Migration of di(2-ethylhexyl) phthalate, diisononylcyclohexane-1,2-dicarboxylate and di(2-ethylhexyl) terephthalate from transfusion medical devices in labile blood products: A comparative study

BACKGROUND AND OBJECTIVES

Polyvinyl chloride (PVC) plasticized with di(2-ethylhexyl) phthalate (DEHP) is a widely used material for medical transfusion devices. Not covalently bound to PVC, DEHP can migrate into blood products during storage. Recognized as an endocrine disruptor and raising concerns about its potential carcinogenicity and reprotoxicity, DEHP is gradually being withdrawn from the medical device market. Therefore, the use of alternative plasticizers, such as diisononylcyclohexane-1,2-dicarboxylate (DINCH) and di(2-ethylhexyl) terephthalate (DEHT), as potential candidates for the replacement of DEHP in medical transfusion devices has been investigated. The purpose of this study was to evaluate the quantity of PVC-plasticizers in the blood components according to their preparation, storage conditions and in function of the plasticizer.

MATERIALS AND METHODS

Whole blood was collected, and labile blood products (LBPs) were prepared by the buffy-coat method with a PVC blood bag plasticized either with DEHP, DINCH or DEHT. DINCH and DEHT equivalent concentrations were quantified in LBPs by liquid chromatography-tandem mass spectrometry or coupled with UV and compared to DEHP equivalent concentrations.

RESULTS

The plasticizer equivalent concentration to which a patient is exposed during a transfusion depends on the preparation of LBPs as well as their storage conditions, that is, temperature and storage time. At day 1, for all LBPs, the migration of DEHP is 5.0 and 8.5 times greater than DINCH and DEHT, respectively. At the end of the 49 days storage period, the DEHP equivalent concentration in red blood cells concentrate is statistically higher when compared to DINCH and DEHT, with maximal values of 1.85, 1.13 and 0.86 μg/dm2 /mL, respectively.

CONCLUSION

In addition to lower toxicity, transfused patients using PVC-DEHT or PVC-DINCH blood bags are less exposed to plasticizers than using PVC-DEHP bags with a ranging exposure reduction from 38.9% to 87.3%, due to lower leachability into blood components.

Effect of phase-change material blood containers on the quality of red blood cells during transportation in environmentally-challenging conditions

Background

The effect of phase-change material blood containers on the quality of stored red blood cells (RBCs) transported in the Qinghai-Tibet Plateau remains to be studied.

Study design and methods

RBCs stored in a phase-change material blood container were transported from Chengdu to Tibet and then back to Chengdu. The detection time points were the 1^st day of fresh-collected RBCs (group 1), the 14^th day of resting refrigerated storage (group 2), and the 14^th day of plateau transportation under refrigerated storage in the container (group 3). RBC counts, hemoglobin (HGB) content, free hemoglobin (FHb) content, blood biochemical indexes, hemorheologic indexes and 2,3-DPG content were detected.

Results

Compared with group 2, RBC counts and HGB were decreased, and the mean corpuscular volume (MCV), FHb and K⁺ content were increased in group 3. The glucose consumption and lactic acid production were significantly increased in groups 2 and 3. Compared with group 2, the 2,3-DPG content and whole blood viscosity were decreased in group 3. After resting refrigerated storage and plateau transportation, the RBC quality still met the national standard (GB18469-2012 whole blood and component blood quality requirements).

Conclusion

The phase-change material blood container can be maintained at a constant temperature under plateau environmental conditions, ensuring that the quality of the stored RBCs is compliant with GB18469-2012 whole blood and component blood quality requirements.

Assessment of the permeability properties of cryopreservation outer bags used in NHSBT

This study was carried out to investigate leakage/transport across the bag material of six outer cryopreservation bags in common use within NHS Blood and Transplant. In order to do this two different leak testing procedures; coloured dye and hydrogen tracer gas, were used. The data obtained show that a coloured dye cannot permeate through the materials both at room temperature and following storage at liquid nitrogen temperature (- 196 °C). In addition, when filled with the smallest elemental molecule, hydrogen, in the form of a tracer gas, all of the bags only allowed trace amounts of hydrogen to escape, either through the seal or the bag material. The data indicated that each of the bag materials tested would be capable of preventing bacterial or viral cross-contamination as long as the material remained intact.

Implementation of a new blood cooler insert and tracking technology with educational initiatives and its effect on reducing red blood cell wastage

BACKGROUND

The objective was to report a successful implementation of a blood cooler insert and tracking technology with educational initiatives and its effect on reducing red blood cell (RBC) wastage.

STUDY DESIGN AND METHODS

The blood bank database was used to quantify and categorize total RBC units issued in blood coolers from January 2010 to December 2015 with and without the new inserts throughout the hospital. Radiofrequency identification tags were used with special software to monitor blood cooler tracking. An educational policy on how to handle the coolers was initiated. Data were gathered from the software that provided a real-time location monitoring of the blood coolers with inserts throughout the institution.

RESULTS

The implementation of the blood cooler with inserts and tracking device reduced mean yearly RBC wastage by fourfold from 0.64% to 0.17% between 2010 and 2015. The conserved RBCs corresponded to a total cost savings of $167,844 during the 3-year postimplementation period.

CONCLUSIONS

The implementation of new blood cooler inserts, tracking system, and educational initiatives substantially reduced the mean annual total RBC wastage. The cost to implement this initiative may be small if there is an existing institutional infrastructure to monitor and track hospital equipment into which the blood bank intervention can be adapted when compared to the cost of blood wastage.

CTC-mRNA (AR-V7) Analysis from Blood Samples-Impact of Blood Collection Tube and Storage Time

Circulating tumour cells (CTCs) are an emerging resource for monitoring cancer biomarkers. New technologies for CTC isolation and biomarker detection are increasingly sensitive, however, the ideal blood storage conditions to preserve CTC-specific mRNA biomarkers remains undetermined. Here we tested the preservation of tumour cells and CTC-mRNA over time in common anticoagulant ethylene-diamine-tetra-acetic acid (EDTA) and acid citrate dextrose solution B (Citrate) blood tubes compared to preservative-containing blood tubes. Blood samples spiked with prostate cancer cells were processed after 0, 24, 30, and 48 h storage at room temperature. The tumour cell isolation efficiency and the mRNA levels of the prostate cancer biomarkers androgen receptor variant 7 (AR-V7) and total AR, as well as epithelial cell adhesion molecule (EpCAM) were measured. Spiked cells were recovered across all storage tube types and times. Surprisingly, tumour mRNA biomarkers were readily detectable after 48 h storage in EDTA and Citrate tubes, but not in preservative-containing tubes. Notably, AR-V7 expression was detected in prostate cancer patient blood samples after 48 h storage in EDTA tubes at room temperature. This important finding presents opportunities for measuring AR-V7 expression from clinical trial patient samples processed within 48 h-a much more feasible timeframe compared to previous recommendations.

