Citrate Phosphate Dextrose Adenine Research Articles

Hemostatic Evaluation of Refrigerated Whole Blood Stored 7 Days Post-Expiration.

The United States Army has shifted doctrine to focus on large-scale combat operations against peer to near-peer adversaries. Future conflicts could result in a limited supply chain, leaving medical providers with only expired blood products for treatment of hemorrhagic shock. This study evaluated quality, function, and safety metrics of whole blood stored for 1 week past regulated expiration (i.e., 35 days, in CPDA-1). Whole blood units (n = 6) were collected in citrate phosphate dextrose adenine-1 (CPDA-1) anticoagulant and stored refrigerated for up to 42 days. Units were sampled on days 35, 37, 39, and 42 of storage and evaluated for the following: complete blood count, blood metabolism and chemistries, clotting dynamics, and presence of bacteria. The majority of evaluated parameters fell outside of normal clinical ranges beginning at day 35 of storage. At 42 days, blood pH was 6.58 ± 0.038, hemolysis was significantly increased (P = .037 vs day 35), and bacterial contamination was not evident. Glucose levels continuously dropped during extended storage. K+ was significantly increased at day 42 compared to day 35 (P = .010). A significant reduction in clot strength, factor V activity, and factor VIII activity was evident beginning at day 39 of storage. Storage of whole blood out to 42 days results in a continuous decline in function, but further in vivo safety studies should be performed to determine if the benefits of expired blood outweigh the risks. Other methods to safely extend storage of whole blood that maintain hemostatic function and preserve safety should be investigated, with emphasis placed on methods that reduce potassium leak and/or hemolysis.

Hematologic and biochemical changes in caprine whole blood stored in CPDA-1 for 28 days

Parasitic anemia is a common affliction of goats in the United States that, in severe cases, requires a blood transfusion. There is currently limited data published on blood storage in small ruminants, goats in particular. With an increase in pet goats as well as a population of show and breeding animal owners, there is an increasing demand for blood transfusions in these patients to treat their anemia. The primary objective of this study was to determine biochemical and hematologic changes in caprine whole blood stored in citrate phosphate dextrose adenine solution (CPDA-1) over 28 days, particularly those that would impact transfusion efficacy, including packed cell vol­ume (PCV) and percent hemolysis in excess of 1%.

DELINEATION OF HEMATOLOGICAL CHANGES OCCURRING IN STORED CITRATE PHOSPHATE DEXTROSE ADENINE CPDA-1 BLOOD

Objectives: To study the changes in red cell indices and counts over a period of 42 days in blood stored in blood bags. Materials and Methods: This research was done in Blood Bank, Khyber Teaching Hospital, Peshawar in collaboration with the main laboratory, Khyber Teaching Hospital, Peshawar. About 450 ml of whole blood was taken from 200 donors into Citrate Phosphate Dextrose Adenine blood bags. The storage temperature for the blood bags was maintained between 2–8°C. Blood samples were collected from blood bags. At days 1 and 42, using a haematology analyser, parameters including haemoglobin, RBC count, WBC count, haematocrit, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration and platelet counts were measured. Mean and standard deviation were used for quantitative variables. Frequency and percentages were used for qualitative variables. Results: Through days 1 to 42, Haemoglobin (Hb) level decreased from 13.4gm/dl to 12.78 gm/dl, white cell count (WBC) decreased from 6.03x109/l to 2.95 x109/l, platelets count fell from 207 x109/l to 121 x109/l, neutrophils decreased from 59.6% to 23.8% while lymphocyte count increased from 28.36% to 66.3%. Conclusion: There is a decrease in haemoglobin level and white cell count over a period of 42 days of storage of blood bags. Lymphocyte counts increased during the storage duration of blood bags.

