长期频繁捐献单采血小板对献血者电解质和骨代谢的影响
摘要
单采血小板受到采集仪器和采集时间以及人们接受程度等多种限制,目前多数血站的血小板捐献者多为固定献血者,这就造成了献血者反复多次捐献单采血小板。且2012年7月1日实施的《献血者健康检查要求》规定单采血小板献血间隔:不少于2周,不大于24次/年;相比2001版规定"每隔4周采集一次",理论上单采血小板献血者较之前单采次数翻倍,且单次捐献2 U时体外循环使用的枸橼酸盐抗凝剂量也大幅增加。目前已知,相对大量枸橼酸盐抗凝剂的应用会引起机体内电解质代谢变化,如血钙、磷水平下降同时引发血甲状旁腺素水平升高。骨代谢平衡是由成骨细胞和破骨细胞在不断的骨重建中维持的,而钙的代谢变化是骨代谢中最主要的环节,因此长期频繁大量枸橼酸盐所致的低钙血症是否引发骨代谢生理变化?引起了人们的兴趣。本文就长期频繁捐献单采血小板对献血者机体电解质和骨代谢的影响作一综述
引文
1高东英.输血技术学基础[M].北京:高等教育出版社,2013:63-71.
2卫生部、国家标准化管理委员会.献血者健康检查要求(GB18467-2011)[S].2012.
3卫生部、国家标准化管理委员会.献血者健康检查要求(GB18467-2011)[S].2012.
4 Das SS,Chaudhary R,Khetan D,et al.Calcium and magnesium levels during automated plateletpheresis in normal donors[J].Transfusion Med,2005,15(3):233-236.
5 Bolan CD,Greer SE,Cecco SA,et al.Comprehensive analysis of citrate effects during plateletpheresis in normal donors[J].Transfusion,2001,41(9):1165-1171.
6陈颖,Dettke M,Hoecker P,等.血小板机采过程中年龄依赖性骨代谢变化分析[J].中华检验杂志,2007,30(8):878-881.
7 Bolan CD,Cecco SA,Yau YY,et al.Randomized placebocontrolled study of oral calcium carbonate supplementation in plateletpheresis:II.Metabolic effects[J].Transfusion,2003,43(10):1414-1422.
8 Bolan CD,Cecco SA,Wesley RA,et al.Controlled study of citrate effects and response to i.v.calcium administration during allogeneic peripheral blood progenitor cell donation[J].Transfusion,2002,42(7):935-946.
9 Mercan D,Bastin G,Lambermont M,et al.Importance of ionized magnesium measurement for monitoring of citrateanticoagulated plateletpheresis[J].Transfusion,1997,37(4):418-422.
10 Dzik W,Kirkley S.Citrate toxicity during massive blood transfusion[J].Transfus Med Rev,1988,2(2):76-94.
11 Kelleher SP,Schulman G.Severe metabolic alkalosis complicating regional citrate hemodialysis[J].Am J Kidney Dis,1987,9(3):235-236.
12 Chen Y,Bieglmayer C,H?cker P,et al.Effect of acute citrate load on markers of bone metabolism in healthy volunteer[J].Vox Sang,2009,97(4):324-329.
13 Schlenke P,Frohn C,Steinhardt MM,et al.Clinically Relevant Hypokalaemia,Hypocalcaemia,and Loss of Hemoglobin and Platelets During Stem Cell Apheresis[J].JClin Apheresis,2000,15(4):230-235.
14 Reik RA,Noto TA,Fernandez HF.Safety of large-volume leukapheresis for collection of peripheral blood progenitor cells[J].J Clin Apheresis,1997,12(1):10-13.
15 Toffaletti J,Nissenson R,Endres D,et al.Influence of continuous infusion of citrate on responses of immunoreactive parathyroid hormone,calcium and magnesium components,and other electrolytes in normal adults during plateletapheresis[J].J Clin Endocrin Metabol,1985,60(5):874-879.