Choline phosphate functionalized cellulose membrane: A potential hemostatic dressing based on a unique bioadhesion mechanism

Wound dressings are a key component in provision of optimal conditions for bleeding control and wound healing. For absorbent dressings, electrostatic interactions are frequently utilized as one of the mechanisms driving dressing adhesion. Herein, a choline phosphate functionalized biocompatible cellulose membrane that can efficiently arrest human red blood cells was developed to have potential application in wound dressing. The bioadhesion is based on the unique multivalent electrostatic interaction between the head groups of phosphatidyl choline based lipids on the cell membrane and its inverse orientation but virtually identical structure, choline phosphate, coupled to the cellulose membrane. For functionalization, the cellulose membrane was decorated with polymer brushes bearing multiple choline phosphate groups via surface-initiator atom transfer radical polymerization followed by click chemistry. The modified cellulose membranes were characterized by ATR-FTIR and the molecular weight and the grafting density of polymer brushes grafted from the cellulose membrane surface were thoroughly evaluated by calibrated force-distance measurements with atomic force microscopy (AFM). This new method provides an approach to estimating polymer brush parameters on rough surfaces of unknown surface area based on the dependence of brush thickness on brush density and polymer molecular weight for a calibration set of brushes. The dependence of binding of human red blood cells (RBCs) to the cellulose membrane surface on the number density of choline phosphate groups (e.g. molecular weight) and the grafting density were investigated using this AFM-based approach. Bound RBCs showed "pseudopodia"-like membrane projections under scanning electron microscopy where cells contacted the microfibers of the cellulose, distorting the RBC shape, reflecting the multivalent interactions between the RBCs and the choline phosphate-doped cellulose membrane. We believe this efficient strategy provides a promising approach to blood conservation and trauma management.

STATEMENT OF SIGNIFICANCE

Uncontrolled bleeding can dramatically affect morbidity and mortality. Absorptive wound dressings provide either adherent or non-adherent layers to control bleeding. Our new adherent material is based on a universal adhesion reaction between cell membrane phosphatidyl choline (PC) headgroups and cellulose membranes (CM) decorated with polymer brushes carrying a CP group per monomer. The CP-PC multivalent interactions provide adherence to cut tissue margins and blood cells, blocking bleeding. We here demonstrate the strong specific binding of red cells to CM-CP but not CM-PC membranes and determine the requisite brush molecular weight and surface concentration via a new approach using atomic force microscopy, applicable to rough surfaces. We believe this strategy provides a promising approach to blood conservation and trauma management.

A new practical technique to reduce allogeneic blood exposure and hospital costs while preserving clotting factors after cardiopulmonary bypass: the Hemobag®

Recent data independently linking allogeneic blood use to increased morbidity and mortality after cardiopulmonary bypass (CPB) warrants the study of new methods to employ unique and familiar technology to reduce allogeneic blood exposure. The Hemobag® allows the open-heart team to concentrate residual CPB circuit contents and return a high volume of autologous clotting factors and blood cells to the patient.

Fifty patients from all candidates were arbitrarily selected to receive the Hemobag® (HB) therapy. A retrospective control group of 50 non-Hemobag® (NHB) patients were matched to the HB group patient-by-patient for comparison according to surgeon, type of procedure, age, body surface area (BSA), body weight and CPB time. Many efforts to conserve blood (Cell Saver® and ANH) were employed in both groups. Post-CPB cell washing of circuit contents was additionally employed in the control group.

There were no significant differences between the HB and NHB groups in regard to patient morphology, pre-op cell concentrations, distribution of surgeon or procedures (41% valve, 16% valve/coronary artery bypass graft (CABG), balance CABG), pump and ischemic times and Bayes National Risk scores. The average volume returned to the patient from the HB was 8179/198 mL (1 SD). Average processing time was 11 min. The Hemobag®contained an average platelet count of 2309/80 K/mm3, fibrinogen concentration of 4139/171 mg/dl, total protein of 8.09/2.8 gm/dl, albumin of 4.49/1.2 gm/dl and hematocrit of 439/7%. Factor VII, IX and X levels in three HB contents averaged 259% greater than baseline. Substantial reductions were achieved in both allogeneic blood product avoidance and cost to the hospital with use of the HB.

Infusion of the Hemobag® concentrate appears to recover safely substantial proteins, clotting factor and cell concentration for all types of cardiac procedures, maintaining the security of a primed circuit.

Towards microfluidic-based depletion of stiff and fragile human red cells that accumulate during blood storage

In this study, the effects of prolonged storage on several biophysical properties of red blood cells (RBCs) were investigated. Single cell deformability was used as an important criterion in determining subgroups of RBCs evolved during storage lesion. A deformability-based microfluidic cell sorting technology was applied, which demonstrates the ability to enrich and separate the less deformable subpopulations of stored blood. These less deformable RBC subpopulations were then associated with other important markers such as osmotic fragility indicating cell integrity as well as microparticle content. This work demonstrates a systematic methodology to both monitor and improve banked blood quality, thereby reducing risks related to blood transfusion.

[Peculiarities of application of a cell saver apparatus in neonathal cardiosurgery using artificial blood circulation]

Elaborated and introduced into the practice method of the blood preservation, while correction of complex inborn heart failures (IHF) in a newborn babies, was proposed. It assumes application of system for intraoperative reinfusion of own erythrocytes with processing of residual perfusate and their reinfusion in a postperfusion period. Impact of the blood preservation on volume of a donor's blood components, hematological indices and methods of application of washed erythrocytes while correction of complex IHF in a newborn babies were presented. The method was applied in 47 newborn babies, to whom an arterial switch was performed for the main vessels transposition.

Randomized study of washing 40- to 42-day-stored red blood cells

BACKGROUND

Pretransfusion washing of red blood cells (RBCs) stored for a longer duration may have theoretical advantages but few data exist to support this practice. In many hospital settings, use of a point-of-care cell washer could conceivably be used to quickly wash allogeneic RBCs before transfusion. The purpose of this preliminary study was to compare a point-of-care device with a common blood bank device for washing longer-stored RBCs.

STUDY DESIGN AND METHODS

Forty RBC units stored for 40 to 42 days were randomized to washing with the COBE 2991 device (Terumo BCT; FDA-cleared for washing stored RBCs) or the Cell Saver Elite (Haemonetics; FDA-cleared point-of-care device for processing and washing fresh autologous shed whole blood). Supernatant and unit RBCs from unwashed (baseline) and washed blood were assayed for potassium, lactate, intracellular ATP, percentage of RBC recovery, cell-free hemoglobin, RBC microparticles, and RBCs were examined for susceptibility to hemolysis by physical stress.