In vitro Evaluation of DINCH-Plasticized Blood Bags for Red Blood Cell Storage with CPDA-1 Anticoagulant

Introduction: Di(2-ethylhexyl) phthalate (DEHP) is a plasticizer commonly used in blood bags. Despite its protective effects on red blood cell (RBC) storage, concerns about its reproductive toxicity exist. This study investigated the in vitro quality of RBC concentrates stored in bags using di(isononyl) cyclohexane-1,2-dicarboxylate (DINCH) as an alternative plasticizer. Methods: Using a pool-and-split study design, we produced 20 matched homogenous quintets of RBC concentrates in two DINCH bags and three DEHP bags with citrate phosphate dextrose adenine (CPDA-1) anticoagulant. RBC storage quality was assessed weekly for 35 days. Results: On day 35, the median hemolysis levels in the DINCH bags (0.297–0.342%) were marginally higher (p < 0.05) than the DEHP bags (0.204–0.240%). All DINCH bags showed <0.8% hemolysis. RBCs in the DINCH bags showed increased mean corpuscular volume and decreased eosin 5′ maleimide binding than in the DEHP bags. Higher pO₂ and lower pCO₂ levels in the DINCH bags indicated better gas permeability than in DEHP bags. Other metabolic parameters were comparable in both bags. Compared to DEHP, DINCH exhibited considerably lower levels of plasticizer leaching into blood bags. Conclusion: The quality of RBC concentrates stored for 35 days in DINCH-plasticized blood bags with CDPA-1 is generally comparable to those in DEHP bags. Hence, DINCH can be a viable alternative to DEHP in blood bags for nonleukoreduced RBC storage even without the use of next-generation additive solutions to improve RBC preservation quality.

Caprine whole blood appears sufficiently stable after 21 days in storage to be suitable for transfusion.

The objective of this study was to determine hematologic changes of stored caprine whole blood in citrate phosphate dextrose adenine solution over a 28-day period. Ten 250-mL bags of whole blood were collected from 10 female Boer goats from Louisiana State University's Division of Laboratory Animal Medicine herd. 10 healthy blood donor goats were selected, and 250 mL of whole blood was drawn from each and stored at 2.78 °C. At the time of collection and every 7 days for a total of 28 days, samples were obtained from the blood bags to determine biochemical and hematologic values of collected blood. Only 5 of the 10 donors had baseline blood bag samples obtained for biochemical evaluation on day 0. At the end of 28 days, the remaining blood was submitted for aerobic and anaerobic culture. Blood values remained within suitable limits for transfusion and below 1% hemolysis for up to 21 days in most samples. Packed cell volume did not change significantly from day 0 to day 28. Lactate significantly increased over the 28 days, though not as dramatically as expected on the basis of other blood storage studies. pH decreased due to anticoagulant acidity but did not drop below 7. Cultures were negative on all blood bags. Changes over time are similar to that in other species, and caprine blood appears biochemically and hematologically stable for up to 21 days in storage. In vivo trials are needed for safety and efficacy.

Citrate phosphate dextrose adenine (CPDA-1) can be sampled from blood collection bags in a multi-dose manner.

To evaluate the sterility of citrate phosphate dextrose adenine (CPDA-1) anticoagulant when sampled from blood collection bags in a multi-dose manner. 10 pre-filled CPDA-1 blood collection bags; 46 bacterial and 28 fungal culture result reports. 10 CPDA-1 blood collection bags were split into 2 equal groups and stored at either room temperature (24 °C) or refrigerator temperature (5 °C) for 30 days. Two bags in each group were designated as controls. Beginning on day 0 a 1.0 mL aliquot was withdrawn from each experimental bag and submitted for bacterial culture (aerobic and anaerobic) every 5 days, and fungal culture every 10 days. All 10 bags were sampled on day 30. Bacterial and fungal culture results were compiled and interpreted. 46 CPDA-1 aliquots were cultured, resulting in 2 positive microbial isolates: Bacillus was cultured from a previously unopened experimental bag on day 0, and Candida was cultured from a refrigerated experimental bag on day 30. Both positives are thought to represent post-sampling contamination, though these suspicions cannot be confirmed in the bag yielding Candida due to a lack of subsequent data. All other samples were negative for microbial growth. CPDA-1 blood collection bags stored at either 24 °C or 5 °C can be used in a multi-dose manner for up to 20 days when each sample is obtained aseptically. These results support the clinician's ability to utilize the contents of 1 bag multiple times rather than discarding the bag after a single use.