16刘佳,冯学胜,王洁,等.血小板单采对献血者血液部分电解质水平的影响[J].科学技术与工程,2012,12(2):413-414.421.
17孙启俊,傅强,李翠萍,等.长期机采血小板献血者甲状旁腺素测定的意义[J].中国输血杂志,2005,18(6):468-469.
18 Farrokhi P,Farahmand H,Bismuth A,et al.How to stabilize the level of ionized calcium and citrate during plateletpheresis[J].Vox Sang,1998,74(1):7-12.
19朱汉民.原发性骨质疏松症防治的进展和趋势[J].老年医学与保健,2003,9(2):67-68.
20 Herrmann M,Herrmann W.The assessment of bone metabolism in female elite endurance athletes by biochemical bone markers[J].Clin Chem Lab Med,2004,42(12):1384-1389.
21 Okabe R,Inaba M,Nakatsuka K,et al.Significance of serum crosslaps as a predictor of changes in bone mineral density during estrogen replacement therapy;comparison with serum carboxyterminal telopeptide of type I collagen and urinary deoxypyridinoline[J].J Bone Miner Metab,2004,22(2):127-131.
22 Hamwi A,Ganem AH,Grebe C,et al.Markers of bone turnover in postmenopausal women receiving hormone replacement therapy[J].Clin Chem Lab Med,2001,39(5):414-417.
23 Han KO,Choi JT,Choi HA,et al.The changes in circulating osteoprotegerin after hormone therapy in postmenopausal women and their relationship with oestrogen responsiveness on bone[J].Clin Endocrinol,2005,62(3):349-353.
24陈颖,曾嘉,Dettke M,等.柠檬酸盐抗凝剂对机体代谢的影响[J].中华检验医学杂志,2008,12(31):1382-1384.
25熊恺轩,卢亮,孙革.多次机采血小板男性献血者甲状旁腺激素水平的研究[J].海南医学,2013(24):3484-3485.
26 Kitahara T,Ueki K,Kuroiwa T,et al.Secretion of parathyroid hormone oscillates depending on the change in serum ionized calcium during hemodialysis and may affect bone metabolism[J].Nephron Clin Pract,2005,101(1):c9-c17.
27 Avbersek-Luznik I,Balon BP,Rus I,et al.Increased bone resorption in HD patients:is it caused by elevated RANKLsynthesis[J]?Nephrol Dial Transplant,2005,20(3):566-570.
28 Amrein K,Katschnig C,Sipurzynski S,et al.Apheresis affects bone and mineral metabolism[J].Bone,2010,46(3):789-795.
29张红,罗湘杭,谢辉,等.基质金属蛋白酶-1,-2与女性年龄、骨转换指标及骨密度的关系[J].中华内科杂志,2006,45(4):306-309.
30 Wichers M,Schmidt E,Bidlingmaier F.Diurnal rhythm of crosslaps in human serum[J].Clin Chem.,1999,45(10):1858-1860.
31 Swaminathan R.Biochemical markers of bone turnover[J].Clin Chim Acta,2001,313(1-2):95-105.
32 Gundberg CM,Markowitz ME,Mizruchi M,et al.Osteocalcin in human serum:a circadian rhythm[J].J Clin Endocrinol Metab,1985,60(4):736-739.
33朱继衍,杨蕊敏.老年人骨折与骨密度及骨代谢生化测定探讨[J].中国老年学杂志,2002,22(3):190-191.
34 Dettke M,Buchta C,Bieglmayer C,et al.Short and long term effects of citrate on bone metabolism and bone mineral density in healthy plateletpheresis donors[J].J Clin Apher,2003,18:87.
35 Wang PL,Meyer MM,Orloff SL,et al.Bone resorption and“relative”immobilization hypercalcemia with prolonged continuous renal replacement therapy and citrate anticoagulation[J].Am J Kidney Dis,2004,44(6):1110-1114.