RESULTS

Both devices recovered a high percentage of RBCs and efficiently removed extracelluar potassium. Washing with the Elite resulted in significant increases in cell-free Hb, percent hemolysis, and RBC microparticle production, whereas washing with the COBE 2991 did not (fold Δ = 2.1 vs. 1.0, 4.6 vs. 1.2, 2.0 vs. 1.1, respectively; p < 0.05). Hemolysis induced by physical stress was not altered by washing.

CONCLUSION

Although point-of-care washing of longer-stored RBCs is appealing, these preliminary data suggest that transfusion of washed, longer-stored units could result in potentially greater exposure to plasma free Hb. More data are needed before this practice can be routinely recommended.

[The EFS metrology: From the production to the reason]

In order to answer statutory requirements and to anticipate the future needs and standards, the EFS is committed, since a few years, in a process of harmonization of its metrology function. In particular, the institution has opted for the skills development by internalizing the metrological traceability of the main critical quantities (temperature, volumetric) measurements. The development of metrology so resulted in a significant increase in calibration and testing activities. Methods are homogenized and improved through accreditations. The investment strategies are based on more and more demanding specifications. The performance of the equipments is better known and mastered. Technical expertise and maturity of the national metrology function today are assets to review in more informed ways the appropriateness of the applied periodicities. Analysis of numerous information and data in the calibration and testing reports could be pooled and operated on behalf of the unique establishment. The objective of this article is to illustrate these reflections with a few examples from of a feedback of the EFS Pyrénées Méditerranée. The analysis of some methods of qualification, the exploitation of the historical metrology in order to quantify the risk of non-compliance, and to adapt the control strategy, analysis of the criticality of an instrument in a measurement process, risk analyses are tools that deserve to be more widely exploited for that discipline wins in efficiency at the national level.

Baseline extracellular potassium level as an indicator of the rate of increase of the same on further storage in CPDA-1 whole blood units: a potential approach to complement FIFO system for prioritisation of blood bags for release from blood-banks

BACKGROUND

Potassium levels in stored blood bags increases as they age. Hyperkalemia in transfused blood has undesirable cardiac effects.

MATERIALS AND METHODS

Within a 19-month period, baseline and weekly samples from 15 CPDA-1 whole blood bags were collected till 28 days of storage and analysed for potassium, sodium, uric acid, albumin and whole blood haemoglobin.

RESULTS

One unit increase in baseline (0 day) potassium in extracellular fluid of blood units was associated with the following increases in potassium levels on later days of storage: around two unit increase at 1 week (r2 = 0·50, P < 0·01) of storage; four units increase at 2 weeks (r2 = 0·64, P < 0·001) and 3 weeks (r2 = 0·51, P < 0·01) of storage; six units at 4 weeks (r2 = 0·53, P < 0·01) of storage. Baseline whole blood haemoglobin showed a moderate association with baseline potassium (r2 = 0·36, P < 0·05) and 2-week potassium (r2 = 0·35, P < 0·05) values.

CONCLUSION

For CPDA-1 blood bags (i) low baseline potassium blood bags might be preferred for transfusion in cases demanding a low potassium load and (ii) coordinating the ‘first-in-first-out’ (FIFO) policy with ‘early release of blood-bags with high initial potassium’ might be helpful in improving the release of suitable blood units from blood-banks.

Automated preparation of whole blood-derived platelets suspended in two different platelet additive solutions and stored for 7 days

BACKGROUND

The Atreus system (Terumo BCT) automates the preparation of blood components from whole blood donations. Intermediate platelet (PLT) products can be pooled manually or with the OrbiSac (Terumo BCT) and suspended in different PLT additive solutions (PASs) to obtain PLT concentrates (PCs). The aim of our study was to compare the in vitro PLT quality of PCs obtained with either the Atreus 2C+ and the OrbiSac or the Atreus 3C and suspended in PAS-II or PAS-IIIM during storage for up to 7 days.

STUDY DESIGN AND METHODS

We prepared eight PCs from buffy coats obtained with Atreus 2C+, pooled with the OrbiSac, and suspended in PAS-II and eight PCs from interim PLT units obtained with the Atreus 3C and suspended either in PAS-II or in PAS-IIIM. We measured volume, PLT content, and mean PLT component and performed metabolic assays (pH, glucose, lactate, pO₂, and pCO₂) and flow cytometry analyses (GPIb, GPIIbIIIa, GPIV, CD62P, CD63, von Willebrand factor [vWF], fibrinogen, Factor V, and annexin V).

RESULTS

PCs prepared with the Atreus 3C showed lower volume and higher PLT concentration when compared with PCs prepared with the Atreus 2C+ and the OrbiSac (p < 0.05). Glucose consumption rate and the expression of CD62P, CD63, and vWF were lower in PCs suspended in PAS-IIIM when compared with PCs suspended in PAS-II (p < 0.05).

CONCLUSION

PCs prepared with the Atreus 3C and suspended in PAS-IIIM preserve satisfactorily the in vitro PLT quality during 7-day storage. PLT activation during a 7-day storage period was lower when the storage solution was PAS-IIIM in comparison with PAS-II.

The use of telemedicine in Italian Blood Banks: a nationwide survey

BACKGROUND

Telemedicine is defined as the use of electronic information and communication technologies to provide health care between distant people. Many activities in transfusion medicine could benefit from the application of telemedicine. To map the spread of the use of telemedicine in transfusion medicine in Italy, the Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) performed a nationwide survey: the results are presented in this paper.

MATERIALS AND METHODS

A survey, dealing with different aspects of the use of telemedicine, was performed by sending a questionnaire to 280 Italian Blood Centres. The survey was designed to evaluate the diffusion of telemedicine and the features of the systems, with special attention to the systems' safety and legal adequacy. One section of the questionnaire was designed to identify the features of the systems considered essential by the respondents.

RESULTS

Out of 280 Blood Services contacted, 196 (70%) filled in at least one of the questions of the online questionnaire. Globally the use of some form of telemedicine was reported by 70% of the respondents. Telemedicine is used for remote validation of laboratory tests by 32% of the Centres that responded, for remote biological validation of blood units by 34% and for assignment of blood components by 29%. Less frequently, telemedicine is used to control electronic refrigerators, for electronic blood requests and for bed-side identification of patients.

DISCUSSION

The use of telemedicine is widespread in Italian Blood Services. There appears to be some heterogeneity between structures with regards to the evaluation of the systems' safety and their legal adequacy. No telemedicine system should be introduced into practice until it has proven to have the same standards of safety as the corresponding "on site" activity.

