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Li Z, Hu J, Kamberi M, Rapoza RJ. Mechanical stress-induced hemolysis of bovine blood is donor-dependent. Artif Organs 2023; 47:342-351. [PMID: 36134430 DOI: 10.1111/aor.14412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/14/2022] [Accepted: 09/13/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In vitro hemolysis testing is an essential method for assessing the hemolytic potential of blood pumps, but has poor reproducibility. Further investigations are needed to determine the sources and extent of variability and to find a practical way to reduce the variation. METHODS A small volume blood circulating loop driven by a Centrimag pump was established to provide relatively higher hemolysis readouts within a short run time and to be able to sequentially perform multiple repeated hemolysis tests in a working day. RESULTS The repeatability with this system was demonstrated as the %RSD at 4.3% for the NIH or MIH from three repeated tests using the same blood. The bovine blood from different randomly selected donors was tested and gave more than a two-fold difference in NIH results (0.077 vs. 0.032 g/100 L) under the same testing conditions and same pump. This wide variation in hemolysis using bovine blood from different donors happened repeatedly. More importantly, it was observed that the difference in hemolysis test results using the blood drawn from the same donor on multiple days was narrow although the native hematocrits varied. The %RSD of NIH values obtained on five different days were 6.8%, 8.4%, 11.5%, and 7.8% for donor-specific blood from donors 1 to 4, respectively. CONCLUSION The study results indicate that the mechanical stress-induced hemolysis behavior is donor-dependent. It has been also demonstrated that the reproducibility of in vitro hemolysis testing can be improved when the blood drawn from same donor is used.
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Affiliation(s)
- Zengji Li
- Research & Development, Abbott Vascular, Santa Clara, California, USA
| | - Jie Hu
- Research & Development, Abbott Vascular, Santa Clara, California, USA
| | - Marika Kamberi
- Research & Development, Abbott Vascular, Santa Clara, California, USA
| | - Richard J Rapoza
- Research & Development, Abbott Vascular, Santa Clara, California, USA
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2
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Singh HK, Biswas AK, Philip J, Kushwaha N, Mukherjee B, Baranwal AK. A study to assess the relationship between donor uric acid levels and supernatant hemolysis in stored packed red blood cell units. Asian J Transfus Sci 2022; 16:251-256. [PMID: 36687532 PMCID: PMC9855221 DOI: 10.4103/ajts.ajts_61_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/29/2021] [Accepted: 07/18/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Most of the red blood cell (RBC) storage lesions can be attributed to oxidative stress encountered by the RBCs throughout the duration of their storage. Various donor variables at the time of donation may be responsible for the total antioxidant capacity of the supernatant and thus, the "storability" and the magnitude of development of these RBC storage lesions. It is known that uric acid (UA) is responsible for more than 60% of the TAC of the blood. This study aims to explore the relationship between donor UA levels and the difference in percentage hemolysis, an important RBC storage lesion, on day 1 and day 21, in stored packed RBCs (PRBCs) units. MATERIALS AND METHODS The serum UA of 100 healthy voluntary male blood donors was estimated at the time of blood donation. The percentage hemolysis in the supernatant of the leukoreduced citrate phosphate dextrose/saline-adenine-glucose-mannitol RBC units (n = 100) prepared from these donors was calculated on day 1 and day 21. The difference in percentage hemolysis between donors with high normal serum UA levels (>7 mg/dL) was compared to that of the donors with low normal serum UA levels (<5 mg/dL) to observe the effect of donor UA levels on the difference in percentage hemolysis. RESULTS The mean of the differences in percentage hemolysis in the supernatant in low UA group (<5 mg/dL) was higher than the mean of the differences in percentage hemolysis in the supernatant in high UA group (>7 mg/dL) and this was statistically significant (P < 0.001). The donor serum UA level and difference in percentage hemolysis on day 21 and day 1 were found to be negatively co-related. CONCLUSION Higher levels of serum UA of blood donors seem to have a protective effect on the stored PRBC units as shown in this study. Hence, the potential of UA as one of the constituents of RBC additive solutions might lead to the enhancement of the quality of stored PRBC units by decreasing the RBC storage lesions.
