven M Frank
Affiliations
Comparative Study

2,3-Diphosphoglycerate Concentrations in Autologous Salvaged Versus Stored Red Blood Cells and in Surgical Patients After Transfusion

Andrew V Scott et al. Anesth Analg. 2016 Mar.

Abstract

Background: Stored red blood cells (RBCs) are deficient in 2,3-diphosphoglycerate (2,3-DPG), but it is unclear how autologous salvaged blood (ASB) compares with stored blood and how rapidly 2,3-DPG levels return to normal after transfusion. Therefore, we compared levels of 2,3-DPG in stored versus ASB RBCs and in patients' blood after transfusion.

Methods: Twenty-four patients undergoing multilevel spine fusion surgery were enrolled. We measured 2,3-DPG and the oxyhemoglobin dissociation curve (P50) in samples taken from the ASB and stored blood bags before transfusion and in blood samples drawn from patients before and after transfusion.

Results: The mean storage duration for stored RBCs was 24 ± 8 days. Compared with fresh RBCs, stored RBCs had decreased 2,3-DPG levels (by approximately 90%; P < 0.0001) and a decreased P50 (by approximately 30%; P < 0.0001). However, ASB RBCs did not exhibit these changes. The mean 2,3-DPG concentration decreased by approximately 20% (P < 0.05) in postoperative blood sampled from patients who received 1 to 3 stored RBC units and by approximately 30% (P < 0.01) in those who received ≥4 stored RBC units. 2,3-DPG was unchanged in patients who received no stored blood or ASB alone. After surgery, 2,3-DPG levels recovered gradually over 3 postoperative days in patients who received stored RBCs.

Conclusions: Stored RBCs, but not ASB RBCs, have decreased levels of 2,3-DPG and a left-shift in the oxyhemoglobin dissociation curve. Postoperatively, 2,3-DPG levels remain below preoperative baseline levels for up to 3 postoperative days in patients who receive stored RBCs but are unchanged in those who receive only ASB RBCs.

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Figures

Figure 1
Figure 1
Mean 2,3-DPG concentrations were significantly less in stored RBCs than in preoperative (preop, fresh) RBCs or in RBCs from autologous salvaged blood (ASB). However, concentrations did not differ significantly between fresh and ASB RBC samples. Data are shown as mean ± SD. **P < 0.0001 versus preop and ASB.
Figure 2
Figure 2
The P50 of stored RBCs was significantly lower than that of preoperative (preop, fresh) RBCs and autologous salvaged blood (ASB) RBCs. Additionally, there was a small but statistically significant difference between the P50 of preop fresh RBCs and that of ASB RBCs. Data are shown as mean ± SD. **P < 0.0001 versus preop fresh and ASB; *P = 0.016 versus preop fresh.
Figure 3
Figure 3
In this representative figure, the oxyhemoglobin dissociation curves (ODC) for preoperative (fresh) RBCs and autologous salvaged blood (ASB) RBCs overlap, with P50 values around 28.5 mmHg. The stored RBC ODC is left-shifted compared to those of the other two, with a P50 around 19 mmHg.
Figure 4
Figure 4
The mean percent change in 2,3-DPG concentrations over the three postoperative days is shown in patients stratified by the total number stored RBC units transfused. Data are shown as mean ± SD. *P<0.05 versus 0 units of stored RBCs or ASB alone; #P<0.05 for within group comparison to preoperative baseline. POD = postoperative day.
Figure 5
Figure 5
The mean percent change in 2,3-DPG concentration over the three postoperative days is shown for the four patients who did not receive any transfusions after the morning of POD1. Immediately following surgery (Postop), the mean 2,3-DPG concentration was approximately 50% below baseline, followed by a gradual recovery - 30% below baseline on POD1 and POD2, and 20% below baseline on POD3. #P<0.05 vs. preoperative baseline. POD = postoperative day.
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