[Promising technologies of packed red blood cells production and storage]

The current article is dedicated to promising technologies of packed red blood cells production and storage. The following new technical approaches are presented: (1) erythrocytes storage in strict anaerobic argon-hydrogen environment, (2) lyophilization of erythrocyte suspension by its atomization in nitrogen gas, (3) lyophilization of erythrocytes by directional freezing under the influence of radio frequency radiation, (4) automated pharming of antigen free packed red blood cells from progenitor cell directly at the battlefield.

Mycelial fungi completely remediate di(2-ethylhexyl)phthalate, the hazardous plasticizer in PVC blood storage bag

This pioneering work describes how simply, inexpensively and efficiently novel fungi utilize the alarming plasticizer, di(2-ethylhexyl)phthalate (DEHP) blended in PVC blood storage bags (BB). In order to quantify total DEHP (33.5%, w/w) present in BB, it was extracted using n-hexane and confirmed by GC-MS. Three mycelial fungi, viz., Aspergillus parasiticus, Fusarium subglutinans and Penicillium funiculosum isolated in our laboratory form heavily plastics-contaminated soil - either singly or in consortium - completely consumed intact DEHP physically bound to BB by static submerged growth (28 °C) in simple basal salt medium (BSM). A two-stage cultivation strategy was adopted for the complete removal of DEHP from BB in situ. During the first growth stage, almost 70% DEHP contained in the BB was consumed in 2 weeks, accompanied by increased fungal biomass (~0.15-0.35 g/g BB; OD ~7 at 600 nm) and a sharp declining (3.3) of initial pH (7.2). Spent BSM was replaced at this stagnant growth state (low pH), thus in the second stage, remaining DEHP bound to BB utilized completely (over 99%). Furthermore, A. parasiticus and F. subglutinans also grew well on scrapes of PVC water pipes in BSM. F. subglutinans was as efficient independently as consortium in completely utilizing the DEHP bound to BB, and these fungi offer great potentials for the inexpensive and eco-friendly bioremediation of phthalates in medical and allied PVC wastes on a large scale through a batch process in alleviating the plactics waste management issue.

In vitro platelet quality in storage containers used for pediatric transfusions

BACKGROUND

The in vitro quality of small-volume platelet (PLT) aliquots for pediatric transfusions was assessed to determine the best practice approach.

STUDY DESIGN AND METHODS

Small volumes (50 mL) of single apheresis PLT components (APCs), collected on either CaridianBCT Trima or Haemonetics MCS+ instruments, were aliquoted on Days 2, 3, 4, and 5 postcollection into Fenwal PL1240 or 4R2014 bags or 60-mL polypropylene syringes. Samples were tested for in vitro quality at their recommended expiry times (4 hr for 4R2014 bags and syringes or Day 5 for PL1240 bags). Assays included pH, CD62P expression, and metabolic measures.

RESULTS

CD62P expression increased throughout storage in all containers. Among the small-volume containers, pH, pCO(2) , lactate, and bicarbonate varied considerably. Regardless of the day of aliquoting, pCO(2) was significantly higher and pO(2) was significantly lower in gas-impermeable syringes than other containers. No bacterial growth was detected in any sample.

CONCLUSION

The quality of APCs aliquoted into small-volume containers meets regulatory requirements and is generally equivalent to that of full-volume APCs at expiry.

[Mechanic reinfusion in emergency surgery]

The article highlights techniques and effects of intraoperative mechanic blood reinfusion in patients with trauma and intraabdominal bleeding in extend, exceeding the self circulating blood volume. The high efficacy of the self blood reinfusion during the emergency operation allowed the 2-fold decrease of the hospital and overall mortality. The mechanic blood reinfusion proved to be a safe and clinically effective method of the globular blood volume deficiency compensation, especially in emergency surgery.

Role of blood bag temperature indicators in maintaining patent temperature of the returned unused blood bags in blood bank

BACKGROUND AND AIMS

The main objective of the present study was to evaluate the temperature chain of red blood cells (RBC) returned unused blood bags using blood temperature indicator and ascertain the factors like transportation time, type, size of coolant box and number of bags per box.

MATERIALS AND METHODS

A total of 250 blood bags with the indicator were observed for the temperature changes with other factors like transportation time, type and size of coolant box and number of bags per box. The recordings were performed at several checkpoints located between the blood bank and the wards.

RESULTS

Out of the 250 bags, 74 (29.6%) showed colour changes in which 64 (86.3%) were returned unused (RU) blood bags. The transportation time for these 74 bags was 818.3 ± 941.643 min, significantly higher than bags without colour changes, (p=0.02). Interestingly, 71.4% of the colour changes occurred within the ward. The 7 litre coolant box with an average of 1-5 blood bags per box had a statistically significant higher percentage of colour change with 59.2% compared to the 5 litre coolant box (p=0.05).

CONCLUSION

This study showed that the temperature chain of blood bags was often not well maintained. These results could be mainly due to the non-adherence to the standard operating procedure (SOP) of blood transfusion and the usage of non-standardized coolant boxes.

[Technology of blood preservation in the surgery of the abdominal aorta]

The results of surgical treatment of abdominal aortic aneurysm in 60 patients are presented. The Cell Saver was used in 22 (36.7%) patients for blood saving. The usage of the Cell Saver didn't effected the needs for red blood cells in the perioperative period.

Improving the management of the blood supply through the use of Haemonetics' MCS-8150 automated double red cell collection devices

Collecting additional red blood cell (RBC) units using the Haemonetics' MCS-8150 double red blood cell (DRBC) capability can improve operational efficiencies, reduce the risk of blood shortages, and influence the type-distribution of RBC inventories. Portable, durable, and reliable, the MCS-8150 is suitable for both in-center and mobile collection situations. Donor acceptance is high and many report an enhanced donation experience making these DRBC donors more likely to donate again. The use of the MCS-8150 is a major contributor to our blood center's collection growth, allowing us to transform from a major importer of RBC units to a self-sufficient exporter.

[Development of wireless monitoring system based on Zigbee technology in blood and bacterin cold chain]

OBJECTIVE

Real-time monitoring for temperature is required in cold chain for the medical products that are sensible with temperature, such as blood and bacterin, to guarantee the quality and reduce their wastage.

METHODS

This wireless monitoring system in cold chain is developed with Zigbee technology.

RESULTS

Functions such as real-time monitoring, analyzing, alarming are realized.

CONCLUSION

The system boasts such characteristics as low power consumption, low cost, big capacity and high reliability, and could improve the capability of real-time monitoring and management in cold chain effectively.

