Quality of red blood cells washed using the ACP 215 cell processor: assessment of optimal pre‐ and postwash storage times and conditions

Abstract

Washing of red blood cell concentrates (RCCs) is required for potassium-sensitive transfusion recipients, including neonates in need of large-volume transfusions. When open, nonsterile washing systems are used, postwash outdate time is limited to 24 hours, often leading to problems providing the component to the patient before expiry. A closed, automated cell processor, the ACP 215 from Haemonetics Corporation, was used to wash RCCs and determine optimal pre- and postwash storage times. Two postwash storage solutions, additive solution (AS)-3 and saline-adenine-glucose-mannitol (SAGM), were compared. The in vitro quality of leukoreduced RCCs, prepared from citrate-phosphate-dextrose-anticoagulated whole blood, was determined postwash and compared to existing guidelines for RCC quality (hemoglobin content, hematocrit, and hemolysis) and predetermined criteria for ATP and supernatant potassium levels. A criterion for visual hemolysis was also applied. The prewash storage time, postwash storage time, and the postwash resuspension solution all contributed to RCC quality postwash. Levels of hemolysis were greater when washed RCCs were resuspended in SAGM (p = 0.01), while AS-3 proved worse at maintaining ATP levels postwash (p < 0.01). Immediately postwash, all units had supernatant K+ levels below the detection limit of the instrument (<1 mmol/L), but these increased to above acceptable levels within 14 days. Based on all acceptance criteria, a maximum 14-day prewash storage period and 7-day postwash storage period in SAGM preservative was found to be optimal. The longer outdate time postwashing should help lessen challenges in providing components to patients before expiry.