Abstract
BackgroundStorage lesions occur in red blood cell products when potassium ions, haemoglobin and lactate dehydrogenase are released into the extracellular plasma due to post-irradiation storage or cellular degeneration. The South African blood transfusion establishments do not comply with the universal leucocyte-reduction policy due to cost and the current HIV pandemic. Various studies regarding storage lesions have been completed in well-developed countries but not in Cape Town, South Africa.ObjectiveThis study aimed to determine cellular degeneration occurring in non-irradiated and irradiated red blood cells (RBC) by comparing the measured biochemical and haematological indices during storage of up to 42 days.MethodEighty whole blood units were collected from voluntary, non-remunerated donors. Blood components tested weekly until expiry were whole blood, RBC concentrate, leucocyte-reduced RBC concentrate (pre-storage) and paediatric RBC concentrate (n = 20). Ten units per product were irradiated and 10 were not. Evaluations included potassium, sodium, glucose, lactate dehydrogenase, phosphate, haemoglobin, haematocrit, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentrate, mean cell volume and plasma haemoglobin. Plasma haemolysis levels were calculated using an approved formula.ResultsThe haemolysis levels evaluated on Day 35 and Day 42 were higher than the recommended 0.8%, whereas results for the non-irradiated components up to expiry were all below 0.8%.ConclusionThis study confirms that gamma irradiation aggravates the RBC storage lesions. The products tested yielded similar results to other studies in developed countries, however the South Africa transfusion medicine policy should remain unchanged.
Highlights
The administration of red blood cell (RBC) products enhances intravascular oxygen-carrying capacity and is considered a vital treatment for patients with anaemia triggered by haemorrhage due to surgery, trauma or various haemoglobinopathies or malignancy.[1]
lactate dehydrogenase (LDH) concentrations increased with statistical significance for leucocyte-reduced RBC concentrate (RBCC) on Days 14, 28 and 42 (p = 0.002) and paediatric RBCC on Day 42 (p = 0.002) (Figure 2)
LDH levels for non-irradiated Whole blood (WB) increased by 164% and irradiated WB increased by 215%, whereas non-irradiated paediatric RBCC increased by 132% and irradiated units increased by 436%
Summary
The administration of red blood cell (RBC) products enhances intravascular oxygen-carrying capacity and is considered a vital treatment for patients with anaemia triggered by haemorrhage due to surgery, trauma or various haemoglobinopathies or malignancy.[1]. Damage to the cell membrane causes haemolysis and potassium leakage, these increases are not regarded as being clinically significant except in the following situations: when patients present with renal failure, at the onset of hyperkalaemia or when aged whole blood is transfused to neonates. When dealing with ill neonates, the potassium levels on storage may become significant, especially when large volumes are transfused. Haemoglobin, lactate dehydrogenase (LDH) and potassium cations are released into the supernatant due to oxidative damage caused by storage lesions.[4] Formation of haemoglobin microparticles due to the loss of RBC membrane structural integrity are caused by glucose consumption. Storage lesions occur in red blood cell products when potassium ions, haemoglobin and lactate dehydrogenase are released into the extracellular plasma due to postirradiation storage or cellular degeneration. Various studies regarding storage lesions have been completed in well-developed countries but not in Cape Town, South Africa
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