Comparison of Several Types of Plasma as Media in the Germ Tube Test for Identification of Candida Albicans

Candida albicans is a commensal on the oral mucosal surfaces of healthy individuals but can be pathogenic in immunocompromised individuals. The germ tube test is an inexpensive, faster, and easier method used to identify and differentiate it from other yeast species. Generally, the test is carried out using serum as the medium. Plasma overall has the same characteristics as serum and differs only in the content of clotting factors. In addition, plasma is easier to obtain than serum in most healthcare services. This study aims to demonstrate three types of plasma as alternative media for germ tube test. CPDA (Citrate Phosphate Dextrose Adenine), EDTA (Ethylenediaminetetraacetic), and Sodium Citrate plasma were compared to serum in producing of germ tubes. Each plasma and serum was tested in five repetitions. The experimental method was carried out in Mycology Laboratory at Health Polytechnic of Jambi. The data were observed based on the germ tube formation time and analyzed with one-way ANOVA test. The result showed the lengths of germ tube formation time were significantly different. Although CPDA plasma was also significantly different compared to serum, it showed the average time which is at the minimum limit of the incubation time range that is recommended in the standard protocol of the test. This study concluded that plasma can be used as a substitute for serum in the germ tube tes, especially CPDA plasma, as it is faster in formating time, easier to obtain, and considered safer to use than others.

BIOCHEMICAL CHANGES IN THE STORED WHOLE BLOOD ASSESSED AT PERIODIC INTERVALS IN CPDA-1 ANTICOAGULANT CONTAINING BLOOD BAGS: A STUDY AT THE BLOOD BANK OF TERTIARY CARE HOSPITAL OF SOUTHERN RAJASTHAN

Objectives: The objectives of this study were to study the various biochemical changes occurring in a stored whole blood unit at day 0, day 17th, and the 35th day in full blood bag containing citrate phosphate dextrose adenine-1 anticoagulant. Methods: A cross-sectional descriptive study had been carried out among 110 healthy volunteer donors in the Department of Transfusion Medicine, RNT Medical College, Udaipur, between August 2019 and July 2020. A 10 mL blood sample from each bag containing anti-coagulated blood being collected, and the level of sodium, potassium, chloride, total protein, and albumin were measured on days 0, 17th, and the 35th. Mean and standard deviation had been calculated for the parameters, a one-way analysis of variance test was applied to compare the differences, and a p&lt;0.05 was considered statistically significant. Results: A higher proportion of males in the age group 18–27 years, and a generally steady increase in serum potassium level with a steady decrease in serum sodium, chloride, total protein, and albumin levels over the 35-day storage period. Conclusions: In this study, stored whole blood undergoing changes in its biochemical parameters had been studied and found to be significant. The study also recommends transfusion of fresh blood for high-risk patients.

The in vitro red blood cell microvesiculation exerts procoagulant activity of blood cell storage in Southeast Asian ovalocytosis

Southeast Asian ovalocytosis (SAO) is characterized by the misfolding of band 3 protein in red blood cells (RBC). The abnormal structure of the band 3 protein results in dysmorphic RBC and related functions. Previous data showed that in vitro storage under hypothermic conditions alters band 3 protein structure and function. Microvesiculation includes shedding of RBC membranes, called RBC-derived microparticles/extracellular vesicles (RMP/EVs), and storage lesions. Unfortunately, there is no evidence of RBC microvesiculation under in vitro storage conditions in heterozygous SAO individuals. This study determined the generation of REVs and procoagulant activity during the storage of SAO blood samples in southern Thailand. Venous blood was collected from eight SAO and seven healthy individuals, preserved in citrate phosphate dextrose-adenine 1 (CPDA-1) at 4 °C for 35 days. The absolute numbers of REVs and PS-expressing RBCs were analyzed using flow cytometry. The procoagulant activity of the produced extracellular vesicles was determined by a clotting time assay. The results showed a significant increase in the number of REVs and PS-expressing RBCs in the SAO blood samples. Significantly correlated PS externalization and procoagulant activity were observed in the SAO blood samples. These lines of evidence indicate that the abnormality of the Band 3 protein is possibly involved in aberrant microvesiculation, exerting procoagulant activity in vitro. Increased pools of REV production and abnormal storage lesions in SAO blood samples should be a concern. Notably, the mechanisms underlying membrane vesiculation depend on the extent of blood cell storage under hypothermic conditions.