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Affiliation(s)
- Himanshu Kumar Singh
- Department of Immunohematology and Blood Transfusion, Armed Forces Medical College, Pune, Maharashtra, India
| | - Amit Kumar Biswas
- Department of Immunohematology and Blood Transfusion, Armed Forces Medical College, Pune, Maharashtra, India
| | - Joseph Philip
- Department of Transfusion Medicine, Bharati Vidyapeeth University, Pune, Maharashtra, India
| | - Neerja Kushwaha
- Department of Immunohematology and Blood Transfusion, Armed Forces Medical College, Pune, Maharashtra, India
| | - Bhasker Mukherjee
- Department of Biochemistry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ajay K. Baranwal
- Department of Immunohematology and Blood Transfusion, Armed Forces Medical College, Pune, Maharashtra, India
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Krisher JA, Malinauskas RA, Day SW. The Effect of Blood Viscosity on Shear-Induced Hemolysis using a Magnetically Levitated Shearing Device. Artif Organs 2022; 46:1027-1039. [PMID: 35030287 DOI: 10.1111/aor.14172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/17/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Blood contacting medical devices, including rotary blood pumps, can cause shear-induced blood damage that may lead to adverse effects in patients. Due in part to an inadequate understanding of how cell-scale fluid mechanics impact red blood cell membrane deformation and damage, there is currently not a uniformly accepted engineering model for predicting blood damage caused by complex flow fields within ventricular assist devices (VADs). METHODS We empirically investigated hemolysis in a magnetically levitated axial Couette flow device typical of a rotary VAD. The device is able to accurately control the shear rate and exposure time experienced by blood and to minimize the effects of other uncharacterized stresses. Using this device, we explored the effects of both hematocrit and plasma viscosity on shear-induced hemolysis to characterize blood damage based on the viscosity-independent shear rate, rather than on shear stress. RESULTS Over a shear rate range of 20,000-80,000 1/s, the Index of Hemolysis (IH) was found to be dependent upon and well-predicted by shear rate alone. IH was independent of hematocrit, bulk viscosity, or the suspension media viscosity, and less correlated to shear stress (MSE=0.46-0.75) than to shear rate (MSE=0.06-0.09). CONCLUSION This study recommends that future investigations of shear-induced blood damage report findings with respect to the viscosity-neutral term of shear rate, in addition to the bulk whole blood viscosity measured at an appropriate shear rate relevant to the flow conditions of the device.
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Affiliation(s)
- James A Krisher
- Kate Gleason College of Engineering, Rochester Institute of Technology
| | | | - Steven W Day
- Kate Gleason College of Engineering, Rochester Institute of Technology
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4
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Barshtein G, Pajic-Lijakovic I, Gural A. Deformability of Stored Red Blood Cells. Front Physiol 2021; 12:722896. [PMID: 34690797 PMCID: PMC8530101 DOI: 10.3389/fphys.2021.722896] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/18/2021] [Indexed: 12/24/2022] Open
Abstract
Red blood cells (RBCs) deformability refers to the cells’ ability to adapt their shape to the dynamically changing flow conditions so as to minimize their resistance to flow. The high red cell deformability enables it to pass through small blood vessels and significantly determines erythrocyte survival. Under normal physiological states, the RBCs are attuned to allow for adequate blood flow. However, rigid erythrocytes can disrupt the perfusion of peripheral tissues and directly block microvessels. Therefore, RBC deformability has been recognized as a sensitive indicator of RBC functionality. The loss of deformability, which a change in the cell shape can cause, modification of cell membrane or a shift in cytosol composition, can occur due to various pathological conditions or as a part of normal RBC aging (in vitro or in vivo). However, despite extensive research, we still do not fully understand the processes leading to increased cell rigidity under cold storage conditions in a blood bank (in vitro aging), In the present review, we discuss publications that examined the effect of RBCs’ cold storage on their deformability and the biological mechanisms governing this change. We first discuss the change in the deformability of cells during their cold storage. After that, we consider storage-related alterations in RBCs features, which can lead to impaired cell deformation. Finally, we attempt to trace a causal relationship between the observed phenomena and offer recommendations for improving the functionality of stored cells.
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Affiliation(s)
- Gregory Barshtein
- Biochemistry Department, The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Alexander Gural
- Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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5
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Avenick D, Kidd L, Istvan S, Dong F, Richter K, Edwards N, Hisada Y, Posma JJN, Massih CA, Mackman N. Effects of storage and leukocyte reduction on the concentration and procoagulant activity of extracellular vesicles in canine packed red cells. J Vet Emerg Crit Care (San Antonio) 2021; 31:221-230. [PMID: 33751799 DOI: 10.1111/vec.13050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 06/01/2019] [Accepted: 06/24/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To characterize the size and procoagulant activity of extracellular vesicles (EV) that accumulate in canine packed red blood cells (pRBCs) over time and the effect of leukocyte reduction on these characteristics. DESIGN Prospective cohort study. SETTING Private small animal specialty referral hospital and university research laboratories. ANIMALS Ten healthy blood donor dogs. INTERVENTIONS Five pRBCs units were obtained according to standard protocols, and 5 were leukocyte-reduced prior to processing. Platelet-free supernatant from the pRBC units was collected on days 0, 10, 20, 32, and 42. MEASUREMENTS AND MAIN RESULTS Nanoparticle tracking analysis was performed to determine the size and concentration of EVs. Thrombin generation associated with phosphatidylserine-positive EVs was determined using a capture assay. Factor Xa generation associated with phosphatidylserine-positive EVs and tissue factor-positive EVs was measured in a subset of EVs isolated by centrifugation of the supernatant at 20,000 × g. R package nparLD and the Mann-Whitney U-test were used to determine the effect of duration of storage and the effect of leukocyte reduction, respectively. Small (mean < 125 nm) procoagulant EVs accumulated over time, with significant increases occurring on or after day 20 in both non-leukocyte reduced and leukocyte-reduced units. The procoagulant activity of the EVs was due to phosphatidylserine, not tissue factor. Increases in EV concentration and procoagulant activity occurred earlier in non-leukocyte reduced units. Extracellular vesicle accumulation and procoagulant activity were not decreased at any individual time point by leukocyte reduction. CONCLUSIONS Further studies characterizing and determining the clinical relevance of small procoagulant EVs in pRBCs are warranted.