[Stakes of pre-analytical parameters in blood transcriptomic and proteomic analysis. Application to clinical research: the GOELAMS trial]

Numerous parameters related to the patients and the conditions of the sample collection can affect the properties of a biological sample. The pre-analytical parameters are especially important to deal with in the setting of multicenter clinical trials. Here, we report the preliminary results of a trial conducted by the cooperative group GOELAMS (Groupe Ouest-Est des Leucémies aiguës et Autres Maladies du Sang) to define the pre-analytical parameters that affect the proteomic analysis of serum samples in patients with B-cell non Hodgkin lymphoma included in clinical trials.

Preservation of in vitro function of platelets stored in the presence of a synthetic dual inhibitor of factor Xa and thrombin

BACKGROUND

The use of citrate anticoagulant limits the clinical significance of platelet function tests. Thrombin inhibitors cannot prevent thrombin-induced platelet activation completely. We examined the influence of benzylsulfonyl-d-Arg-Pro-4-amidinobenzylamide (BAPA), a dual inhibitor of Factor Xa (FXa) and thrombin, on platelet responsiveness to agonists when measured between 2 and 24 h after venipuncture.

METHODS

Blood samples from 36 individuals were anticoagulated with citrate and BAPA, respectively. Turbidimetric platelet aggregometry (TPA) and impedance platelet aggregometry (IPA), a whole blood platelet counting assay for measuring platelet aggregation (PCA), and Platelet Function Anlayzer-100 (PFA-100 closure times (CTs) were determined after whole blood storage between 2 and 24 h after venipuncture. Native whole blood was studied over 48 h to determine the inhibition of thrombin generation by BAPA, hirudin and melagatran.

RESULTS

BAPA inhibited thrombin generation completely for 48 h, while hirudin and melagatran did not. The use of citrate resulted in significantly reduced TPA induced by arachidonic acid (AA) or adenosine 5'-diphosphate (ADP), and significantly reduced IPA regardless of agonist when measured 10 and 24 h after blood collection. PCA ratios in citrated blood also dropped significantly 10 and 24 h after venipuncture. The length of storage of BAPA-anticoagulated blood samples over 24 h had no significant influence on any platelet response. The reproducibility of platelet function assay results obtained from BAPA-anticoagulated samples was significantly better than corresponding data from citrated blood.

CONCLUSION

TPA, IPA, PCA or PFA-100 CTs remain stable for 24 h when whole blood is anticoagulated with a dual inhibitor of FXa and thrombin. This would greatly simplify the shipment of samples for platelet function testing.

Changes in canine ionised calcium under three storage conditions

OBJECTIVES

To determine the ionised calcium concentration following aerobic collection of blood and to compare ionised calcium concentration and pH of heparinised whole blood and plasma at 48 hours following collection under three different storage conditions to assess if ionised calcium concentration can be measured retrospectively.

METHODS

Blood was collected from 17 dogs for analysis of ionised calcium concentration and pH using a Rapidpoint 400 (Bayer) blood gas analyser. Blood was collected into a commercial preheparinised syringe and into a plain syringe, with subsequent transfer to a commercially available heparinised sample tube. Samples were analysed within 10 minutes, and the remainder was divided for storage. One aliquot was set-aside at room temperature for 48 hours, and the other was immediately centrifuged and the plasma divided for storage at room temperature and at 4 degrees C for 48 hours each. In all samples, ionised calcium concentration and pH were measured again at 48 hours after storage.

RESULTS

There was no significant difference in ionised calcium concentration or pH between anaerobically and aerobically collected heparinised whole blood analysed within 10 minutes of collection. At 48 hours, ionised calcium concentrations had decreased under all storage conditions irrespective of the direction of pH change.

CLINICAL SIGNIFICANCE

Ionised calcium concentration can be measured in aerobically collected samples within 10 minutes and at 48 hours after collection under the conditions described.

Leukoreduction filtration of whole-blood units from sickle trait donors: effects of a metered citrate anticoagulant system

BACKGROUND

Polymerization of hemoglobin (Hb) S is exacerbated by acidic and hyperosmotic citrate anticoagulant solutions and often results in occlusion of leukoreduction filters by red blood cells (RBCs) from sickle cell trait (Hb AS) donors. This study evaluates a blood collection instrument that adds citrate anticoagulant in a metered fashion, thus mitigating adverse citrate effects.

STUDY DESIGN AND METHODS

Collection of whole blood by a metered anticoagulant system was compared to traditional phlebotomy in 12 Hb AS and 12 non-sickle trait (Hb AA) donors. Each donated twice; on one occasion, units were filtered after 4-hour storage at 20 to 24 degrees C, and on the other, units were stored at 1 to 6 degrees C for 24 hours before filtration.

RESULTS

Filtration times, RBC recoveries, and residual white blood cell (WBC) counts met defined criteria more often in Hb AS units collected by a metered anticoagulant system (9 of 12, 8 of 12, and 4 of 12, respectively) compared to traditional phlebotomy (1 of 12, 2 of 12, and 0 of 12, respectively). Overall, Hb AS units filtered better after storage at 1 to 6 degrees C for 24 hours, with units collected by a metered anticoagulant system undergoing filtration most effectively (5 of 6 had >85% RBC recovery, 3 of 6 had <5 x 10(6) residual WBC). Units exhibited similar changes in RBC storage parameters.

CONCLUSION

Use of a metered anticoagulation instrument demonstrates potential for successful leukoreduction and acceptable storage of Hb AS units; however, the system needs further modifications and improvements before it can be utilized to collect and leukoreduce Hb AS blood.

Effects of syringe type and storage temperature on results of blood gas analysis in arterial blood of horses

BACKGROUND

Results of arterial blood gas analysis can be biased by pre-analytical factors, such as time to analysis, syringe type, and temperature during storage. However, the acceptable delay between time of collection and analysis for equine arterial blood gas remains unknown.

HYPOTHESIS

Dedicated plastic syringes provide better stability of arterial blood gases than multipurpose plastic syringes.

ANIMALS

Eight mares, 1 stallion, and 1 gelding, ages 3 to 10 years old.

METHODS

Arterial blood samples were collected in a glass syringe, a plastic syringe designated for blood gas collection, and a multipurpose tuberculin plastic syringe. Blood samples were stored at ambient temperature or in iced water. For each sample, partial pressure of oxygen in arterial blood (PaO2), partial pressure of carbon dioxide in arterial blood (PaCO2), and pH were measured within a few minutes of collection and at 5, 20, 30, 60, 90, and 120 minutes after collection.

