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Biomedical subjects

R B Dawson

Publications and source records attributed to R B Dawson.

At least 19 recordsLinked to original sources

Hemapheresis in pregnancy.

Plasma exchange in pregnancy has benefited those diseases that occur and are treated in the nonpregnant patient. In addition, special emphasis was given to diseases unique to pregnancy, such as hemolytic disease of the newborn, which is significantly modified by plasma exchange therapy. Fluid volumes, replacement solution, and techniques were discussed.

Blood Component Removal

Autotransfusions.

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Blood Transfusion, Autologous

The significance of 2,3-DPG in red blood cell transfusions.

This review will begin by giving the highlights of the history and explain development of the basic science knowledge of hemoglobin chemistry, function, and physiology. The necessary involvement of red cell metabolism, as it pertains to the maintenance of 2,3-diphosphoglycerate (2,3-DPG) levels, both normally and under the perturbed and experimental conditions of blood storage, will be given as part of the basic science data. The clinical science and transfusion data will comprise the main critical aspects of the paper. Analysis and comment of over 20 studies will be given on the effects of animal and human transfusions with altered 2,3-DPG levels. Decreased survival and organ function have been demonstrated with transfusion of low 2,3-DPG red cells, with or without anemia, in the conditions of exercise, shock, hypotension, ischemia, cardiac surgery, hypoxia, sepsis, and acidosis. By critical analysis of these studies, recommendations on general and specific patient needs for red cell transfusions with normal or high 2,3-DPG levels are given.

Adult

Preservation of erythrocytes using metabolic regulators and mutrients. V. Inosine and methylene blue.

Methylene blue and inosine have been shown to stimulate glycolytic metabolism in the erythrocytes, increasing the concentration of 2.3-diphosphoglycerate (2,3-DPG), which is necessary for hemoglobin function, by regulating oxidative metabolism and providing a five-carbon nutrient for glycolysis, respectively. However, a recent study suggested that the methylene blue effect was dependent on the presence of inosine. This study was designed to establish, if possible, the existence of a methylene blue effect and to confirm the usefulness of inosine. The optimal concentration of inosine for increasing 2,3-DPG synthesis in a CPD-adenine preservative is confirmed to be 10--15 mM. Concentrations of 2,3-DPG were maintained in the erythrocytes at normal or higher levels for 21 days of storage with 10 or 15 mM inosine, whether the methylene blue was present or not. However, when methylene blue was present, 2,3-DPG concentrations were significantly better maintained.

Adenine

Hemoglobin function in stored blood, XVII. Maintenance of red cell 2,3 DPG (function) and ATP (viability) for six weeks in ACD or CPD-adenine-inosine-methylene blue.

Blood preservatives containing adenine for six week storage have been prepared with inosine and methylene blue at various pH levels in order to maintain, 23-DPG levels for immediate oxygen transport upon transfusion. In one experiment, the adverse effect of a high pH on ATP maintenance was demonstrated in the presence of methylene blue and inosine. In this and other experiments it was clear that ATP was better maintained in low pH preservatives and DPG better maintained in higher pH preservatives. However, 2,3-DPG levels were kept from falling with CPD-adenine-inosine over a wide range of pH values. A CPD-adenine-inosine preservative at a pH 5.8 maintained normal DPG levels for three weeks of storage. A similar preservative but with a pH of 6.6 maintained normal DPG levels for 35 days of storage. It is suggested that if all blood bank units are going to have normal DPG levels for optimal oxygen transport at the time of transfusion then a CPD preservative with a higher pH and/or metabolic nutrients and regulators such as inosine or methylene blue would be required.

Adenine

Hemoglobin function in stored blood. XIII. A citrate-adenine preservative with optimal pH to maintain red cell 2,3-DPG (function) and ATP (viability).

Increasing pH by a 0.5 increment over the commonly used preservative, acid-citrate-dextrose with adenine (ACD-Ad), results in a significant improvement in 2,3-DPG, with no significant loss in concentrations of ATP. The intermediate pH preservative, 6.0, also had ATP concentrations which equaled those of the low pH preservatives, 5.0 and 5.5, from the 21st to the 42nd day of storage. A citrate-adenine preservative, with a pH between 5.5 and 6.0, would seem to be optimal for maintenance of hemoglobin function and red cell viability, as determined by measurements of 2,3-DPG and ATP concentrations.

Adenosine Triphosphate

Blood preservation XVI packed red cell storage in CPD-adenine.

Interest has been renewed in CPD-adenine as a long-term liquid blood preservative. The question of whether the metabolic product of adenine, 2,8-dioxyadenine was toxic to humans has apparently been resolved by extensive animal and human studies in favor of there being no potential toxicity in the amounts used in blood preservation. Sweden is adopting CPD-adenine (0.25 mM) as its national blood preservative after ten years of clinical experience in trials. They have shown that each additional week of storage time beyond the current three weeks with CPD results in a 50 per cent reduction of wasteage caused by outdating. They are adopting the 35-day time for regular use with 42 days for an emergency reserve supply. However, many units of blood in the U.S. are stored as packed red blood cells and the question has been raised as to whether there is sufficient glucose in the preservative to maintain red blood cell metabolism in the packed cell unit. The present investigation indicates that there is sufficient glucose for 35 days of packed cell storage in CPD-adenine (0.25 mM) but in some units this might be marginal at 42 days of storage.

Adenine

Blood preservation using metabolic regulators and nutrients: XXI. Further studies on pyruvate and DHA (dihydroxyacetone).

CPD-adenine is being adopted in Europe for five weeks for regular blood bank storage and six weeks for emergency use storage. There may be a need to maintain normal levels of 2,3-DPG during this prolonged storage time. In a pilot study from this laboratory, improved 2,3-DPG maintenance was noted with DHA and pyruvate during the fifth and sixth weeks of storage. DHA and pyruvate are relatively unstable in aqucous solutions and in the present study extra care was taken with their experimental use. The additive effect of using DHA and pyruvate together in maintaining 2,3-DPG was confirmed in this study in which significant improvements were seen as early as the seventh day of storage.

Adenine

Blood storage XXII. Improvement in red blood cell 2,3-DPG levels at six weeks by 20 mM PO4 in CPD-adenine-inosine.

Inorganic phosphate has been known to assist red blood cell maintenance of ATP and in the presence of inosine to assist in the maintenance of 2,3-DPG. High concentrations of phosphate, while helping ATP maintenance, were found to be deleterious to 2,3-DPG maintenance in CPD-adenine preservatives. However, in the presence of inosine, concentrations of phosphate as high as 10 mM were advantageous to 2,3-DPG maintenance. The present study extends the observations on ATP and 2,3-DPG maintenance in CPD-adenine-inosine preservatives from the previous 10 mM to 20 mM phosphate. A high phosphate (20 mM) effect has been seen as improved maintenance of 2,3-DPG levels during the fifth and sixth weeks of storage of whole blood at 4C. This supports the previously reported observation of improved maintenance of 2,3-DPG in a 10 mM phosphate preservative. This is ten times the 2 mM phosphate concentration in CPD-adenine. In the low phosphate preservative (2 mM), 2,3-DPG maintenance is less than that in all of the higher phosphate preservatives after the second week of storage. ATP concentrations in this experiment show good maintenance throughout six weeks of storage.

Adenine