Evaluation of Haemogram Parameters in Refrigerated Therapeutic Whole Blood at the Blood Transfusion Center of the Douala General Hospital Cameroon

Blood transfusion is a substitute therapy which consists to administered blood or one of its components to one or more sick person. hematological components retain their stability if the cold chain is maintained between 2 and 6°C. essential for good transfusion performance. The aim of this work was to evaluate the stability of haemogram parameters under the influence of cold chain on whole blood bags seronegative from infections transmissible by blood transfusion (ITT).&#x0D; Methodology: A cohort of 200 blood collected into the citrate phosphate dextrose adenine (CPDA) blood bag collected consecutively at the blood transfusion center of the Douala General Hospital constituted the population of the study conducted from March 1st to September 30th, 2018. 5ml of this blood from the donor’s blood bag was collected into a dry tube (for the blood count using URIT 3000 Plus machine) and the rest was stored in a BIOBASE brand refrigerator at a temperature between 2 and 6. On the day of delivery, a second sample was taken by section of the tubing of the bag for the analysis of a second haemogram of the same blood bags. Temperature, refrigerator opening frequency and blood were collected every day. Data analysis was done using by SPSS 20.0 for Windows software. The results were considered significant at p˂0.05.&#x0D; Results: The storage temperature significantly (p˂0.05) decrease the rate of leukocytes, erythrocytes and hemoglobin. When the shelf life and the frequency of opening the refrigerator increased, hemoglobin, hematocrit, MCV and lymphocyte decreased significantly while leukocyte, MCHC, thrombocytes and granulocytes increase significantly.&#x0D; Conclusion: This study showed that, the decrease in leukocytes, red blood cells and hemoglobin levels was significantly related to shelf life and frequency of opening the refrigerator. Knowledge on this variation could be very useful in the selection of refrigerated blood or pint and the efficiency of transfusion.

Storage lesions after irradiation: Comparison between blood stored in citrate phosphate dextrose adenine and saline adenine glucose mannitol

Background and Objectives: Saline adenine glucose mannitol (SAGM) with citrate phosphate dextrose (CPD) or CPD adenine (CPDA) are two common red cell preservatives used in our country. This study analyzed and compared serial biochemical changes on different days of storage in irradiated packed red blood cells stored in CPDA and SAGM solutions. The aim of this study was to see if these changes are influenced by or different, if any, in these two storage solutions. Patients and Methods: Ninety units of RBCs were randomly chosen, with 45 units each collected in CPDA and SAGM, respectively. Nine units each were irradiated by gamma irradiator using cobalt 60 (BI 2000) on days 1, 7, 14, and 21 of their storage, respectively. Nine units were not irradiated and used as controls. All the units were weekly assessed for their plasma levels of potassium, sodium, glucose, lactate dehydrogenase (LDH), and lactate by Clinical Chemistry Auto-analyzer, Beckman Coulter AU680. The values were documented and analyzed by SPSS. Results: Baseline values on day 1 for potassium, lactate, and LDH were similar between SAGM- and CPDA-stored blood bags. Glucose and sodium levels were slightly higher in SAGM bags compared to CPDA. Postirradiation, the changes (increase in K+, Lactate, LDH and decrease in Na+, glucose) were higher in CPDA bags than SAGM bags, and the difference in this trend was not significantly different from that seen in nonirradiated blood bags stored in these two preservative solutions. Conclusion: Storage lesions (biochemical parameters) after irradiation were severe, but paralleled that observed in nonirradiated bags. The storage solution, either SAGM or CPDA, made no difference to these changes.

Ferric reducing ability of plasma: A potential marker in stored plasma

<b>BACKGROUND:</b> The ferric reducing ability of plasma (FRAP) assay is used for measuring the antioxidant capacity. FRAP is proportional to the molar concentration of the antioxidant capacity. <b>AIM:</b> The objective of this study attempts to analyze the possibilities of FRAP as an indicator of oxidative stress (OS). <b>SETTINGS AND DESIGN:</b> Blood was drawn from male <i>Wistar</i> rats and stored over a period of 20 days at 4°C in citrate phosphate dextrose adenine-1 (CPDA-1). They were divided into two groups: controls and experimentals. The experimentals were added with antioxidants-L-carnitine, curcumin (Cu), Vitamin C (VC), and caffeic acid (CA) of varying concentrations-10, 30, and 60 mM (<i>n</i> = 5 for each group). <b>MATERIALS AND METHODS:</b> Plasma was isolated from these samples at regular intervals (every 5 days) and FRAP and Protein were assayed. Results were analyzed by two-way ANOVA, using GraphPad Prism 6 (GraphPad Software, Inc. USA). <b>RESULTS:</b> FRAP was maintained in controls. VC (ascorbic acid) was the most potent antioxidant in terms of FRAP during storage compared to the above antioxidants. <b>CONCLUSION:</b> This study emphasizes the use of FRAP as a potential marker of OS in plasma of stored blood. FRAP can be utilized as a reliable marker for determining the antioxidant capacity.