RESULTS

Collection into glass syringes stored in iced water provided adequate PaO2 results for up to 117 +/- 35 minutes, whereas blood collected in either of the plastic syringes resulted in a variation >10 mm Hg after 10 +/- 3 to 17 +/- 2 minutes, depending on the storage conditions. Plastic syringes kept at ambient temperature offered more stability for PaCO2 analysis because they could be stored up to 83 +/- 16 minutes without significant variations. Values of pH did not show variations more than 0.02 for the first hour, irrespectively of storage condition.

CONCLUSIONS AND CLINICAL IMPORTANCE

Glass syringes placed on ice are preferable for analysis of PaO2. Blood collected in plastic syringes should be analyzed within 10 minutes, irrespective of the storage temperature, to ensure the accuracy of PaO2 values.

Prospective evaluation of double RBC collection using three different apheresis systems

BACKGROUND

Automated component collection systems offer the possibility of increasing blood supply and improving transfusion safety.

DESIGN

30 blood donors were randomly assigned to double RBC collection with either the Baxter Alyx (AX), the Haemonetics MCS Plus (MCS+), or the Gambro Trima Accel (TA). Procedures were prospectively evaluated focussing on yield, time, efficiency, citrate donor load, and in vitro quality.

RESULTS

All units showed sufficient in vitro quality throughout 42 days of storage and complied with international requirements. Donor reactions were limited to mild citrate reactions. AX was the fastest and most efficient system* * (* *p approximately 0.001) attaining the highest yield* * from similar amounts of whole blood. The drawbacks were a higher RBC loss* (*p < 0.05) and accelerated citrate infusion* *. Due to lower collection rates* * * (* * *p < 0.001), MCS+ was slower than TA* * * but compensated with lower citrate load * * *.

CONCLUSION

Double RBC apheresis was performed safely and efficiently with all three instruments. AX had advantages for most parameters evaluated.

An evaluation of automated blood collection mixers

BACKGROUND AND OBJECTIVES

We investigated the mixing capacity of two whole blood (WB) collection mixers.

MATERIALS AND METHODS

WB was simulated by using a 25% glycerol solution warmed to 35 degrees C. Citrate-phosphate-dextrose (CPD) anticoagulant of a collection system was stained with toluidine blue, and simulated WB was added at 30, 60 or 90 ml/min, respectively (n = 3 per flow speed). The optical density (OD) of 10-ml fractions was measured, and results are expressed as percentage of a well-mixed '100%-sample'.

RESULTS

CompoGuard showed adequate mixing at all three flow speeds (average ODs 96-103%). HemoLight showed good mixing at 60 and 90 ml/min (ODs from 97 to 101%). At 30 ml/min, mixing appeared suboptimal, but still conformed to our requirements with ODs from 96% to 104%.

CONCLUSION

Both mixers give sufficient mixing of whole blood with anticoagulant.

Viability of red cells prepared with S-303 pathogen inactivation treatment

BACKGROUND

A nucleic acid-targeted pathogen inactivation process with S-303 was developed to treat red blood cells (RBCs).

STUDY DESIGN AND METHODS

Three studies in healthy subjects investigated posttransfusion recovery, life span, and immunogenic potential of autologous RBCs treated with S-303 and stored for 35 days. A two-arm trial in 42 subjects (1A) examined recovery of 35-day-old S-303 RBCs after a single transfusion. A one-arm study (1B) measured recovery and immune response in 28 subjects after multiple transfusions of S-303 RBCs. A randomized, crossover study (1C) in 29 subjects compared recovery and life span of 35-day-old S-303 RBCs and conventional RBCs.

RESULTS

In Studies 1A and 1B, mean recovery of S-303 RBCs ranged from 78.7 to 84.4 percent. In Phase 1C, the mean 24-hour posttransfusion recoveries of S-303 and untreated RBCs were 81.7 +/- 6.3 and 84.5 +/- 6.2 percent (p = 0.05). The median life spans (t(1/2)) of S-303 and control RBCs were identical (37.4 days, p = 0.98). No antibodies to S-303 RBCs were detected.

CONCLUSION

The mean 24-hour recovery of 35-day-old S-303 RBCs was less than untreated RBCs, but greater than 75 percent. RBCs treated with S-303 and stored for 35 days exhibited median life span not different from that of conventional RBCs.

Use of a (proposed) standard protocol to validate Terumo TSCD-II connections between dissimilar blood bag tubing

BACKGROUND AND OBJECTIVES

ISO standards for blood bags do not adequately define and control the dimensions of blood bag transfer tubing. This lack of standardization presents potential difficulties when making sterile connections between the wide range of tubing that has evolved in the absence of such standards. We aim to validate the suitability of the TSCD-II and provide a minimum standard for assessing the suitability of sterile connections (welds) between dissimilar tubing.

MATERIALS AND METHODS

The Terumo TSCD-II was used in this study to connect by hermetic welding seven tubing types with a wide range of dimensions from five suppliers. Thirty sterile connections were made between each combination split between dry/dry, wet/wet and dry/wet connections. Welds were assessed for visual defects, by tensile stress test (TST) and pressure tests.

RESULTS

All welds passed visual inspection and pressure tests. All welds had a minimum tensile strength of greater than 40 N and mean of greater than 45 N.

CONCLUSION

Successful connections have been made between dissimilar tube types and this work does not support the requirement for 'tight' tubing dimensional specifications. We have recommended to the ISO Technical Committee 76 Work Group 1 that ISO 3826-1 be revised and should include a minimum standard validation protocol for joining dissimilar tubing.

In vitro pH effects on in vivo recovery and survival of platelets: an analysis by the BEST Collaborative

BACKGROUND

The pH environment of stored platelet (PLT) products is recognized as an important factor and is generally used as a key surrogate measure of PLT viability. It is the only in vitro measurement that has been translated into industry standards and regulatory rules or specifications for storage of PLT products. The objective of this study was to evaluate the effect of in vitro pH on the in vivo recovery and survival of autologous PLT products.

STUDY DESIGN AND METHODS

Data from individual autologous radiolabeled PLT kinetic studies were solicited from independent laboratories. PLTs stored for at least 5 days in 100 percent autologous plasma with a pH(22 degrees C) of at least 6.2 were analyzed. Data were fit to a mixed-effects regression model with fixed effects of pH(22 degrees C), time of storage, and preparation method-storage bag combination.

RESULTS

Eight research laboratories reported 476 individual recovery and survival results with associated pH before labeling from a variety of autologous, radiolabeled PLT kinetic studies from September 1999 to March 2005. These results are from 254 individual subjects who donated a total of 386 PLT units, with up to nine collections per subject reported. The effect of pH on either PLT recovery (p = 0.86) or survival (p = 0.55) was not significant. Time of storage and the method-bag combination both had significant effects on these outcomes (p < 0.0001).

