Currently used systems for red blood cell (RBC) collection and storage for transfusion have the disadvantage that the RBC 2,3-bisphosphoglycerate (BPG) concentration is depleted within two weeks of storage, resulting in a left-shift of the oxygen dissociation curve and a temporarily impaired capacity to deliver oxygen. We have studied the effects on red cell metabolism, morphology and in vivo recovery of 49-day storage of RBC, with collection in half-strength citrate CPD (0.5CPD) and storage in an additive solution containing citrate, adenine, mannitol, phosphate and glucose (RAS2). Traditional CPD-SAGM was used for comparison. Component preparation was performed after an initial holding period of the whole blood at ambient temperature for 8h. The BPG concentration in 0.5CPD-RAS2 RBC was 0.633±0.120 mol (mol Hb)^-1 as compared to 0.454±0.138 mol (mol Hb)^-1 in CPD-SAGM RBC which implied a decrease to 67 and 48% of normal concentration, respectively. The mean RBC BPG concentration was maintained at the initial level for 28 days in the new system but decreased to very low levels within 14 days in the controls. The total adenine nucleotides were well maintained in both systems, adenosine triphosphate slightly better in the new system. Hemolysis after 49 days was 0.35±0.21% in the new system and 0.72±0.25% in the controls (p<0.001). The morphology was better maintained in the new system (p<0.001). The 24-hour posttransfusion survival of 49-day stored RBC was 78.9±7.1%. The membrane leakage of sodium and potassium was not significantly different in the two systems. The concentration of inorganic phosphate (Pi) in the extracellular fluid of 0.5 CPD-RAS2 RBC was initially 7.1±0.8 mmol l^-1. It decreased to approximately 5.5 mmol l^-1 during the first 2 weeks of storage and then slowly increased to 9.4±0.9 mmol l^-1 on day 49. Pi in the CPD-SAGM controls was low initially but rose to 6.2±0.4 mmol l^-1 at the end of storage. The new system offers clearcut advantages as compared to traditional systems and does not seem to raise any serious clinical objections against its use even in massive transfusions.
Background: Red blood cells stored as concentrates or suspensions in additive solutions change rapidly their oxygen affinity mainly due to the loss of 2,3-diphosphoglycerate (2,3-DPG). When collected in CPD with half of the normal concentration of citrate and citric acid (0.5 CPD) and stored in a new additive solution (Erythro-Sol), 2,3-DPG is better maintained. No studies of the oxygen affinity of red cells stored under these conditions have been published. In Erythro- Sol, red cells have a satisfactory in vivo recovery for 49 days but the conditions after 28 days, within which time most red cell units are transfused, have not been investigated. Of importance is also to be able to make platelet concentrates (PCs) from 0.5 CPD blood. Little data are available concerning the clinical usefulness of platelets prepared from 0.5 CPD buffy coats (BCs). Methods: Blood was collected in 0.5 CPD, held at 20°C for 3-4 h, then separated with the bottomand- top technique into red cells, plasma and BC. In a storage experiment with 6 U the 2,3-DPG and P(50) values were determined weekly and a number of in vitro parameters were tested on day 28. In 6 donors the in vivo recovery and survival of red cells were determined using a single-chromium technique. Transfusions of 212 0.5 CPD-Erythro-Sol red cell units were given to hematological patients under supervision. PCs derived from pools of 0.5 CPD BCs suspended in PAS2 (T-Sol) were transfused to 20 thrombocytopenic patients and compared with CPD-BC- PCs suspended in PAS 1. Corrected count increments (CCI) were determined. Results: The erythrocyte 2,3-DPG and P(50) values were normal or slightly subnormal initially but increased to supernormal levels during the 1 week, and remained at these levels for a further 1-3 weeks; the 2,3-DPG was two thirds of normal after 28 days, the P(50) was 3.72 ± 0.28 kPa after 14 days and 2.84 ± 0.41 after 28 days (mean ± SD). The P(50), values corresponded closely (r^2 = 0.903) to 2,3- DPG. The in vivo recovery of 4-week-stored red cells was 89.6 ± 5.5% and the T(50) was 32.2 ± 2.0 days. No adverse effects were observed in the transfusions. The CCI values did not differ between test and control groups; in both, 3- to 5-daystored PCs gave lower CCI than fresh (0-2 days) PCs. Patients with acute myeloid leukemia AML (n = 11) had significantly lower CCI values than patients with myelodysplastic syndrome, myeloma and lymphoma (n = 9; CCI(1h): p = 0.001; CCI(24h),: p = 0.006). Conclusions: Red cells stored in Erythro-Sol sustain a normal or slightly lowered oxygen affinity for 2-4 weeks, their viability is excellent, and they are well tolerated in clinical transfusions. Platelets prepared from 0.5 CPD-BCs cause CC1(S) of the same magnitude as CPD-BCs.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.