Storage Time Of Red Cells Research Articles

Comparison of in vitro responses to fresh whole blood and reconstituted whole blood after collagen stimulation.

In patients who have large bleeds, there is a tendency to transfuse more plasma and platelets than recommended in earlier guidelines, and accordingly many hospitals now provide "transfusion packages" with an intended red cell:platelet:plasma ratio of 1:1:1. The purpose of this study was to investigate in vitro functions of transfusion packs compared with fresh whole blood. "Reconstituted whole blood" was prepared with the same ratio of red cells, platelets and plasma as used in local transfusion packages. The aggregation and thrombin-antithrombin complex formation responses to collagen stimulation of this reconstituted whole blood were compared with those of fresh whole blood. The storage time of red cells and platelets was varied in a systematic manner, giving nine different compositions of reconstituted whole blood that simulated transfusion packs. The responses varied significantly between whole blood and reconstituted whole blood -and between the reconstituted whole blood of different compositions. A significant decrease (p<0.005) in collagen-induced platelet count reduction was seen with increasing platelet and red blood cell age. Thrombin-antithrombin complex formation peaked in studies with platelets stored for 5 days. The red cells stored for the longest time induced the greatest thrombin-antithrombin complex formation. Fresh whole blood gives more consistent responses, and the aggregation response to collagen is stronger than in reconstituted whole blood. Our results indicate that in vitro responses of reconstituted whole blood vary substantially according to how long the red cells and platelets are stored for. As the responses obtained by testing whole blood are more consistent and usually stronger, the alternative use fresh whole blood in special conditions should not be excluded without further consideration.

Storage Time of Red Blood Cells and Mortality of Transfusion Recipients

Storage of red cells and the associated storage lesion have been suggested to contribute to adverse clinical outcomes. The aim of this study was to investigate whether increasing storage time of red cells is associated with mortality of recipients. From all patients who received red cell transfusions between January 2005 and May 2009, in the Leiden University Medical Center, we selected those who received only-young or only-old red cells, defined as below or above the median storage time. Mortality was compared in a Cox regression model. Subsequently, similar comparisons were made between subgroups with increasing contrast between old and young red cells. Among adult patients, after correction for potential confounders, the hazard ratio of death within 1 year after receiving red cells stored for more than 17 days compared with 17 days or less was 0.98 (95% confidence interval, 0.83-1.2). With increasing contrast, the hazard ratio decreased to 0.56 (95% confidence interval, 0.32-0.97) for red cells stored for more than 24 days compared with less than 10 days. In contrast to what has previously been suggested, we find an almost 2-fold increase in mortality rate after the transfusion of fresh red cells compared with old red cells. Results dependent on analyses chosen and previous studies may not have used optimal analyses. The tendency to demand ever-fresher blood could actually be detrimental for at least some patient groups.

No Early Effect of Storage Time of Transfused Red Blood Cells on Fatigue and Plasma Cytokines in Patients with Anaemia from Non-Acute Gastrointestinal Bleeding

Background: Fatigue in anaemia is empirically reduced byblood transfusion. Long storage time of red cells may be associatedwith immunomodulatory effects, and blood stored for along time may cause tissue hypoxia upon transfusion. Patientsand Methods: 22 patients admitted with haemoglobin < 6.0mmol/l, complaints of fatigue and no active bleeding were included.Eleven patients received two red cells units (SAGM)stored less than 1 week (short storage time, S), and 11 patientsreceived two units stored more than 3 weeks (long storagetime, L). Fatigue was self-estimated on a visual analogue scale.Clinical observations and blood samples were obtained beforetransfusion was started, and were repeated 2-8 h after transfusionof the 2nd unit. Measured plasma parameters included IL-1ß, IL-6, IL-8, IL-10, IL-12 and TNF-a. Results: There were no significantdifferences between group S and L (nsSL) in demographicdata, observational data and blood plasma values.Haemoglobin increased from mean (± SD) 5.2 ± 0.6 to 6.4 ± 0.7mmol/l after transfusion (nsSL). Fatigue score significantly decreasedfrom a pre-transfusion median 6.6 (range 0.1-9.9) topost-transfusion 4.7 (0.6-10.0) (p = 0.02) for all patients (nsSL).Beside increase in haemoglobin the only significant change inblood parameters after transfusion was a decrease in thrombocytecount (nsSL). No significant differences were seen in concentrationsof cytokines before and after transfusion. Conclusion:Transfusion of two units of red cells relieved self-estimatedfatigue, independent of blood storage time. Thrombocytecount decreased after transfusion, probably due to dilution bytransfused blood. Aged red cells may not, or only sparsely, directlytrigger the interleukin cascade.

The extension of 4 degrees C storage time of frozen-thawed red cells.

Blood was drawn from volunteer donors and frozen using the high glycerin, mechanical freezing procedure accepted by the United States Navy. Subsequently, the units of blood were thawed and washed. Various anticoagulants were added, and the red cells were stored in a refrigerator at 4 degrees C for periods of up to 28 days. Chemical analyses were performed periodically. These showed that the addition of the anticoagulants ACD, CPD and CPDA-1 caused the red cells to be preserved better than the currently accepted 0.9-percent NaCl, 0.2-percent glucose solution. In vivo 51Cr viability studies performed on blood stored with CPDA-1 for 14 days showed a 24-hour viability of 78.8 +/- 8.4 percent. In a subsequent study, the blood was stored for 21 days prior to freezing and then was rejuvenated and frozen. The cells were thawed, washed, and stored at 4 degrees C with CPDA-1 for an additional 14 days. The 24-hour viability of these cells was determined to be 74.0 +/- 5.1 percent. These findings show that the postthaw storage time of red cells can be increased greatly over the now-accepted 24 hours, if bacterial sterility can be assured.