The red blood cell (RBC) storage lesion is a series of morphological, functional and metabolic changes that RBCs undergo following collection, processing and refrigerated storage for clinical use. Since the biochemical attributes of the RBC unit shifts with time, transfusion of older blood products may contribute to cardiac complications, including hyperkalemia and cardiac arrest. We measured the direct effect of storage age on cardiac electrophysiology and compared with hyperkalemia, a prominent biomarker of storage lesion severity. Donor RBCs were processed using standard blood banking techniques. The supernatant was collected from RBC units (sRBC), 7-50 days post-donor collection, for evaluation using Langendorff-heart preparations (rat) or human stem-cell derived cardiomyocytes. Cardiac parameters remained stable following exposure to fresh sRBC (day 7: 5.9 +/- 0.2 mM K+), but older blood products (day 40: 9.7 +/- 0.4 mM K+) caused bradycardia (baseline: 279 +/- 5 vs day 40: 216 +/- 18 BPM), delayed sinus node recovery (baseline: 243 +/- 8 vs day 40: 354 +/- 23 msec), and increased the effective refractory period of the atrioventricular node (baseline: 77 +/- 2 vs day 40: 93 +/- 7 msec) and ventricle (baseline: 50 +/- 3 vs day 40: 98 +/- 10 msec) in perfused hearts. Beating rate was also slowed in human cardiomyocytes after exposure to older sRBC (-75+9%, day 40 vs control). Similar effects on automaticity and electrical conduction were observed with hyperkalemia (10-12 mM K+). This is the first study to demonstrate that older blood products directly impact cardiac electrophysiology, using experimental models. These effects are likely due to biochemical alterations in the sRBC that occur over time, including, but not limited to hyperkalemia. Patients receiving large volume and/or rapid transfusions may be sensitive to these effects.

中文翻译：

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红细胞储存病变对心脏电生理的潜在影响

红细胞（RBC）储存病变是一系列形态，功能和代谢变化，RBC在收集，加工和冷藏后用于临床用途。由于RBC单位的生化属性会随时间变化，因此输注较老的血液可能会导致心脏并发症，包括高钾血症和心脏骤停。我们测量了储存年龄对心脏电生理的直接影响，并与高钾血症进行了比较，高钾血症是储存病变严重程度的重要生物标志。使用标准的血库技术处理捐赠者的红细胞。在捐献者收集后7-50天从RBC单位（sRBC）收集上清液，以使用兰根多夫心脏制剂（大鼠）或人干细胞来源的心肌细胞进行评估。暴露于新鲜sRBC（第7天：5.9 +/- 0.2 mM K +）后，心脏参数保持稳定，但较老的血液制品（第40天：9.7 +/- 0.4 mM K +）引起心动过缓（基线：279 +/- 5 vs.天40：216 +/- 18 BPM），延迟的窦房结恢复（基线：243 +/- 8 vs第40天：354 +/- 23毫秒），并延长了房室结的有效不应期（基线：77 + / -在灌注心脏中，第40天相对于第40天：93 +/- 7毫秒）和心室（基线：第40天相对于第40天：98 +/- 10毫秒）。暴露于较老的sRBC后，人心肌细胞的搏动率也减慢了（-75 + 9％，与对照组相比，第40天）。高钾血症（10-12 mM K +）观察到对自动化和导电性的类似影响。这是第一项使用实验模型证明较旧的血液制品直接影响心脏电生理的研究。这些影响可能是由于sRBC中随时间发生的生化改变，包括但不限于高钾血症。接受大量和/或快速输血的患者可能对这些影响敏感。