The Protection Of MAP Solution On Erythrocytes As A Washing Solution In Intraoperative Blood Salvage

Objective:To evaluate the effect of MAP solution (Natrium Citricum-Citric Acid-Sali ne-Phosphate-Adenine-Dextrose-Mannitol) on metabolism,morphology,function and phy siological characteristics of erythrocytes in intraoperative blood salvage.Methods:Based on the processes of intraoperative autologous blood salvage in clinic, this study was divided into the two parts. In first one,twenty-one ASA I or IIpatients of both sexes aged20-55yr undergoing elective radical operation with6cases neurosurgery benign meningiomas,10cases spinal surgery,5cases hepatobiliary surgery spleen resection were enrolled in this study.8ml of arterial blood were harvested from every paptient, and then divided into two parts to be preserved in MAP solution and in NS solution respectively in a ratio of1:4, as MAP preservation group and NS preservation group respectively. RBC morphology, the concentration of fHB and adenine nucleotids (ATP,ADP,AMP) in RBC were detected. In the second one,,twenty-one ASA Ⅰ or Ⅱpatients of both sexes aged20-55yr undergoing elective radical operation with15cases neurosurgery benign meningiomas,30cases spinal surgery,17cases hepatobiliary surgery spleen resection were enrolled in this study. Washed RBCs of intraoperative blood salvage was divided randomly into MAP washing group (n=31) and NS washing group (n=31) based on the different washing solutions.Then the morphology, Mean Corpuscular Volume (MCV), adenine nucleotids, and2,3-DPG, GR activity in RBC were determined.Results:In first one, with the extension of storage in vitro, RBCs lost its biconcave disc-shape, and the fHb levels in supernatant increased. Compared with NS preservation group, RBC in MAP preservation group kept normal, the fHB levels were lower (P<0.01);the contents of adenine nucleotids were all higher (P<0.05) in MAP preservation group. In the second one, compared with NS washing group, ATP levels in erythrocyte washed with MAP solution in intraoperative blood salvage were higher, while AMP levels were lower in MAP washing group (P<0.01). The image showed that the erythrocyte shrieked or enlarged, and became stomatocyte after NS washed, while they kept normal or became acanthocyte in MAP washing group. This was confirmed by MCV of erythrocyte that73.9%of them were in normal in MAPwashing group compared with62.5%in NS washing group. There was no difference of2,3DPG levels and Glutathione Reductase activities in erythrocyte between two groups (P>0.05).Conclusion:In vitro, MAP solution is beneficial to generating adenine nucleotids in erythrocytes, keeping the normal shape of erytherocyte, improving erytherocyte deformability and reducing erythrocyte destruction. The processes of storage in vitro, centrifugation and washing affects erythrocyte energy metabolism, impairs erythrocyte morphology. MAP, as a washing solution, can provide energy substrate to generate ATP, keep the shape of erytherocyte normal. Thence, the protection on MAP solution on erythrocytes as a washing solution is obvious in intraoperative blood salvage, preferred to traditional washing solution (0.9%sodium chloride injection).