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Changes of blood oxygen affinity and capacity and red cell 2,3-diphosphoglycerate evoked by exchange transfusions with ACD preserved blood in newborn infants: Their interrelationship and influences on oxygen supply of tissues and erythropoiesis

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Abstract

In 20 newborns and infants suffering from hyperbilirubinemia due to blood group incompatibility and other causes “in vivo” blood oxygen affinity and capacity, acid-base equilibrium, reticulocyte count, and red cell 2,3-diphosphoglycerate (2,3-DPG) were determined before and after exchange transfusion (ET) with ACD preserved blood. Functional and biochemical revival of donor blood occurs in vivo during ET; in vitro revival of comparable extent is observed after THAM buffering of the ACD stored blood prior to ET. Normal properties of adult blood in the recipient infants are reached after 24 hrs. A further increase of 2,3-DPG with the resulting enhanced oxygen releasing ability of hemoglobin occurs within 3 to 6 days. Lateron 2,3-DPG and the oxygen releasing ability are being reduced to subnormal values. The resulting decrease of mixed venous oxygen tension at this time is followed by reticulocytosis. Thus 2,3-DPG can be assumed as a regulator of erythropoiesis. Since our results demonstrate a possibility to manipulate the oxygen carrying characteristics of blood of the newborn, factors which are to be considered in states of severe shunt hypoxemia are outlined.

Zusammenfassung

Bei 20 Neugeborenen und Säuglingen mit Hyperbilirubinämie, die durch Blutgruppenunverträglichkeit oder andere Ursachen bedingt war, wurden die “in vivo” O2-Affinität und-Kapazität des Blutes, die Säuren-Basen-Parameter, Reticulocyten und 2,3-Diphosphoglycerat (2,3-DPG) im Erythrocyten vor und nach Austauschtransfusion (AT) mit ACD-Blut bestimmt. Funktionelle und biochemische Regeneration des Spenderblutes erfolgt in vivo noch während der AT; in vitro wird eine Regeneration vergleichbaren Ausmaßes nach THAM-Pufferung vor dem Gebrauch der Konserve beobachtet. Die P50-Werte (PO 2 bei 50% O2-Sättigung des Hämoglobins, pH 7,4, 37°C) vor (21,5 Torr) und am Ende der AT (21,8 Torr) sind gleich. Normale Eigenschaften von Erwachsenenblut werden im Kreislauf des Empfängers nach 24 Std erreicht (P5025 Torr; 2,3-DPG 4,7 μmole/ml); die mittlere Hb-Konzentration beträgt zu diesem Zeitpunkt 11,3 g/100 ml Blut. Ein weiterer Anstieg des 2,3-DPG (5,8 μmole/ml) mit entsprechend erhöhter O2-Abgabefähigkeit des Hämoglobins (P50 27,7 Torr) erfolgt zwischen 3. und 6. Tag. Später fallen das 2,3-DPG und die O2-Entladungskapazität des Blutes auf subnormale Werte ab. An der Reduktion der O2-Entladungskapazität sind sowohl die 2,3-DPG-abhängige O2-Affinität als auch die zunehmende Anämisierung (Hb-Minimum 8,5 g/100 ml) beteiligt. Dem hieraus resultierenden Abfall des O2-Drucks im gemischtvenösen Blut folgt eine Reticulocytenkrise. 2,3-DPG kann demnach als ein Regulator der Erythropoiese angesehen werden. Da unsere Resultate Möglichkeiten aufzeigen, die O2-Transportfunktion von Neugeborenenblut zu “manipulieren”, wird auf die Größen näher eingegangen, die dabei zu beachten sind, vor allem bei erheblicher Shunt-Hypoxämie.

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Authors and Affiliations

  1. Department of Pediatrics, University of Munich Medical School, Munich, Germany

    Hans Versmold, Johannes Wenner & Klaus Riegel

  2. Department of Pediatrics, Hannover School of Medicine, Mannover, Germany

    Hans Versmold, Johannes Wenner & Klaus Riegel

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  1. Hans Versmold
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Supported by Deutsche Forschungsgemeinschaft, Sonderforschungsbereich 51, Medizinische Molekularbiologie und Biochemie.

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Versmold, H., Wenner, J. & Riegel, K. Changes of blood oxygen affinity and capacity and red cell 2,3-diphosphoglycerate evoked by exchange transfusions with ACD preserved blood in newborn infants: Their interrelationship and influences on oxygen supply of tissues and erythropoiesis. Z. Kinder-Heilk. 113, 1–18 (1972). https://doi.org/10.1007/BF00444886

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