Quality and safety of red blood cells stored in two additive solutions subjected to multiple room temperature exposures.

Abstract

Many international standards state that red blood cell (RBC) products should be discarded if left out of controlled temperature storage for longer than 30min to reduce the risk of bacterial growth and RBC loss of viability. This study aimed to verify whether repeated short-time exposures to room temperature (RT) influence RBCs quality and bacterial proliferation. Saline-adenine-glucose-mannitol (SAGM) and AS-3 RBC units were split and exposed to RT for 30 or 60min on day 2, 7, 14, 21, and 42 of storage while reference units remained stored at 1-6°C. Red blood cell in vitro quality parameters were evaluated after each exposure. In a second experiment, SAGM and AS-3 RBC units were split and inoculated with Staphylococcus epidermidis (5CFU/ml), Serratia marcescens (1CFU/ml), and Serratia liquefaciens (1CFU/ml). Reference units remained in storage while test units were exposed as described previously. Bacterial concentrations were investigated after each exposure. No differences were noticed between reference and test units in any of the in vitro parameters investigated. S.epidermidis did not grow in either reference or exposed RBCs. While S.marcescens did not grow in AS-3, bacterial growth was observed in RT-exposed SAGM RBCs on day 42. Similar growth was obtained for S.liquefaciens in the two additive solutions for both reference and test units. Short-time exposures to RT do not affect RBC quality and do not significantly influence bacterial growth. An expansion of the '30-minute' rule to 60min should be considered by regulatory agencies.