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Affiliation(s)
| | - Linda Kidd
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California
| | | | - Fanglong Dong
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, California
| | - Keith Richter
- Veterinary Specialty Hospital, San Diego, California
| | | | - Yohei Hisada
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jens J N Posma
- Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Cherein Abdel Massih
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California
| | - Nigel Mackman
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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6
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Sparrow RL, Payne KA, Adams GG. Higher donor body mass index is associated with increased hemolysis of red blood cells at 42-days of storage: A retrospective analysis of routine quality control data. Transfusion 2020; 61:449-463. [PMID: 33231302 DOI: 10.1111/trf.16203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND For reasons unclear, some stored red blood cells (RBCs) have low hemolysis, while others have high hemolysis, which impacts quality consistency. To identify variables that influence hemolysis, routine quality control (QC) data for 42-days-stored RBCs with corresponding donor information were analyzed. STUDY DESIGN AND METHODS RBC QC and donor data were obtained from a national blood supplier. Regression models and analyses were performed on total cohort stratified by donor sex and by high hemolysis (≥90th percentile) vs control (<90th percentile) samples, including matching. RESULTS Data included 1734 leukoreduced RBCs (822 female, 912 male), processed by buffy coat-poor or whole blood filtration methods. Male RBCs had larger volume, hemoglobin content, and higher hemolysis than female RBCs (median hemolysis, 0.24% vs 0.21%; all P < .0001). Multivariable regression identified increased body mass index (BMI) and RBC variables were associated with higher hemolysis (P < .0001), along with older female age and buffy coat-poor processing method (P < .002). Logistic regression models comparing the high and control hemolysis subsets, matched for RBC component variables and processing method, identified overweight-obese BMI (>27 kg/m2 ) in males remained the single donor-related variable associated with higher hemolysis (P < .0001); odds ratio, 3 (95% confidence interval [CI], 1.3-6.7), increasing to 4 (95% CI, 1.8-8.6) for obese males (BMI > 30 kg/m2 ). Female donor obesity and older age trended toward higher hemolysis. CONCLUSION Donor BMI, sex, and female age influence the level of hemolysis of 42-days-stored RBCs. Other factors, not identified in this study, also influence the level of hemolysis.
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Affiliation(s)
- Rosemary L Sparrow
- Formerly Research and Development, Australian Red Cross Blood Service, West Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Katherine A Payne
- Formerly Research and Development, Australian Red Cross Blood Service, West Melbourne, Victoria, Australia.,National Manufacturing and Quality Division, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Geoffrey G Adams
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
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7
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Barshtein G, Rasmusen TL, Zelig O, Arbell D, Yedgar S. Inter-donor variability in deformability of red blood cells in blood units. Transfus Med 2020; 30:492-496. [PMID: 33015934 DOI: 10.1111/tme.12725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/26/2019] [Accepted: 09/07/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study aimed to examine the donor-to-donor variability in the deformability of red blood cells (RBCs) from freshly collected blood donations (F-RBC) and packed RBCs. BACKGROUND Packed RBCs are supplied for transfusion by the first-in-first-out (FIFO) criterion, assuming that their quality is the same for packed RBCs with equal storage duration. To challenge this notion, we determined the deformability of F-RBC and packed RBCs stored for different durations. METHODS Three RBC groups were employed: A. 79 samples of F-RBC; B. 76 samples of packed RBC units, randomly used for transfusion at different storage durations; and C. 65 samples of outdated packed RBCs stored for 35 to 37 days. All packed RBC units were non-leukofiltrated and stored in Citrate-phosphate-dextrose solution with adenine (CPDA-1). RBC deformability was determined using a computerised cell-flow properties analyser, which monitors the shape change of cells directly visualised in a narrow-gap flow chamber and provides the cells' deformability distribution in a large RBC population. RESULTS The F-RBC deformability exhibited a wide-range inter-donor variability. The cold storage of packed RBCs exerted a mild reduction of deformability, which became significant, compared to the initial inter-donor variability, only after 3 weeks of storage. CONCLUSION Packed RBCs are generally supplied for transfusion by the FIFO criterion based on the assumption that the storage duration is a key factor of RBC quality. This study demonstrates that the deformability of red blood cells is significantly different in donors, and substantial variability persists throughout the entire process of their storage. Therefore, the FIFO criterion is not sufficient for assessing the RBC deformability, which should, therefore, be specifically characterised for each unit.
