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Mannitol-adenine-phosphate: a novel solution for intraoperative blood salvage

Authors

  • Ping Yang,

    1. Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
    2. Department of Anesthesiology, Three Gorges Central Hospital of Chongqing, Chongqing, China
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    • Both authors contributed equally to the paper.
  • Jing Zhou,

    1. Department of Lab Medicine, West China Hospital, Sichuan University, Chengdu, China
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    • Both authors contributed equally to the paper.
  • Yi Kang,

    1. Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
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  • Lina Gong,

    1. Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
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  • Jie Zhang,

    1. Key Laboratory of Transplant Engineering and Immunology, Ministry of Health, West China Hospital, Sichuan University, Chengdu, China
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  • Jie Yu,

    1. Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
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  • Xiaorong Yin,

    1. Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
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  • Chongwei Zhang,

    1. Department of Lab Medicine, West China Hospital, Sichuan University, Chengdu, China
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  • Guangyue Liu,

    1. Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
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  • Jin Liu,

    1. Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
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  • Lei Du

    Corresponding author
    1. Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
    • Address reprint requests to: L. Du, Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, 37 Guoxuexiang, Chengdu, Sichuan, 610041 China; e-mail: dulei@scu.edu.cn.

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  • This study was supported by the National Natural Science Foundation of China (No. 81171651 and 81270324)

Abstract

Background

Intraoperative blood salvage (IBS) procedures include washing with normal saline (NS), which may deplete red blood cell (RBC) nutrients. The mannitol-adenine-phosphate (MAP) solution, commonly used for RBC preservation, provides glycolytic substrates; therefore, MAP should be a better solution than NS in IBS. In this study, we determined whether using MAP could reduce washing-associated RBC damage and destruction.

Study Design and Methods

Adenine nucleotide contents, RBC morphology, and plasma free hemoglobin (PF-Hb) level of RBCs treated with NS or MAP solution were compared under three conditions: 1) 4-hour preservation of fresh blood from healthy volunteers, 2) collection from the shed blood of patients, and 3) incubation of the collected shed blood with plasma.

Results

Adenine nucleotide level and RBC elongation index were greater and PF-Hb level was lower in MAP groups than NS groups (p < 0.05) after preservation and incubation. In NS, RBCs lost their deformability and became stomatocytes, and even RBC “ghosts” 48 hours after incubation, while they remained normal in MAP solution.

Conclusion

The MAP solution helps preserve RBC morphology and function, and reduces hemolysis, possibly due to improved energy production. Therefore, MAP should replace NS during IBS.

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