Anti-Whole Serum polyclonal antibody

Introduction Several different whole-body physiology simulation tools (PST) using modeling techniques are now available with potential use for healthcare simulation, but these novel technologies lack objective analysis from an independent organization. Methods We identified BioGears, HumMod, and Muse as 3 PSTs that met our requirements for testing. We ran mild, moderate, and severe hemorrhage scenarios on each PST and collected outputs for comparison with each other and published human physiology data. Results All PSTs tested followed the expected tachycardic and hypotensive response to hemorrhage for all levels of severity with variable qualitative patterns. Complete data for analysis were not available in all PSTs for urine output, stroke volume, blood volume, hemoglobin, and serum epinephrine concentration, but the partial findings are discussed in detail. We determined the predicted time to reach hemorrhage shock based on the hemorrhage guidelines and compared this with time to cardiovascular collapse from each PST. Overall, the differences from known human physiology were much larger than expected before testing and trends show HumMod with the smallest difference for severe (-6.25%) and moderate (-1.42%) and Muse with the smallest difference for mild hemorrhage (27.9%). BioGears demonstrated the largest differences in all classifications of severity. Conclusions Our analysis of currently available whole-body PSTs provides insight into the novel, evolving field. We hope our efforts shed light to a wider audience to the exciting developments and uses of mathematical modeling for whole-body simulation and the potential for integration into healthcare simulation for medical education.

BACKGROUND Recent military and civilian experience suggests that fresh whole blood may be the preferred for treatment of hemorrhagic shock, but its use is limited by its 21-day shelf life. The red blood cell storage lesion and coagulation status of packed red blood cells (pRBCs) salvaged from expired whole blood are unknown. We hypothesized that pRBCs can be salvaged from previously stored whole blood. METHODS Cold stored, low-titer, O-positive, nonleukoreduced, whole blood units were obtained at 21 days of storage. Erythrocytes were separated by centrifugation, resuspended in AS-3, and stored for 21 additional days as salvaged pRBCs. The red blood cell storage lesion parameters of microvesicles, Band-3, free hemoglobin, annexin V, and erythrocyte osmotic fragility were measured and compared with pRBCs prepared at the time of donation and stored in AS-3 for 42 days (standard pRBCs). In additional experiments, murine pRBCs were prepared from expired whole blood units and compared with those stored under standard conditions. Mice underwent hemorrhage and resuscitation with standard and salvaged pRBC units, and serum cytokines and free hemoglobin were determined. RESULTS There were no significant differences in microvesicle formation or cell-free hemoglobin concentration between salvaged and standard pRBCs. There was decreased Band-3 and increased phosphatidylserine in the salvaged units as well as greater osmotic fragility. Salvaged pRBCs maintained consistent clot firmness. After hemorrhage and resuscitation in a murine model, salvaged pRBCs did not demonstrate increased serum cytokine levels. CONCLUSION Salvaged pRBCs from previously stored whole blood accumulate the red blood cell storage lesion in a similar fashion to standard pRBCs and maintain consistent coagulability when reconstituted with plasma. Salvaged pRBCs are not associated with an increased inflammatory response when used for resuscitation in a murine model. Salvaged pRBCs may be a viable product for utilization in the treatment of traumatic hemorrhagic shock.