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Affiliation(s)
- Gregory Barshtein
- Department of Biochemistry, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Tanja L Rasmusen
- Department of Biochemistry, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Orly Zelig
- Blood Bank, Hadassah-Hebrew University Hospital, Jerusalem, Israel
| | - Dan Arbell
- Department of Pediatric Surgery, Hadassah-Hebrew University Hospital, Jerusalem, Israel
| | - Saul Yedgar
- Department of Biochemistry, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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8
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Tarasev M, Chakraborty S, Light L, Alfano K, Pagani F. Red blood cell mechanical fragility as potential metric for assessing blood damage caused by implantable durable ventricular assist devices: Comparison of two types of centrifugal flow left ventricular assist devices. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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9
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Islamzada E, Matthews K, Guo Q, Santoso AT, Duffy SP, Scott MD, Ma H. Deformability based sorting of stored red blood cells reveals donor-dependent aging curves. LAB ON A CHIP 2020; 20:226-235. [PMID: 31796943 DOI: 10.1039/c9lc01058k] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A fundamental challenge in the transfusion of red blood cells (RBCs) is that a subset of donated RBC units may not provide optimal benefit to transfusion recipients. This variability stems from the inherent ability of donor RBCs to withstand the physical and chemical insults of cold storage, which ultimately dictate their survival in circulation. The loss of RBC deformability during cold storage is well-established and has been identified as a potential biomarker for the quality of donated RBCs. While RBC deformability has traditionally been indirectly inferred from rheological characteristics of the bulk suspension, there has been considerable interest in directly measuring the deformation of RBCs. Microfluidic technologies have enabled single cell measurement of RBC deformation but have not been able to consistently distinguish differences between RBCs between healthy donors. Using the microfluidic ratchet mechanism, we developed a method to sensitively and consistently analyze RBC deformability. We found that the aging curve of RBC deformability varies significantly across donors, but is consistent for each donor over multiple donations. Specifically, certain donors seem capable of providing RBCs that maintain their deformability during two weeks of cold storage in standard test tubes. The ability to distinguish between RBC units with different storage potential could provide a valuable opportunity to identify donors capable of providing RBCs that maintain their integrity, in order to reserve these units for sensitive transfusion recipients.
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Affiliation(s)
- Emel Islamzada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada and Centre for Blood Research, University of British Columbia, Canada
| | - Kerryn Matthews
- Centre for Blood Research, University of British Columbia, Canada and Department of Mechanical Engineering, University of British Columbia, Canada.
| | - Quan Guo
- Department of Mechanical Engineering, University of British Columbia, Canada.
| | - Aline T Santoso
- Centre for Blood Research, University of British Columbia, Canada and Department of Mechanical Engineering, University of British Columbia, Canada.
| | - Simon P Duffy
- Centre for Blood Research, University of British Columbia, Canada and Department of Mechanical Engineering, University of British Columbia, Canada. and British Columbia Institute of Technology, Canada
| | - Mark D Scott
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada and Centre for Blood Research, University of British Columbia, Canada and Canadian Blood Services, Canada
| | - Hongshen Ma
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada and Centre for Blood Research, University of British Columbia, Canada and Department of Mechanical Engineering, University of British Columbia, Canada. and School of Biomedical Engineering, University of British Columbia, Canada
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10
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Jani VP, Mailo S, Athar A, Lucas A, Williams AT, Cabrales P. Blood Quality Diagnostic Device Detects Storage Differences Between Donors. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2017; 11:1400-1405. [PMID: 28981425 PMCID: PMC5779850 DOI: 10.1109/tbcas.2017.2749304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In 2013, nearly 15 million units of banked blood were transfused in the United States of America alone. Blood shortages are expected to increase globally. Donated blood is not equal due to differences in quality and deterioration rate. There are no methods to detect time-dependent biochemical and biophysical changes of red blood cells (RBCs) or the deterioration rate of donated RBCs. Nine randomly selected RBC units collected by the San Diego Blood Bank were examined for interdonor variability over six weeks of storage. In vitro RBC quality was assessed weekly by conventional biochemical tests including free Hb, K+, ATP, P50, 2,3 DPG, lactate, and pH. Deformability was measured via cell filtration. Briefly, the RBC suspension (10% Hct), was forced through a 5.0-μm pore membrane (106 mm2) at various flow rates. No interdonor variability in biochemical or mechanical parameters was observed at baseline. Interdonor variability in biochemical properties (free Hb, K+, ATP, P50, 2,3 DPG, lactate, and pH) was observed after 14 days of storage. However, significant differences from baseline in RBC mechanical properties (i.e., filterability) were observed as early as 7 days into storage at the lowest flow rates and after 28 days of storage at all flow rates. There was a net decrease in filterability over time for all donors, but the rate at which filterability decreased (i.e., deterioration rates) was different when comparing individual donors. Changes in all biochemical parameters were significant different between donors. These data suggest that filterability is more sensitive to changes in blood quality than conventional biochemical parameters.