Assessment of Average Hematocrit of Red Cell Units for Erythrocytapheresis Procedure in Sickle Cell Disease

Background:Erythrocytapheresis, or red blood cell exchange (RCE) is a non-invasive procedure in which a patient's erythrocytes are removed from the bloodstream while being replaced with erythrocytes from blood donors. RCE is commonly used as a transfusion technique in patients with sickle cell disease (SCD) to help treat and prevent complications associated with sickling of erythrocytes and iron overload.The AABB consensus report (1) outlines the procedural guidelines for RCE including appropriate indications and ideal forms of vascular access. However, the guidelines make no recommendation for determining the hematocrit (Hct) of the red cell bags for the procedure.Institutions take several different approaches to determine how many red cell units to exchange. The number of units needed depends on the volume and Hct of the individual units as well as the patient's pre-procedure Hct and HbS levels, height, weight, and the desired HbS and Hct targets. Red cell units are routinely labeled with volume, but are not generally labeled with Hct. The AABB consensus report (1) states that some institutions use an estimated Hct of 56% to 57% for each unit. The report rationalizes the use of an estimated Hct for input for the RCE, by citing the approximated Hct of bags of red cells (55% to 60%) with additive solution produced from whole blood donation, based on limited data.The goal of our study was to determine the average Hct on the red cell units used for RCE.Methods:This study used a retrospective chart review to investigate the Hct of red cell units during a RCE in a calendar year. Our institution uses pre-storage leuko-reduced red blood cells units in citrate phosphate dextrose adenine (CPDA-1) and adsol preservative (AS-1), which are 21 days old or less for RCE. The average Hct of the bags of red cells infused during the procedure was determined by accessing each bag for a small sample of blood to determine the Hct. Data was excluded if the patient did not meet standard weight requirements (> 30 kg) or required additional treatment protocols including the use of washed cells or machine priming.Results:A total of 297 encounters were recorded for 30 different patients. A total of 1953 bags (approximately 517 liters of red cell units in volume) were administered. Data from the encounters were used to calculate measures of central tendency. The average calculated Hct for each encounter was 63.3%, with a median and mode Hct being 63% and 62%. The range of Hct from the bags was 54.6% to 72.9%. The average Hct of the bags ranged from 60.6% (in March) to 64.8 % (in July).Conclusions:Our study suggests a higher average Hct of transfused red cell units than stated in the AABB consensus report (1), which was based on limited data. Our findings indicate that a standardized average of 63.3%, would be appropriate for our institution. Conversely, our findings also signify that the standardized average Hct must be determined in each institution prior to their application for RCE. However, our data also reveals that it is possible to subject patients to estimates as far as 9.7% above and 9.6 % below the true average Hct of the red cell bags used. The process of determination of Hct for each of the red cell units increases the time of pre-service activities, laboratory costs, and the overall infusion center time for the patients leading to higher costs per infusion. Consequently, using a standardized average of the Hct would result in cost savings. We have therefore adopted the practice of using the standardized average of Hct of 63.3% for RCE in our patients.Reference:1. Biller E, Zhao Y, Berg M, Boggio L, Capocelli KE, Fang DC, Koepsell S, Music-Aplenc L, Pham HP, Treml A, Weiss J, Wool G, Baron BW. Red blood cell exchange in patients with sickle cell disease-indications and management: a review and consensus report by the therapeutic apheresis subsection of the AABB. 2018 Aug;58(8):1965-1972. doi: 10.1111/trf.14806 DisclosuresMunson: Terumo Medical Corporation: Consultancy, Honoraria, Speakers Bureau. Raj: Terumo Medical Corporation: Honoraria, Speakers Bureau; Global biotherapeutics: Speakers Bureau; Forma therapeutics: Consultancy.

