title: 2,3-Diphosphoglycerate Concentrations in Autologous Salvaged Versus Stored Red Blood Cells and in Surgical Patients After Transfusion.
abstract: BACKGROUND
  Stored red blood cells (RBCs) are deficient in 2,3-diphosphoglycerate (2,3-DPG), but it is unclear how autologous salvaged blood (ASB) compares with stored blood and how rapidly 2,3-DPG levels return to normal after transfusion. Therefore, we compared levels of 2,3-DPG in stored versus ASB RBCs and in patients' blood after transfusion.
  
  
  METHODS
  Twenty-four patients undergoing multilevel spine fusion surgery were enrolled. We measured 2,3-DPG and the oxyhemoglobin dissociation curve (P50) in samples taken from the ASB and stored blood bags before transfusion and in blood samples drawn from patients before and after transfusion.
  
  
  RESULTS
  The mean storage duration for stored RBCs was 24 ± 8 days. Compared with fresh RBCs, stored RBCs had decreased 2,3-DPG levels (by approximately 90%; P < 0.0001) and a decreased P50 (by approximately 30%; P < 0.0001). However, ASB RBCs did not exhibit these changes. The mean 2,3-DPG concentration decreased by approximately 20% (P < 0.05) in postoperative blood sampled from patients who received 1 to 3 stored RBC units and by approximately 30% (P < 0.01) in those who received ≥4 stored RBC units. 2,3-DPG was unchanged in patients who received no stored blood or ASB alone. After surgery, 2,3-DPG levels recovered gradually over 3 postoperative days in patients who received stored RBCs.
  
  
  CONCLUSIONS
  Stored RBCs, but not ASB RBCs, have decreased levels of 2,3-DPG and a left-shift in the oxyhemoglobin dissociation curve. Postoperatively, 2,3-DPG levels remain below preoperative baseline levels for up to 3 postoperative days in patients who receive stored RBCs but are unchanged in those who receive only ASB RBCs.
authors.affiliation: From the Departments of Anesthesiology/Critical Care Medicine, Orthopedic Surgery, and Biomedical Engineering, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Andrew V
authors.initials: AV
authors.lastname: Scott
authors.forename: Enika
authors.initials: E
authors.lastname: Nagababu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Johnson
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Kebaish
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Lipsitz
authors.forename: Ian M
authors.initials: IM
authors.lastname: Dwyer
authors.forename: Gabriel S
authors.initials: GS
authors.lastname: Zuckerberg
authors.forename: Viachaslau M
authors.initials: VM
authors.lastname: Barodka
authors.forename: Dan E
authors.initials: DE
authors.lastname: Berkowitz
authors.forename: Steven M
authors.initials: SM
authors.lastname: Frank
mesh_terms: D019794:2,3-Diphosphoglycerate / Q000097:blood*; D000328:Adult; D000368:Aged; D001793:Blood Preservation; D001804:Blood Transfusion, Autologous; D017707:Erythrocyte Transfusion; D004912:Erythrocytes / Q000737:chemistry*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057725:Operative Blood Salvage; D010108:Oxyhemoglobins / Q000032:analysis; D013123:Spinal Fusion
chemical_list: D010108:Oxyhemoglobins; D019794:2,3-Diphosphoglycerate