36 Krishnan RG,Coulthard MG.Minimising changes in plasma calcium and magnesiumconcentrations during plasmapheresis[J].Pediatr Nephrol,2007,22(10):1763-1766.
37 Kishimoto M,Ohto H,Shikama Y,et al.Treatment for the decline of ionized calcium levels during peripheral blood progenitor cell harvesting[J].Transfusion,2002,42(10):1340-1347.
38 Bolan CD,Wesley RA,Yau YY,et al.Randomized placebo-controlled study of oral calcium carbonate administration in plateletpheresis:I.Associations with donor symptoms[J].Transfusion,2003,43(10):1403-1413.
2卫生部、国家标准化管理委员会.献血者健康检查要求(GB18467-2011)[S].2012.
3卫生部、国家标准化管理委员会.献血者健康检查要求(GB18467-2011)[S].2012.
4 Das SS,Chaudhary R,Khetan D,et al.Calcium and magnesium levels during automated plateletpheresis in normal donors[J].Transfusion Med,2005,15(3):233-236.
5 Bolan CD,Greer SE,Cecco SA,et al.Comprehensive analysis of citrate effects during plateletpheresis in normal donors[J].Transfusion,2001,41(9):1165-1171.
6陈颖,Dettke M,Hoecker P,等.血小板机采过程中年龄依赖性骨代谢变化分析[J].中华检验杂志,2007,30(8):878-881.
7 Bolan CD,Cecco SA,Yau YY,et al.Randomized placebocontrolled study of oral calcium carbonate supplementation in plateletpheresis:II.Metabolic effects[J].Transfusion,2003,43(10):1414-1422.
8 Bolan CD,Cecco SA,Wesley RA,et al.Controlled study of citrate effects and response to i.v.calcium administration during allogeneic peripheral blood progenitor cell donation[J].Transfusion,2002,42(7):935-946.
9 Mercan D,Bastin G,Lambermont M,et al.Importance of ionized magnesium measurement for monitoring of citrateanticoagulated plateletpheresis[J].Transfusion,1997,37(4):418-422.
10 Dzik W,Kirkley S.Citrate toxicity during massive blood transfusion[J].Transfus Med Rev,1988,2(2):76-94.
11 Kelleher SP,Schulman G.Severe metabolic alkalosis complicating regional citrate hemodialysis[J].Am J Kidney Dis,1987,9(3):235-236.
12 Chen Y,Bieglmayer C,H?cker P,et al.Effect of acute citrate load on markers of bone metabolism in healthy volunteer[J].Vox Sang,2009,97(4):324-329.
13 Schlenke P,Frohn C,Steinhardt MM,et al.Clinically Relevant Hypokalaemia,Hypocalcaemia,and Loss of Hemoglobin and Platelets During Stem Cell Apheresis[J].JClin Apheresis,2000,15(4):230-235.
14 Reik RA,Noto TA,Fernandez HF.Safety of large-volume leukapheresis for collection of peripheral blood progenitor cells[J].J Clin Apheresis,1997,12(1):10-13.
15 Toffaletti J,Nissenson R,Endres D,et al.Influence of continuous infusion of citrate on responses of immunoreactive parathyroid hormone,calcium and magnesium components,and other electrolytes in normal adults during plateletapheresis[J].J Clin Endocrin Metabol,1985,60(5):874-879.
16刘佳,冯学胜,王洁,等.血小板单采对献血者血液部分电解质水平的影响[J].科学技术与工程,2012,12(2):413-414.421.
17孙启俊,傅强,李翠萍,等.长期机采血小板献血者甲状旁腺素测定的意义[J].中国输血杂志,2005,18(6):468-469.
18 Farrokhi P,Farahmand H,Bismuth A,et al.How to stabilize the level of ionized calcium and citrate during plateletpheresis[J].Vox Sang,1998,74(1):7-12.
19朱汉民.原发性骨质疏松症防治的进展和趋势[J].老年医学与保健,2003,9(2):67-68.