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11
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Bjerkvig CK, Strandenes G, Eliassen HS, Spinella PC, Fosse TK, Cap AP, Ward KR. "Blood failure" time to view blood as an organ: how oxygen debt contributes to blood failure and its implications for remote damage control resuscitation. Transfusion 2017; 56 Suppl 2:S182-9. [PMID: 27100755 DOI: 10.1111/trf.13500] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 12/22/2015] [Accepted: 12/22/2015] [Indexed: 01/08/2023]
Abstract
Hemorrhagic shock is both a local and systemic disorder. In the context of systemic effects, blood loss may lead to levels of reduced oxygen delivery (DO2 ) sufficient to cause tissue ischemia. Similar to other physiologic debts such as sleep, it is not possible to incur a significant oxygen debt and suffer no consequences for lack of timely repayment. While the linkage between oxygen debt and traditional organ failure (renal, hepatic, lung, and circulation) has been long recognized, we should consider failure in two additional linked and very dynamic organ systems, the endothelium and blood. These systems are very sensitive to oxygen debt and at risk for failing, having further implications on all other organ systems. The degree of damage to the endothelium is largely modulated by the degree of oxygen debt. Thus hypoperfusion is believed to begin a cascade of events leading to acute traumatic coagulopathy (ATC). This combination of oxygen debt driven endothelial damage and ATC might be considered collectively as "blood failure" due to the highly connected networks between these drivers. This article presents the implications of oxygen debt for remote damage control resuscitation strategies, such as permissive hypotension and hemostatic resuscitation. We review the impact of whole blood resuscitation and red blood cell efficacy in mitigation of oxygen debt. At last, this article recognizes the need for simple and durable, lightweight equipment that can detect the adequacy of tissue DO2 and thus patient needs for resuscitative care. Point-of-care lactate measuring may be a predictive tool for identifying high-risk trauma patients and occult shock because it provides information beyond that of vital signs and mechanism of injury as it may help predict the level of oxygen debt accumulation and need for resuscitation. Serial measurements may also be valuable as a tool in guiding resuscitative efforts.
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Affiliation(s)
- Christopher K Bjerkvig
- Norwegian Naval Special Operations Command , Haukeland University Hospital, Bergen, Norway.,Department of Anesthesia and Intensive Care , Haukeland University Hospital, Bergen, Norway
| | - Geir Strandenes
- Norwegian Naval Special Operations Command , Haukeland University Hospital, Bergen, Norway.,Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Håkon S Eliassen
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Philip C Spinella
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri.,Coagulation and Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Theodor K Fosse
- Norwegian Naval Special Operations Command , Haukeland University Hospital, Bergen, Norway.,Department of Anesthesia and Intensive Care , Haukeland University Hospital, Bergen, Norway
| | - Andrew P Cap
- Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Kevin R Ward
- Michigan Center for Integrative Research in Critical Care; Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
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12
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Levy E, David M, Barshtein G, Yedgar S, Livshits L, Ben Ishai P, Feldman Y. Dielectric Response of Cytoplasmic Water and Its Connection to the Vitality of Human Red Blood Cells. II. The Influence of Storage. J Phys Chem B 2017; 121:5273-5278. [PMID: 28453275 DOI: 10.1021/acs.jpcb.7b02662] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Maintaining an appropriate inventory of packaged blood products is a critical part of modern medicine. Consequently, the assessment of red blood cell (RBC) functionality is instrumental for the monitoring of the quality of stored RBC (sRBC) in the blood bank. We present a comprehensive study of sRBC lesion kinetics in SAGM (saline, adenine, glucose, mannitol) solution, using microwave dielectric spectroscopy (0.5-50 GHz) and cell deformability. As part of the research, we have isolated the microwave dielectric response of cytoplasmic water in sRBC. The extracted dielectric parameters are sensitive to the age of the cells and, in particular, to the critical moment of transition from discocyte to echinocyte. From the analysis of the dielectric relaxation as a function of storage-duration, we postulate that the behavior is rooted in the delicate interplay between bound and bulk water in the cellular interior. In particular, the microwave dielectric response reflects the moment when the continuous diffusion of oxygen to the cell and the oxygenation of hemoglobin affects the role played by water in the maintenance of cell integrity. These results open a possible new avenue for the noninvasive inspection of stored red blood cells, permitting a true inventory system for the modern blood bank.
