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

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 to 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 following 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 ≈ 90%; P<0.0001), and a decreased P50 (by ≈ 30%; P<0.0001). However, ASB RBCs did not exhibit these changes. The mean 2,3-DPG concentration decreased by ≈ 20% (P<0.05) in postoperative blood sampled from patients who received 1 – 3 stored RBC units, and by ≈ 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 three 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 three postoperative days in patients who receive stored RBCs, but are unchanged in those who receive only ASB RBCs.

Autologous blood salvage in the era of patient blood management

“…In contrast, banked blood stored for 25 days had a >90% depletion in 2,3‐DPG, thus shifting the haemoglobin‐oxygen saturation curve substantially to the left, which is associated with decreased oxygen off‐loading and delivery (Fig. ) . Other investigators have shown that salvaged red cells have a twofold or greater amount of 2,3‐DPG relative to banked blood .…”

“…For example, 2,3‐DPG, which facilitates offloading of oxygen from the haemoglobin molecule, has been reported to be present in essentially normal levels (<5% depletion) in salvaged blood (Fig. ) . In contrast, banked blood stored for 25 days had a >90% depletion in 2,3‐DPG, thus shifting the haemoglobin‐oxygen saturation curve substantially to the left, which is associated with decreased oxygen off‐loading and delivery (Fig.…”

Should modulation of p50 be a therapeutic target in the critically ill?

“…Amongst other changes,(55) after 7 days of refrigerated storage, the p50 is significantly reduced from a baseline of 27 to 22 then to a nadir of 18 mmHg after 21 days storage. (16) This is echoed in lowered 2,3 DPG levels in patients receiving allogeneic units rather than cell-saver blood during surgery, (56) and in older studies that observed However, the concept of p50 modulation as a transfusion intervention has not been formally tested by any of the aforementioned studies, because "fresh" blood had been stored for an average of 6 ± 5 days (ABLE), 8 ± 5 days (RECESS), or 13 ± 8 days (INFORM), and 2,3 DPG levels would already have been substantially reduced.…”

Rapid bedside rejuvenation of red blood cell with an autologous cell salvage device

“…Ex‐vivo rejuvenation of allogeneic RBCs, with a solution containing sodium pyruvate, inosine, adenine and sodium phosphates, increases the levels of ATP and 2,3‐DPG and increases the p50 of stored RBCs by right‐shifting the Oxyhaemoglobin Dissociation Curve towards a state where disassociation of oxygen from haemoglobin is more likely to occur . This is represented by a higher RBC Oxygen Release Capacity (ORC), or the per cent of oxygen removed from haemoglobin across the arterial (100 mmHg O 2 )–venous (40 mmHg O 2 ) pressure gradient .…”