ACD 용액과 CPD 용액에서의 혈액응고 인자와 섬유소 용해 정도의 변동에 관한 연구

Abstract

[한글]

적혈구생존률과 산소운반능동에서 Citrate - Phosphate - Dextrose (이하 CPD로 약함) 보존액이 보다 우수하다는 사실은 알려져 있으나, 아직 우리나라에서는 Acid - Citrate - Dextrose (이하 ACD로 약함) 보존액을 사용하고 있다. 본 연구에서는 혈액 응고인자의 보존면에서 두 보존액을 비교하기 위하여 건강한 성인 남자 10명의 혈액으로, 국산 제품인 ACD-B (녹십자) 및 외국제품인 CPD(Terumo) 채혈액(bag)을 사용하여 보존기간에 따르는 변화를 관찰하였다.

혈액 응고인자 활성도의 측정은 각 인자 결핍혈장을 사용한 clotting time 법을 사용하였고, 섬유소 용해정도는 FDP(fibrinogen/fibrin degradation product)를 측정하였다. 위와 같은 방법에 의해 채혈 직후의 혈액 응고인자 활성도를 기준으로 저장기간 6,24,48,72시간 및 7,14,21,35일에 걸쳐 그 변화를 추적 관찰하여 본 결과를 종합하면 다음과 같다.

1) Fibrinogen (Ⅰ) 및 Ⅶ, Ⅸ, Ⅹ, XI, XII의 활성도 유지는 저장 35일까지 두 보존액간에 유의한 차이가 없었다.

2) 인자 Ⅴ는 저장 6시간까지는 두 보존액간에 유의한 차이가 없었으나, 24시간 이후에는 CPD 보존액에서의 활성도 감소가 대체적으로 경미하여 ACD 보존액에 비해 그 보존도가 우수하였다.

3) 인자 Ⅷ은 저장 6시간까지는 두 보존액간에 유의한 차이가 없었으나, 24시간 및 48시간에서는 CPD 보존액이 ACD 보존액에 비해 유의하게 우수하였다. (각각 P<0.01 ; P<0.05). 그러나 72시간 이후에는 유의한 차이를 보이지 않았다.

4) 인자 Ⅰ, Ⅶ, Ⅸ, Ⅹ, XI, XII의 경우에는 보존에 따른 활성도 감소가 비교적 적어, ACD 보존액의 사용 기준일인 21일까지도 채혈직후의 약 50%를 유지하는 반면, 인자 Ⅴ는 7일, Ⅷ은 48시간에 이미 채혈직후의 50%이하로 감소함을 보였다.

5) 두 보존액 모두에서 저장 35일까지 섬유소 용해현상의 유의한 증가는 없었다.

이상과 같은 연구 결과를 종합하여 볼 때, 인자 Ⅴ 및 Ⅷ을 제외한 인자 Ⅰ, Ⅶ, Ⅸ, Ⅹ, XI, XII는 두 보존액 모두에서 비교적 그 활성도의 안정성이 유지된 바, 보존 기준일인 21일 이후의 폐기혈장도 인자결핍증을 위한 보충액으로 사용될 수 있을 것으로 사료되었다.

A Comparative Study on Sequential Changes of Coagulation Factors and Fibrinolytic

Activities of Blood Stored in ACD-B and CPD Preservatives

Hyun Cheol Chung

Department of Medical Science, The Graduate School, Yonsei University

(Directed by Prof. Kyung Soon Song, M.D.)

Since Gibson et al (1957) introduced citrate-phosphate-dextrose (CPD) as a

preservative solution for bank blood, many authors have found it to give a longer

24-hour survival time for the red blood cells than acid-citrate-dextrose (ACD)

solution, particularly if blood is stored longer than 21 days. CPD was also shown

to preserve 2,3-diphosphoglycerate (2,3-DPG) better than ACD due to a more

favorable pH.

However, most of our Korean blood banks use ACD solution. There are some reports

concerning the stability of coagulation factors in ACD-B solution, since ACD-B and

CPD are widely used as preservative solutions.

Ten donations were studied at zero, six, twenty-four, forty-eight, seventy-two

hours and seven, fourteen, twenty-one, thirty-five days. Activities of factors Ⅰ,

Ⅶ, Ⅸ, Ⅹ, XI, XII did not deteriorate significantly. There were no significant

differences between the two solutions in preservating coagulation activities among

above factors.

Factor Ⅴ was stable for the first 6 hours in both solutions. The activity was

decreased down to 94% in ACD at 24 hours, 85% at 48 hours, meanwhile 97% at 24

hours and 94% at 48 hours in CPD. The findings indicate that factor Ⅴ is better

preserved in fresh CPD than in fresh ACD-B bank blood (24 hours, p<0.05 ; 48 hours,

p<0.025).

The most labile component, factor Ⅷ coagulant activity was stable at least 6

hours in blood bank refrigerator. Then it decreased to 62% in ACD at 24 hours, 25%

at 48 hours, meanwhile 89% at 24 hours, 31% at 48 hours in CPD. The finding

indicate that factor Ⅷ is better preserved in fresh CPD during the first 2 days

(24 hours, p<0.01 ; 48 hours, p<0.05).

There was no further decrease in the activities among stable factors in ACD-B

solutions beyond 21 days of whole blood storage. Therefore outdated plasma may be

utilized without screening of clotting factor activity for replacement of factor,

Ⅰ, Ⅶ, Ⅸ, Ⅹ, XI, XII.

The fibrinolytic activities were not increased during the entire storage days in

both solutions.

[영문]

Since Gibson et al (1957) introduced citrate-phosphate-dextrose (CPD) as a preservative solution for bank blood, many authors have found it to give a longer 24-hour survival time for the red blood cells than acid-citrate-dextrose (ACD) solution, particularly if blood is stored longer than 21 days. CPD was also shown to preserve 2,3-diphosphoglycerate (2,3-DPG) better than ACD due to a more favorable pH.

However, most of our Korean blood banks use ACD solution. There are some reports concerning the stability of coagulation factors in ACD-B solution, since ACD-B and CPD are widely used as preservative solutions.

Ten donations were studied at zero, six, twenty-four, forty-eight, seventy-two hours and seven, fourteen, twenty-one, thirty-five days. Activities of factors Ⅰ,Ⅶ, Ⅸ, Ⅹ, XI, XII did not deteriorate significantly. There were no significant

differences between the two solutions in preservating coagulation activities among above factors.

Factor Ⅴ was stable for the first 6 hours in both solutions. The activity was decreased down to 94% in ACD at 24 hours, 85% at 48 hours, meanwhile 97% at 24hours and 94% at 48 hours in CPD. The findings indicate that factor Ⅴ is better preserved in fresh CPD than in fresh ACD-B bank blood (24 hours, p<0.05 ; 48 hours,

p<0.025).

The most labile component, factor Ⅷ coagulant activity was stable at least 6 hours in blood bank refrigerator. Then it decreased to 62% in ACD at 24 hours, 25%

at 48 hours, meanwhile 89% at 24 hours, 31% at 48 hours in CPD. The finding indicate that factor Ⅷ is better preserved in fresh CPD during the first 2 days (24 hours, p<0.01 ; 48 hours, p<0.05).

There was no further decrease in the activities among stable factors in ACD-B solutions beyond 21 days of whole blood storage. Therefore outdated plasma may be utilized without screening of clotting factor activity for replacement of factor,Ⅰ, Ⅶ, Ⅸ, Ⅹ, XI, XII.

The fibrinolytic activities were not increased during the entire storage days in both solutions.