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Affiliation(s)
- Evgeniya Levy
- Department of Applied Physics, The Rachel and Selim Benin School of Engineering and Computer Science, The Hebrew University of Jerusalem , Edmond J. Safra Campus, Jerusalem, 91904, Israel
| | - Marcelo David
- Department of Applied Physics, The Rachel and Selim Benin School of Engineering and Computer Science, The Hebrew University of Jerusalem , Edmond J. Safra Campus, Jerusalem, 91904, Israel
| | - Gregory Barshtein
- Department of Biochemistry & Molecular Biology, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem , Ein Kerem, Jerusalem, 91120, Israel
| | - Saul Yedgar
- Department of Biochemistry & Molecular Biology, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem , Ein Kerem, Jerusalem, 91120, Israel
| | - Leonid Livshits
- Department of Biochemistry & Molecular Biology, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem , Ein Kerem, Jerusalem, 91120, Israel
| | - Paul Ben Ishai
- Department of Physics, Ariel University , P.O.B. 3, Ariel 40700, Israel
| | - Yuri Feldman
- Department of Applied Physics, The Rachel and Selim Benin School of Engineering and Computer Science, The Hebrew University of Jerusalem , Edmond J. Safra Campus, Jerusalem, 91904, Israel
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13
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Tarasev M, Muchnik M, Light L, Alfano K, Chakraborty S. Individual variability in response to a single sickling event for normal, sickle cell, and sickle trait erythrocytes. Transl Res 2017; 181:96-107. [PMID: 27728824 DOI: 10.1016/j.trsl.2016.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 09/15/2016] [Accepted: 09/17/2016] [Indexed: 12/26/2022]
Abstract
Hemoglobin S (Hb-S) polymerization is the primary event in sickle cell disease causing irreversible damage to red blood cell (RBC) membranes over repeated polymerization cycles. A single polymerization triggered by a hypoxic environment was reported to result in reversibly (upon reoxygenation) decreased RBC deformability and increased mechanical fragility (MF). Individualized responses have not been reported, although RBC fragility can vary significantly even among healthy individuals. This study evaluates individual variability in response to a single hypoxia-induced sickling event, through changes in RBC MF. Blood was drawn from 10 normal (AA), 11 sickle cell (SS), and 7 sickle trait (AS) subjects-with Hb-S fraction, osmotic fragility, and medical history also collected. Mechanical stress was applied using a bead mill at 50-Hz oscillation for 0.5-30 minutes. MF profiles here give percent hemolysis upon successive durations of stressing. MF was measured for AA, SS, and AS cells-each equilibrated (1) with air, (2) with nitrogen in an anaerobic chamber, and (3) with air after the hypoxic event. While AA subjects exhibited significantly different changes in fragility upon hypoxia, in all cases there was recovery to close to the initial MF values on reoxygenation. For AS subjects, recovery at reoxygenation was observed only in about half of the cases. Fragility of SS cells increased in hypoxia and decreased with reoxygenation, with significantly variable magnitude of recovery. The variability of response for individual AS and SS subjects indicates that some are potentially at higher risk of irreversible hypoxia-induced membrane damage.
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Affiliation(s)
| | | | - Lucia Light
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
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14
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Ziegler LA, Olia SE, Kameneva MV. Red Blood Cell Mechanical Fragility Test for Clinical Research Applications. Artif Organs 2016; 41:678-682. [PMID: 27925242 DOI: 10.1111/aor.12826] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/30/2016] [Accepted: 07/13/2016] [Indexed: 12/31/2022]
Abstract
Red blood cell (RBC) susceptibility to mechanically induced hemolysis, or RBC mechanical fragility (MF), is an important parameter in the characterization of erythrocyte membrane health. The rocker bead test (RBT) and associated calculated mechanical fragility index (MFI) is a simple method for the assessment of RBC MF. Requiring a minimum of 15.5 mL of blood and necessitating adjustment of hematocrit (Ht) to a "standard" value (40%), the current RBT is not suitable for use in most studies involving human subjects. To address these limitations, we propose a 6.5 mL reduced volume RBT and corresponding modified MFI (MMFI) that does not require prior Ht adjustment. This new method was assessed for i) correlation to the existing text, ii) to quantify the effect of Ht on MFI, and iii) validation by reexamining the protective effect of plasma proteins on RBC MF. The reduced volume RBT strongly correlated (r = 0.941) with the established large volume RBT at matched Hts, and an equation was developed to calculate MMFI: a numerical estimation (R2 = 0.923) of MFI if performed with the reduced volume RBT at "standard" (40%) Ht. An inversely proportional relationship was found between plasma protein concentration and RBC MF using the MMFI-reduced volume method, supporting previous literature findings. The new reduced volume RBT and modified MFI will allow for the measurement of RBC MF in clinical and preclinical studies involving humans or small animals.