Effect of storage on biochemical parameters of packed red blood cells of goats in............ 257-261 citrate phosphate dextrose adenine/ saline adenine glucose mannitol

A study was conducted to assess the suitability of citrate phosphate dextrose adenine / saline adenine glucose mannitol as a storage media for packed RBCs of goats. Samples collected from ten apparently healthy goats were utilized for the study. Biochemical studies were carried out on day 0, 14, 28 and 42 days of storage using the parameters, viz. pH, glucose, potassium, malondialdehyde and reduced glutathione. The pH was stable throughout the study, whereas glucose showed significant reduction. Rest of the parameters increased significantly from 0th day to 42nd day. Based on the results, the storage media can be considered to be suitable for storing caprine packed RBCs.

Time Dependent Erythrocyte Morphometric Changes of Prolonged Stored Blood and its Effect on Target Post-transfusion Haematocrit of Splenectomised Mongrel Dogs

Background: Mean values of erythrocytic morphometric parameters of very old blood and its effect on the target post-transfusion haematocrit changes of splenectomised dogs was studied. Methods: Two hundred and fifty milliliters of blood each were drawn from healthy dogs (n=6) into citrate phosphate dextrose adenine-1 anti-coagulated blood bags, preserved for 35 days for the evaluation of erythrocyte morphometric and viability parameters. Thereafter, twenty adult male splenectomised dogs were randomly assigned into 5 groups (n=3). Post-splenectomy, 4, 14, 21 and 28 day old blood (DOB) were transfused to groups II-V while group I animals were not transfused. Intraoperative blood loss was determined during the surgery while post-transfusion, animals haematocrit were assayed and used to calculate the targeted haematocrit. Result: Findings revealed irreversible progressive time dependent morphometric changes by day 14 of blood storage. Hence, it is recommended that for transfusion purposes, 4 DOB should be the hallmark as it achieved the desired haematocrit and no morphometric changes were observed from it.

CDPA-1 Stored Blood Induced Effect on some Haematological Parameters

Background: Most blood collection bags contain 63 mL CPDA anticoagulant which is sufficient to anticoagulant and ensures the viability of blood cells in 450 mL±10% blood for up to 28–35 days when the blood is stored at 2–8°C. Prolonged storage of blood leads to alteration in cells hematologically which may lose viability with time. Aim: The study was conducted to determine the effect of storage on CPDA-1 for varying periods on some hematological parameters. Materials and methods: The study was conducted on blood donated by 30 healthy volunteer donors. Effect of storage was analyzed at 1, 7, 14, 21and 28 days intervals. Hematological parameters were measured using Mindary PS 300 hematology analyzer. Results: There is a highly significant increase in hemoglobin concentration, packed cell volume (P.C.V. %), MCV, and also a decrease in lymphocyte, granulocyte, and platelet count. The results also showed an insignificant decrease in total white blood cell count. Conclusion: There are degenerative changes observed in blood parameters in samples collected in citrate phosphate dextrose adenine (CPDA-1).

Ferric reducing ability of plasma: a potential oxidative stress marker in stored plasma

Introduction: The ferric reducing ability of plasma (FRAP) assay is used for measuring the antioxidant capacity. FRAP is proportional to the molar concentration of the antioxidant capacity. This study attempts to analyze the possibilities of FRAP as an indicator of oxidative stress. Methods: Blood was drawn from male Wistar rats and stored for 20 days at 4 ○ C in citrate phosphate dextrose adenine 1. The rats were divided into two groups: controls and experimentals. The experimentals were added with antioxidants — l-carnitine, curcumin, vitamin C (VC), and caffeic acid of varying concentrations — 10, 30, and 60 mM (n =5 for each group). Plasma was isolated from these samples at regular intervals (every 5 days), and FRAP and protein were assayed. Results were analyzed by two-way ANOVA, using GraphPad prism 6. FRAP was maintained in controls. Results: VC (ascorbic acid) was the most potent antioxidant in terms of FRAP during storage compared with the above antioxidants. This study emphasizes the use of FRAP as a potential marker of oxidative stress in plasma of stored blood. Conclusion: FRAP can be utilized as a reliable marker for determining the antioxidant capacity.

