Article Summary: Red blood cell deformability during storage, towards functional proteomics and metabolomics in the Blood Bank

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Judith C.A. CluitmansMax R. HardemanSip DinklaRoland Brock, and Giel J.C.G.M. Bosman

During the storage of blood at blood banks, storage lesions of RBC’s can occur; various metabolic, structural and morphologic changes. Blood bank quality guidelines focus on the acceptable extent of these metabolic changes. However, the actual consequences of these changes for RBC survival after transfusion are mostly unknown. The storage-associated morphological changes suggest that alterations in membrane structure are more likely to cause an increase in harmful effects; in this article available data are reviewed on aging-associated and storage-associated alterations in RBC deformability.

RBC deformability is a major determinant of RBC survival and the ability to adapt their shape to the dynamic flow conditions plays a key role in the microcirculation. Changes in  mean corpuscular hemoglobin concentration (MCHC) occur during storage in Saline, Adenine, Glucose and Manitol solution (SAGM), proteomic and biochemical data suggest oxidation as well as breakdown of structural proteins already in the first weeks of storage. Recent data, obtained by the Lorrca®, did not indicate that the deformability of SAGM-stored RBC’s decreases with storage time, not even after 5 weeks. In contrast, a comparison of fresh RBC’s isolated directly from whole blood with RBC’s in their first week of storage strongly suggests that deformability does already decrease during the three days of processing from blood to blood bag in the blood bank.

Functionally relevant molecular changes are likely to become irreversible after 14 to 21 days of storage, because of progressive proteolysis and vesicle formation. It will be instrumental to uncover the triggering events and the underlying signaling pathways to eventually understand and possible prevent the untimely disappearance of a considerable fraction of the transfused RBC’s within the first hours after transfusion. Proteomics and metabolomics will contribute in analyzing the accompanying changes in membrane structure. The main challenge is the development of biologically relevant read-out systems, and the transition of blood bank research from quality control in the blood bag to quality control in the patient.

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