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Affiliation(s)
- Luke A Ziegler
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Salim E Olia
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marina V Kameneva
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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15
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Tarasev M, Chakraborty S, Light L, Davenport R. Impact of environment on Red Blood Cell ability to withstand mechanical stress. Clin Hemorheol Microcirc 2016; 64:21-33. [DOI: 10.3233/ch-152037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- M. Tarasev
- Blaze Medical Devices, Ann Arbor, MI, USA
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16
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Barshtein G, Pries AR, Goldschmidt N, Zukerman A, Orbach A, Zelig O, Arbell D, Yedgar S. Deformability of transfused red blood cells is a potent determinant of transfusion-induced change in recipient's blood flow. Microcirculation 2016; 23:479-486. [DOI: 10.1111/micc.12296] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/06/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Gregory Barshtein
- Department of Biochemistry; Hebrew University Faculty of Medicine; Jerusalem Israel
| | | | - Neta Goldschmidt
- Department of Hematology; Hadassah University Hospital; Jerusalem Israel
| | - Ayelet Zukerman
- Department of Biochemistry; Hebrew University Faculty of Medicine; Jerusalem Israel
| | - Ariel Orbach
- Department of Biochemistry; Hebrew University Faculty of Medicine; Jerusalem Israel
| | - Orly Zelig
- Blood Bank; Hadassah-Hebrew University Hospital; Jerusalem Israel
| | - Dan Arbell
- Department of Pediatric Surgery; Hadassah- Hebrew University Hospital; Jerusalem Israel
| | - Saul Yedgar
- Department of Biochemistry; Hebrew University Faculty of Medicine; Jerusalem Israel
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17
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Alfano KM, Chakraborty S, Tarasev M. Differences in bead-milling-induced hemolysis of red blood cells due to shape and size of oscillating bead. Biomed Mater Eng 2016; 27:405-412. [PMID: 27689573 DOI: 10.3233/bme-161594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Red blood cell (RBC) susceptibility to hemolysis - or fragility - can be profiled by subjecting a sample to progressive durations of mechanical stress and measuring hemolysis upon each. The ability to control stress application with multiple variable parameters can be useful in various areas of research. Bead milling, by oscillating an object in a blood sample, can offer control of parameters including oscillation force and frequency. OBJECTIVE This work addresses the role of bead shape and size, for a given container, in potentially creating qualitatively as well as quantitatively different fluidic stresses in the sample. METHODS Identical, diluted RBC samples were stressed via bead milling using different beads, with other parameters the same. Resulting hemolysis was plotted for several time increments in each case. RESULTS For a cylindrical bead oscillating at a given frequency and force, bead length was a determinant of albumin's protective effect on RBC, as reflected by mechanical fragility. Compared to a sphere of same diameter, the protective effect was absent with shorter cylinders, whereas for longer ones it appeared enhanced. CONCLUSIONS Bead milling based RBC fragility testing could present a useful tool for creating, and studying effects of different shear stress types in inducing hemolysis.
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Affiliation(s)
- Kenneth M Alfano
- University of Michigan, Ann Arbor, MI 48109, USA.,Blaze Medical Devices, 330 E. Liberty, LL, Ann Arbor, MI 48104, USA. E-mails: , ,
| | - Sumita Chakraborty
- Blaze Medical Devices, 330 E. Liberty, LL, Ann Arbor, MI 48104, USA. E-mails: , ,
| | - Michael Tarasev
- Blaze Medical Devices, 330 E. Liberty, LL, Ann Arbor, MI 48104, USA. E-mails: , ,
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18
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Farrugia A, Starr D. Where now for transfusion: the evolution of a paradigm and its logical progression. Transfusion 2016; 56 Suppl 2:S224-32. [PMID: 27100760 DOI: 10.1111/trf.13581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/12/2015] [Accepted: 02/15/2016] [Indexed: 12/27/2022]
Abstract
The development of transfusion over the past century and a half has been described as one of the blessings of modern medicine. But, in some ways, it is emerging as a decidedly mixed blessing, bringing epidemics as well as improved health. Given all the practice has been through, now is the right time to take a critical look at blood transfusion as it is practiced today, and whether it serves the individual patient as effectively as the interests of those who administer it.
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Affiliation(s)
- Albert Farrugia
- School of Surgery, QEII Medical Centre, The University of Western Australia (M509), Crawley, Australia.,Kedrion S.P.A, Lucca, Italy
| | - Douglas Starr
- College of Communication, Boston University, Boston, Massachusetts
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19
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Tzounakas VL, Georgatzakou HT, Kriebardis AG, Voulgaridou AI, Stamoulis KE, Foudoulaki-Paparizos LE, Antonelou MH, Papassideri IS. Donor variation effect on red blood cell storage lesion: a multivariable, yet consistent, story. Transfusion 2016; 56:1274-86. [PMID: 27028307 DOI: 10.1111/trf.13582] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/11/2016] [Accepted: 02/11/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies have shown that baseline hematologic characteristics concerning or influencing red blood cell (RBC) properties might affect storage lesion development in individual donors. This study was conducted to evaluate whether variation in hemolysis, microparticle accumulation, phosphatidylserine (PS) exposure, and other storage lesion-associated variables might be a function of the prestorage hematologic and biologic profiles of the donor. STUDY DESIGN AND METHODS Ten eligible, regular blood donors were paired and studied before donation (fresh blood) and during storage of RBCs in standard blood banking conditions. Plasma and cellular characteristics and modifications were evaluated by standard laboratory and biochemical or biologic analyses as well as by statistical and network analysis tools. RESULTS Nitrate/nitrite and other bioactive factors exhibited high interdonor variability, which further increased during storage in a donor-specific manner. Storage lesion evaluators, including RBC fragility and PS exposure, fluctuated throughout the storage period in proportion to their values in fresh blood. Donors' levels of phosphatidylserine exposure and hemoglobin F correlated with stored cells' mean cell (RBC) Hb concentration, oxidative stress markers, and cellular fragility. DISCUSSION Storage lesion indicators change in an orderly fashion, namely, by following donor-related prestorage attributes. These correlations are illustrated for the first time in "prestorage versus storage" biologic networks, which might help determine the best candidates for in vivo biomarkers of storage quality and provide deeper insight into the apparently complex donor variation effect on the RBC storage lesion.