Cytoskeletal changes in Erythrocytes during storage in banked blood

Introduction: Erythrocytes have flexible, non-nucleated bi-concave shape with lipid bilayer cytoskeleton. Any alterations of erythrocyte shape make it susceptible to hemolysis. Blood for transfusion purpose is routinely stored in Citrate Phosphate Dextrose Adenine (CPDA-1) containing blood bags. During storage, blood undergoes an array of different morphological changes termed as “storage lesions” which makes it more fragile. This study was aimed to determine the structural and functional modifications in erythrocytes in CPDA-1 blood stored in local blood bank of KPK. Material &amp; Methods: Blood from twenty healthy volunteer donors was taken and kept in CPDA-1 containing blood bags at Institute of Basic Medical Sciences (IBMS), Khyber Medical University (KMU). Hb-levels and Erythrocyte, Reticulocyte counts, Mechanical Fragility Index (MFI) and immunofluorescence staining for ankiyrin1 protein were performed on fresh blood samples. Samples for reticulocyte count was taken for 5 consecutive days while for the remaining parameters, blood was taken at 5 days interval till day 20th. The light and fluorescence micrographs were obtained accordingly and osmotic fragility tests were performed. Results: A significant mean reduction in erythrocyte counts and Hb-level was observed from day 0 to 20 (p=0.001), while MFI increased from day 0 to day 20 (12.88%±7.58 p=0.001). Reticulocyte count also decreased from day 0 up to day 5 (p=0.001). A weak association was observed between changes in MFI and erythrocyte morphology from day 0 to 20 (r=0.349), while the intensity and pattern of ankyrin1 protein expression appeared to change from day 10. Conclusion: Blood stored for a week has same properties as fresh blood, however, important structural alterations start to appear after the first week of storage and worsen with time. Therefore, to gain better transfusion results, blood stored for up to one week can safely be transfused.

Evaluation of cellular changes in blood stored for transfusion at Bungoma County Referral Hospital, Kenya.

Introductionduring the storage of transfusion blood, it may undergo a series of cellular changes that in speculation could be the reason behind the risk of using prolonged stored blood. It's important therefore to monitor the cellular changes that may reduce its survival and function. The objective was to assess the cellular changes in whole blood stored for transfusion at Bungoma county referral hospital.Methodsa single center, prospective and observational study design involving 20 randomly selected donor blood units in citrate phosphate dextrose adenine (CPDA-1) anticoagulant was employed, cellular changes were evaluated for 35 days. The changes were tested using the Celtac F Haematology analyzer. Statistical Analysis of variance was employed in the descriptive statistics. All the investigation was executed using statistical package for social sciences (SPSS V.23). Results were regarded as significant at P<0.05. Results were presented in tables and charts.Resultsat the end of the 35 days blood storage at blood bank conditions, WBC, RBC, platelets counts and MCHC decreased significantly (P<0.0001, =0.0182, <0.0001, =0.0035). The MCV, HCT and MCH increased significantly (P <0.0001, =0.0003, =0.0115) while HGB had insignificant variance (P =0.4185).Conclusionplatelets, WBC, RBC counts, and indices are significantly altered in stored blood especially when stored over two weeks based on most of the cellular components analyzed in this study. The study, therefore, recommends the utilization of fresh blood to avoid the adverse outcome of cellular changes of reserved blood.

Biochemical changes in whole blood stored for transfusion at Bungoma County Referral Hospital, Kenya.

BackgroundDuring storage, transfusion blood may undergo a series of biochemical changes that could pose risks to patients when used. It is important therefore to monitor biochemical changes that may reduce survival or function of stored blood cells.ObjectiveThis study assessed biochemical changes in whole blood stored for transfusion at Bungoma County Referral Hospital in the western region of Kenya between February 2019 and August 2019.MethodsA prospective study design involving 20 randomly selected donor blood units in citrate phosphate dextrose adenine anticoagulant was employed. Biochemical changes were evaluated for 35 days. Potassium and sodium levels were tested using the HumaLyte Plus5 analyser. Blood pH level was estimated using the Hanna pH meter.ResultsAt the end of the 35 days of storage under blood bank conditions, the mean potassium level significantly increased from 7.31 mmol/L at baseline to 20.14 mmol/L at week 5 (p < 0.0001), and the mean sodium level significantly decreased from 150.72 mmol/L at baseline to 121.56 mmol/L at week 5 (p < 0.0001). The pH level decreased insignificantly from 7.48 at baseline to 7.38 at the end of week 1 (p = 0.0757) but decreased significantly to 6.15 at the end of week 5 (p < 0.0001).ConclusionPotassium increased and sodium concentrations decreased significantly from the first week of blood storage. The pH decreased significantly from the second week of storage. Therefore, aged blood should be avoided to circumvent potential adverse outcomes from biochemical changes and stored blood should be tested before use.