Pre-separation storage of whole blood: the effect of temperature on red cell 2,3-diphosphoglycerate and myeloperoxidase in plasma

Do We Store Packed Red Blood Cells under "Quasi-Diabetic" Conditions?

Red blood cell (RBC) transfusion is one of the most common therapeutic procedures in modern medicine. Although frequently lifesaving, it often has deleterious side effects. RBC quality is one of the critical factors for transfusion efficacy and safety. The role of various factors in the cells’ ability to maintain their functionality during storage is widely discussed in professional literature. Thus, the extra- and intracellular factors inducing an accelerated RBC aging need to be identified and therapeutically modified. Despite the extensively studied in vivo effect of chronic hyperglycemia on RBC hemodynamic and metabolic properties, as well as on their lifespan, only limited attention has been directed at the high sugar concentration in RBCs storage media, a possible cause of damage to red blood cells. This mini-review aims to compare the biophysical and biochemical changes observed in the red blood cells during cold storage and in patients with non-insulin-dependent diabetes mellitus (NIDDM). Given the well-described corresponding RBC alterations in NIDDM and during cold storage, we may regard the stored (especially long-stored) RBCs as “quasi-diabetic”. Keeping in mind that these RBC modifications may be crucial for the initial steps of microvascular pathogenesis, suitable preventive care for the transfused patients should be considered. We hope that our hypothesis will stimulate targeted experimental research to establish a relationship between a high sugar concentration in a storage medium and a deterioration in cells’ functional properties during storage.

Effects of whole blood storage in a polyolefin blood bag on platelets for acute normovolemic hemodilution

Acute normovolemic hemodilution (ANH) is a potential transfusion method for platelets, as well as for red blood cells. However, previous studies have shown that whole blood storage in ANH decreases platelet aggregability by 14.7–76.3% and that this decrease is not recovered by reinfusion. We investigated whether a new whole blood storage method for 6 h using a polyolefin bag, based on the platelet concentrates storage method, would maintain platelet function better than the conventional method using a polyvinyl chloride bag. We demonstrated that storage of whole blood in a polyolefin bag maintained ADP-induced aggregation rates at more than twofold higher than those in a polyvinyl chloride bag, and also significantly suppressed P-selectin expression, a platelet activation marker (ADP-induced aggregation rates: 24.6 ± 5.1% vs. 51.7 ± 11.5%, p = 0.002; P-selectin expression; 50.3 ± 8.4MFI vs. 31.6 ± 9.3MFI, p = 0.018). These results could be attributed to the high gas permeability of polyolefin, which lowered PCO₂ and maintained a high pH with or without agitation. There were no significant changes in platelet count and red blood cell parameters due to the storage methods. Our results suggest that ANH using polyolefin bags is advantageous in improving hemostatic function compared to the conventional method.

Ambient overnight hold of whole blood prior to the manufacture of blood components

Blood services routinely separate whole blood into components that are then stored under different conditions. The storage conditions used for whole blood prior to separation must therefore be a compromise between the needs of the red cells (which benefit from refrigeration) and plasma and platelets (which are better preserved at ambient temperature). For many years, the approach has been to manufacture plasma and platelet components on the day of blood collection, and to refrigerate any unprocessed blood for manufacture into red cell components on the following day. However, this can make it challenging to maintain adequate stocks of all components. The European practice of 'ambient hold' of whole blood for up to 24 hours prior to processing allows greater flexibility in blood component manufacture, and the data reviewed suggest there is relatively little impact on the quality of red cell or plasma components, and an improvement in the quality of platelet components.

The effect of storing whole blood at 22 degrees C for up to 24 hours with and without rapid cooling on the quality of red cell concentrates and fresh-frozen plasma

BACKGROUND

Storage of whole blood (WB) for less than 24 hours at ambient temperature is permitted in Europe, but data directly comparing storage with and without active cooling are lacking, which was investigated and compared to current standard methods.

STUDY DESIGN AND METHODS

WB was stored in one of four different ways for 24 hours after donation before processing on Day 1 to red cell concentrates (RCCs) in saline-adenine-glucose-mannitol and fresh-frozen plasma (FFP; n = 20 each): 1) at 22 degrees C in plastic trays, 2) in cooling devices (Compocool II, NPBI), 3) at 4 degrees C, or 4) processed from WB without storage less than 8 hours from donation (Day 0).

RESULTS

2,3-Diphosphoglycerate (2,3-DPG) in RCCs were lower after ambient storage compared with those processed on Day 0 or after 4 degrees C storage. Rapid cooling slowed the loss of 2,3-DPG but levels were undetectable by Day 21 with any method. On Day 42 of RCC storage, there was no significant difference between storage methods in levels of adenosine triphosphate or hemolysis. Potassium levels were lower in RCCs from WB stored at ambient compared with those produced on Day 0, regardless of the use of cooling plates. FFP produced from WB on Day 0 or after storage at ambient with or without active cooling met UK specifications (>75% of units >0.70 IU/mL Factor VIII).

CONCLUSION

These data suggest that RCCs and FFP produced from WB that has been stored at ambient temperature with or without active cooling are of acceptable quality compared with those produced using current standard methods in the United Kingdom.

The effect of pre-storage cooling on 2,3-DPG levels in red cells stored in SAG-M

BACKGROUND

The concentration of red cell 2,3-DPG (2,3-diphosphoglycerate) rapidly decreases during storage. A favourable effect on red cell 2,3-DPG has been demonstrated by rapid cooling of whole blood prior to storage. In our study we have investigated how different methods of cooling whole blood immediately after donation effect 2,3-DPG levels during storage.

STUDY DESIGN AND METHODS

Thirty-six whole blood units (in 6 groups) of 450 ml were collected in 63 ml CPD. SAG-M was used as preservative solution for red cell concentrates (RCC). The units in one group were cooled down at ambient temperature, while units in the other groups were cooled down rapidly by different ways immediately after bleeding. Samples from the whole blood units were collected at various days during storage for 2,3-DPG measurements.

RESULTS

The decline in 2,3-DPG during the first two weeks of storage was significantly slower in the groups which were cooled down rapidly to 17-18 degrees C within 1h after bleeding (all p<or=0.0001).

CONCLUSION

The rapid fall in 2,3-DPG can be delayed significantly by cooling whole blood units rapidly after bleeding. Most of the methods we used in our study can easily be implemented in daily routine practise in any blood bank.