CONCLUSION

These data suggest that there is no relationship between in vitro pH at a pH(22 degrees C) of at least 6.2 and in vivo PLT viability as measured by radiolabeled recovery and survival of autologous PLTs.

A minipool process for solvent-detergent treatment of cryoprecipitate at blood centres using a disposable bag system

BACKGROUND AND OBJECTIVES

Single-donor or small-pool cryoprecipitates are produced by blood establishments, mostly in developing countries, for substitute therapy in haemophilia A, von Willebrand disease and fibrinogen deficiency, as well as for the manufacture of fibrin sealant. As cryoprecipitate may be contaminated with pathogenic plasma-borne viruses, there is an urgent need to develop a simple method for the viral inactivation of cryoprecipitate.

MATERIALS AND METHODS

Cryoprecipitate was obtained according to standard procedures. Ten minipools of five or six donations of cryoprecipitate were prepared and subjected, in sterile closed bags, to a viral inactivation treatment using either 2% tri(n-)butyl phosphate (TnBP) for 4 h at 37 degrees C or the combination of 1% TnBP and 1% Triton X-45 for 4 h at 31 degrees C. The cryoprecipitates were subsequently extracted three times in their processing bags by mixing and decantation using 7.5% sterile ricinus oil. The TnBP-treated cryoprecipitates were further subjected to a clarifying centrifugation step at 3800 g for 30 min. The final products were dispensed into individual bags and frozen at -30 degrees C or lower.

RESULTS

The cryoprecipitates treated with either 2% TnBP or 1% TnBP + 1% Triton X-45 showed excellent (> 93%) mean recovery of coagulant factor VIII (FVIII), ristocetin cofactor Von Willebrand factor (VWF:RCo), and clottable fibrinogen activity. Prothrombin time, international normalized ratio and activated partial thromboplastin time increased during solvent-detergent treatment but returned to initial values after oil extractions. The final content of TnBP and Triton X-45 was < 10 and 50 ppm, indicating excellent removal by the oil-extraction procedure.

CONCLUSIONS

Viral inactivation treatment by TnBP, with or without Triton X-45, can be applied to minipools of cryoprecipitate, with good recovery of FVIII, VWF and fibrinogen. The viral inactivation and solvent-detergent removal process can be performed in a closed bag system and using simple blood establishment techniques and equipment. This technology could be considered for the improved viral safety of cryoprecipitate which is used to treat haemophilia A, von Willebrand disease or fibrinogen deficiency, or to prepare fibrin sealant.

Effects of syringe material, sample storage time, and temperature on blood gases and oxygen saturation in arterialized human blood samples

BACKGROUND

The practice of on-ice storage of arterial-blood samples in plastic syringes for delayed analysis continues, and the effects of storage time and temperature on the measurement of blood-oxygen-saturation values (S(aO2)) have not been adequately described.

OBJECTIVE

To determine the effects of syringe material, storage time, and storage temperature on normal arterialized blood gas and S(aO2) values.

METHODS

We used a temperature-controlled extracorporeal circuit to "arterialize" 500 mL of fresh, whole human blood at 37 degrees C, and we used certified calibration gases of 12% O2 and 5% CO2 to produce normal blood-gas values. From that arterialized blood we took 90 samples and randomly assigned them to 6 groups, until there were 15 samples in each group. The groups were (1) plastic syringe, analyzed immediately, (2) plastic syringe, stored 30 min at 0-4 degrees C, (3) plastic syringe, stored 30 min at 22 degrees C, (4) glass syringe, analyzed immediately, (5) glass syringe, stored 30 min at 0-4 degrees C, and (6) glass syringe, stored 30 min at 22 degrees C.

RESULTS

Compared to the samples that were analyzed immediately, the P(O2) of the samples stored in plastic syringes for 30 min at 22 degrees C and at 0-4 degrees C was significantly higher, with a clinically important magnitude of 11.9-13.7 mm Hg. The P(CO2) of blood stored in glass for 30 min at 0-4 degrees C was significantly lower, although the magnitude of the difference (1.5 mm Hg) was not clinically important. There were no statistically significant differences in pH or oxygen saturation among the 6 groups.

CONCLUSION

For accurate arterial-blood-gas results, samples drawn in plastic syringes should be analyzed immediately. If the analysis is going to be delayed, the samples should be drawn and stored in glass.

Determination of optimal conditions for studies of electrophoretic mobility of human erythrocytes loaded with cryoglobulins

For studies of the charge characteristics of human erythrocytes loaded with cryoglobulins the cells should be stored in Alsever solution with 0.1% sodium azide no longer than 1 week after blood collection. Erythrocytes should be loaded with cryoglobulins by incubation during at least 4 h, the final concentration of cryoproteins in the solution being no lower than 30 microg/ml.

Storage of platelet-rich plasma-derived platelet concentrate pools in plasma and additive solution

BACKGROUND

Prestorage pooling of platelet (PLT)-rich plasma (PRP)-derived PLT concentrates (PCs) and storage in either plasma (PS) or an additive solution (AS) is logistically feasible and would result in a product similar to buffy-coat or apheresis PLTs.

STUDY DESIGN AND METHODS

On Day 0, PS PRP PCs were pooled with a sterile connecting device into a new 1.3-L storage container (ELX, PALL Medical). AS-PCs were prepared by addition of a new low-pH glucose-containing AS to the PLT sediment. AS-PCs were pooled into a 1.3-L ELX bag containing four tablets of NaHCO3. PC pools were sampled on Days 1, 5, and 7.

RESULTS

PS pools containing 5 units had a mean PLT yield similar to the AS pools (39 x 10(10) +/- 3 x 10(10) vs. 37 x 10(10) +/- 6 x 10(10); p = 0.25). All pools had WBC counts of less than 1 x 10(6). pH and HCO3 decreased in PS pools with storage, but either increased or remained constant in the AS pools. On Day 7, no differences were seen in morphology score or extent of shape change. Hypotonic shock response was better preserved in the plasma pools (71 +/- 12% vs. 56 +/- 13%, p < 0.01); however, surface P-selectin was expressed less in the AS pools (6 +/- 4% vs. 18 +/- 10%, p < 0.01).

CONCLUSION

Manufacture and storage of PRP-PCs in pools either in plasma or in a glucose-containing AS in this new container are feasible, and there is good preservation of PLT quality to Day 7.

Effects of skin disinfection method, deviation bag, and bacterial screening on clinical safety of platelet transfusions in the Netherlands

BACKGROUND

Bacterial contamination of blood products is a great hazard for development of fatal transfusion reactions. Bacterial screening of platelet concentrates (PC) by aerobic and anaerobic culturing (BacT/ALERT, bioMérieux) was introduced in the Netherlands in October 2001.