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Affiliation(s)
| | | | - Anastasios G Kriebardis
- Laboratory of Hematology and Transfusion Medicine, Department of Medical Laboratories, Faculty of Health and Caring Professions, Technological and Educational Institute of Athens, Athens, Greece
| | | | - Konstantinos E Stamoulis
- Hellenic National Blood Centre, Acharnes, Athens, Greece.,Regional Blood Transfusion Center, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
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20
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Atkins CG, Buckley K, Chen D, Schulze HG, Devine DV, Blades MW, Turner RFB. Raman spectroscopy as a novel tool for monitoring biochemical changes and inter-donor variability in stored red blood cell units. Analyst 2016; 141:3319-27. [DOI: 10.1039/c6an00373g] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Raman spectroscopy has been used to retrieve biochemical information from the supernatant of stored red blood cells (RBCs), demonstrating that some units of donated RBCs accumulate lactate much more readily than others.
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Affiliation(s)
- Chad G. Atkins
- Michael Smith Laboratories
- The University of British Columbia
- Vancouver
- Canada
- Department of Chemistry
| | - Kevin Buckley
- Michael Smith Laboratories
- The University of British Columbia
- Vancouver
- Canada
| | - Deborah Chen
- Department of Pathology and Laboratory Medicine
- The University of British Columbia
- Vancouver
- Canada
- Centre for Blood Research
| | - H. Georg Schulze
- Michael Smith Laboratories
- The University of British Columbia
- Vancouver
- Canada
| | - Dana V. Devine
- Department of Pathology and Laboratory Medicine
- The University of British Columbia
- Vancouver
- Canada
- Centre for Blood Research
| | - Michael W. Blades
- Department of Chemistry
- The University of British Columbia
- Vancouver
- Canada
| | - Robin F. B. Turner
- Michael Smith Laboratories
- The University of British Columbia
- Vancouver
- Canada
- Department of Chemistry
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21
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22
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Winter KM, Johnson L, Webb RG, Marks DC. Gamma-irradiation of deglycerolized red cells does not significantly affect in vitro quality. Vox Sang 2015; 109:231-8. [PMID: 25953334 DOI: 10.1111/vox.12282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/11/2015] [Accepted: 03/11/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Red cells frozen with glycerol may require gamma-irradiation after thawing and deglycerolization for transfusion to at-risk patients. Both freezing and irradiation are known to cause red cell damage. However, the effect of irradiation on the quality of deglycerolized red cells and the optimal shelf life of such a component is currently unknown. MATERIALS AND METHODS Red cells (<7 days) were pooled, split and glycerolized using an ACP-215 automated cell washer (n = 12 pairs) and frozen at -80°C. Red cells were thawed, deglycerolized and resuspended in SAG-M. One of each pair was gamma-irradiated, while the other served as a control. Products were stored at 2-6°C and sampled for in vitro testing immediately after irradiation, and at 24 and 48 h postirradiation. RESULTS Irradiation of deglycerolized red cells led to a >1·5-fold increase in extracellular potassium, compared to control units at 24 and 48 h postirradiation. Other parameters, including haemolysis, were not significantly affected by irradiation postdeglycerolization. CONCLUSION Deglycerolized, irradiated red cells had increased supernatant potassium, but remained of acceptable quality for 24 h postirradiation.
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Affiliation(s)
- K M Winter
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia
| | - L Johnson
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia
| | - R G Webb
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia
| | - D C Marks
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia
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23
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24
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Classic and alternative red blood cell storage strategies: seven years of "-omics" investigations. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 13:21-31. [PMID: 25369599 DOI: 10.2450/2014.0053-14] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/13/2014] [Indexed: 12/12/2022]
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25
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Spencer BR. Have it your way: customized donor management in the information age. Transfusion 2014; 54:758-61. [DOI: 10.1111/trf.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Bryan R. Spencer
- New England Blood Services Region; American Red Cross; Dedham MA
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