20 Herrmann M,Herrmann W.The assessment of bone metabolism in female elite endurance athletes by biochemical bone markers[J].Clin Chem Lab Med,2004,42(12):1384-1389.
21 Okabe R,Inaba M,Nakatsuka K,et al.Significance of serum crosslaps as a predictor of changes in bone mineral density during estrogen replacement therapy;comparison with serum carboxyterminal telopeptide of type I collagen and urinary deoxypyridinoline[J].J Bone Miner Metab,2004,22(2):127-131.
22 Hamwi A,Ganem AH,Grebe C,et al.Markers of bone turnover in postmenopausal women receiving hormone replacement therapy[J].Clin Chem Lab Med,2001,39(5):414-417.
23 Han KO,Choi JT,Choi HA,et al.The changes in circulating osteoprotegerin after hormone therapy in postmenopausal women and their relationship with oestrogen responsiveness on bone[J].Clin Endocrinol,2005,62(3):349-353.
24陈颖,曾嘉,Dettke M,等.柠檬酸盐抗凝剂对机体代谢的影响[J].中华检验医学杂志,2008,12(31):1382-1384.
25熊恺轩,卢亮,孙革.多次机采血小板男性献血者甲状旁腺激素水平的研究[J].海南医学,2013(24):3484-3485.
26 Kitahara T,Ueki K,Kuroiwa T,et al.Secretion of parathyroid hormone oscillates depending on the change in serum ionized calcium during hemodialysis and may affect bone metabolism[J].Nephron Clin Pract,2005,101(1):c9-c17.
27 Avbersek-Luznik I,Balon BP,Rus I,et al.Increased bone resorption in HD patients:is it caused by elevated RANKLsynthesis[J]?Nephrol Dial Transplant,2005,20(3):566-570.
28 Amrein K,Katschnig C,Sipurzynski S,et al.Apheresis affects bone and mineral metabolism[J].Bone,2010,46(3):789-795.
29张红,罗湘杭,谢辉,等.基质金属蛋白酶-1,-2与女性年龄、骨转换指标及骨密度的关系[J].中华内科杂志,2006,45(4):306-309.
30 Wichers M,Schmidt E,Bidlingmaier F.Diurnal rhythm of crosslaps in human serum[J].Clin Chem.,1999,45(10):1858-1860.
31 Swaminathan R.Biochemical markers of bone turnover[J].Clin Chim Acta,2001,313(1-2):95-105.
32 Gundberg CM,Markowitz ME,Mizruchi M,et al.Osteocalcin in human serum:a circadian rhythm[J].J Clin Endocrinol Metab,1985,60(4):736-739.
33朱继衍,杨蕊敏.老年人骨折与骨密度及骨代谢生化测定探讨[J].中国老年学杂志,2002,22(3):190-191.
34 Dettke M,Buchta C,Bieglmayer C,et al.Short and long term effects of citrate on bone metabolism and bone mineral density in healthy plateletpheresis donors[J].J Clin Apher,2003,18:87.
35 Wang PL,Meyer MM,Orloff SL,et al.Bone resorption and“relative”immobilization hypercalcemia with prolonged continuous renal replacement therapy and citrate anticoagulation[J].Am J Kidney Dis,2004,44(6):1110-1114.
36 Krishnan RG,Coulthard MG.Minimising changes in plasma calcium and magnesiumconcentrations during plasmapheresis[J].Pediatr Nephrol,2007,22(10):1763-1766.
37 Kishimoto M,Ohto H,Shikama Y,et al.Treatment for the decline of ionized calcium levels during peripheral blood progenitor cell harvesting[J].Transfusion,2002,42(10):1340-1347.
38 Bolan CD,Wesley RA,Yau YY,et al.Randomized placebo-controlled study of oral calcium carbonate administration in plateletpheresis:I.Associations with donor symptoms[J].Transfusion,2003,43(10):1403-1413.