STUDY DESIGN AND METHODS

In November 2002, a nationwide, uniform skin cleansing method was introduced with a double-swab disinfection with 70 percent isopropyl alcohol. One location routinely used an integrated diversion bag to collect the first 20 to 30 mL.

RESULTS

Over the calendar years 2002 and 2003, in total 113,093 PCs derived from pooled buffy coats were screened. After introduction of the new disinfection method, 0.85 percent were initially positive. This was a small reduction compared to the previous disinfection methods under which 0.95 percent were initially positive. The location with use of the diversion bag showed a significantly lower frequency of bacterial contamination, with 0.50 percent before and 0.37 percent after introduction of 70 percent isopropyl alcohol. In addition 8000 apheresis PCs were also screened, showing 24 initially positive samples (0.30%).

CONCLUSION

The use of the diversion bag and, to a lesser extent, the use of double swabs with 70 percent isopropyl alcohol, led to a reduction of contamination. As expected, predominant contamination with resident skin bacteria was reduced. The combination of diversion bag and new disinfection led to a frequency of initial positive results for pooled five-donor PCs, which is similar to that of single-donor apheresis PCs. Furthermore, the bacterial detection system and associated product recall procedures have been shown to be effective in preventing transfusion of contaminated PCs and/or related red cells, especially for rapidly growing bacteria.

Comparison of two sterile connection devices and the effect of sterile connections on blood component quality

BACKGROUND

Sterile connection devices (SCDs) are used to connect pieces of polyvinylchloride tubing between blood bag systems. After observing a slight decrease in inner diameter of tubing welded with the CompoDock S2 SCD, the effect of welded tubing on storage characteristics of white blood cell (WBC)-reduced red blood cells (RBCs) and platelet (PLT) concentrates was studied. Welds were made with Terumo SCD (T-SCD) or CompoDock S2, and unwelded tubing served as reference.

STUDY DESIGN AND METHODS

Three WBC-reduced RBC units or 3 PLT concentrates were pooled and divided to prevent donor-dependent differences. The units were transferred 10 times over (1) tubing with a T-SCD weld, (2) a CompoDock S2 weld, or (3) unwelded tubing. RBCs were stored for 42 days and free hemoglobin (Hb) was measured; PLT concentrates were stored for 8 days and CD62P expression was measured, as markers for blood component quality (n = 10 paired experiments).

RESULTS

WBC-reduced RBC units had similar hemolysis at the end of storage: 0.47 +/- 0.28, 0.47 +/- 0.35, and 0.49 +/- 0.38 percent of total Hb, for tubing with a T-SCD weld, a CompoDock S2 weld, or no weld, respectively (not significant). CD62P expression of stored WBC-reduced PLT concentrates was not significantly different between the groups: 20.3 +/- 5.1, 19.8 +/- 5.1, and 22.3 +/- 9.8 percent for tubing with a T-SCD weld, a CompoDock S2 weld, or no weld, respectively.

CONCLUSION

The quality of blood components, measured as RBC hemolysis and platelet CD62P expression, is not adversely affected by the presence of a sterile connection in the tubing, made by either the CompoDock S2 or the T-SCD.

Development of an automated umbilical cord blood collection system

In this paper, the development of an automated umbilical cord blood (UCB) collection system is presented. The overall control system is comprehensive, comprising of various selected control and instrumentation components, integrated within a configuration of hardware architecture centered around a dSPACE DS1002 Digital Signal Processing (DSP) board. The hardware architecture, software development platform, user interface, and all constituent control components will be elaborated on in the paper.

Freeze-drying of human platelets: influence of intracellular trehalose and extracellular protectants

Freeze-drying is an ideal alternative for long-term preservation of platelets in blood banks. Intracellular trehalose is believed to be an effective lyoprotectant for preserving cells during freeze-drying. In this study, 13 mM intracellular trehalose was loaded into human platelets through fluid-phase endocytosis pathway. Bovine serum albumin and trehalose were used as extracellular protectants. The effects of intracellular trehalose and extracellular protectants on freeze-dried platelets were studied respectively. The results showed 13 mM intracellular trehalose was beneficial to freeze-dried human platelets, but only slightly enhanced the protection afforded by extracellular protectants. Loaded with 13 mM intracellular trehalose, platelets were freeze-dried in a formulation of 1 percent bovine serum albumin and 1 percent trehalose, 40 days later, the survival rate of rehydrated platelets was about 85 percent, the morphology of rehydrated platelets was intact and the aggregation percentage with thrombin (1 U/ml) was 97.3 percent.

ISBT 128 blood labeling: introduction and reference laboratory applications

ISBT 128 will be implemented in the United States during the next two years. In addition to improving unit traceability and lookback tracking, this information technology standard has the power to detect and prevent errors in data entry by using data identifiers and check characters. Additionally, its ability to encode special testing results such as CMV and RBC phenotype on a label provides laboratories a computerized mechanism to verify the accuracy of such labels.

Evaluation and analysis of exposure levels of di(2-ethylhexyl) phthalate from blood bags

BACKGROUND

The US FDA and The Ministry of Health, Labor and Welfare of Japan have indicated that the risk assessment of di(2-ethylhexyl) phthalate (DEHP) released from polyvinyl chloride (PVC) medical devices requires immediate attention. In particular, the analysis of the exposure to DEHP from blood bags is very important for medical treatment. However, human exposure to DEHP via blood transfusion remains poorly understood. We evaluated DEHP and mono(2-ethylhexyl) phthalate (MEHP) levels, migration patterns, and metabolism in blood products for the detailed assessment of exposure to DEHP.

METHODS

A method that is based on column-switching liquid chromatography-electrospray mass spectrometry (LC-MS) coupled with on-line extraction was used for the direct analysis of DEHP and MEHP in the blood products. From the Japanese Red Cross Society, 78 blood products (red blood cell concentrate: n=18, irradiated red blood cell concentrate: n=18, whole blood: n=18, blood platelet: n=18, and frozen plasma: n=6) were sampled in January 2003 for use in this study.

RESULTS

The detection levels of DEHP and MEHP ranged from 1.8 to 83.2 microg/ml and from 0.1 to 9.7 microg/ml, respectively. The levels of MEHP and DEHP in the blood products were increased with increasing storage time. In addition, whole blood products in PVC bags had the highest DEHP levels compared to the other blood products. Our results indicate that the maximum level of human exposure to DEHP released from blood bags is 0.7 mg/kg weight/time.

CONCLUSION

This first quantitative evidence may be useful for the risk assessment of DEHP released from blood bags.