Biochemical changes in stored donor units: implications on the efficacy of blood transfusion

Abstract

BackgroundBlood transfusion with allogeneic blood products is a common medical intervention to treat anemia or prepare patients for surgical procedures. Generally, the blood units are secured and stored prior to expected transfusion. During storage, a number of biochemical changes occur (generally known as storage lesion), which can affect the efficacy of blood transfusion. The aim of the study was to evaluate the biochemical changes that occur in blood units during storage and to project the impact of these changes on transfusion.MethodsThe study protocol was approved by the Faculty of Medicine Research Ethics committee of Mbarara University of Science and Technology. A total of 200 blood recipients were categorized into two study arms: group I received fresh blood (n=100) and group II received old blood (n=100), who were formally consented and recruited consecutively. A total of 2 mL of venous blood was collected from each participant in EDTA tubes before transfusion (for pre-transfusion hemoglobin [Hb] estimation) and after transfusion (for post-transfusion Hb estimation). Each crossmatched unit was sampled to collect plasma for pH, lactate and potassium assays. Data were analyzed with STATA version 12.0.ResultsA total of 200 blood transfusion recipients aged 1–60 years were enrolled in the study. Up to 60% of the participants were females. The pH of the stored blood dropped from 7.4 to 7.2 in the first 3 days to ~7.0 by day 11 and to <7.0 by day 35 (p=0.03). The average rise in lactate level was 25 g/dL in blood stored for 0 to 11 days and 32.4 g/dL in blood stored for 21–35 days. The highest increase was encountered in blood stored beyond 28 days: 40–57 g/dL by 35 days (p=0.001). Potassium levels equally increased from ~4.6 mmol/L in the first 5 days of storage to ~14.3 mmol/L by 11 days. From the third week of blood storage and beyond, there was exponential increase in potassium levels, with the highest record in blood units stored from 30 to 35 days (p=0.068).ConclusionWhole blood stored for >14 days has reduced efficacy with increased markers of red cell storage lesion such as increased potassium level, lactate and fall in pH. These lesions increase the length of hospital stay.

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

“…Potassium ions increased significantly after one week and further increased significantly through to 35 days of storage. This result compares with previous studies in Portugal, 10 Uganda, 9 India 11 and Nigeria 12 which demonstrated that potassium significantly increased throughout the storage period.…”

“…Regardless of the advantages of blood transfusion in clinical care (such as to treat anaemia, prepare patients for a surgical process, and limit manifestations of blood depletion), the procedure may cause harm to patients. 9 There are various deleterious after-effects of blood transfusion that could occur despite cautious laboratory methods in handling and cross-matching the donors and the recipient. The undesired effects may be attributed to changes in the usual micro-environment or biochemistry of the blood cells in the course of blood storage.…”

The therapeutic importance of acid-base balance

“…On a related theme, the usefulness of stored blood for transfusion can be compromised by numerous storage lesions including low pH that follows anaerobic metabolism by stored cells [364] , [365] . Finally, an acidic tissue environment appears to favor natural wound healing, yet alkaline pH favors the success of skin grafts [366] .…”

Establishment of a model for equine small intestinal disease: effects of extracorporeal blood perfusion of equine ileum on metabolic variables and histological morphology – an experimental ex vivo study

“…Arterial and venous lactate concentrations were significantly increased, partly due to the lack of the lactate-metabolizing-effect of the liver [24], and as a consequence, arterial and venous pH was lower than reference intervals. Lactate concentrations in the initial arterial blood samples were also higher than reference intervals; this leads to the conclusion that besides the partially anaerobic metabolism of the perfused organ, the blood itself also shows anaerobic metabolism; this is in accordance with human blood transfusions, where increasing lactate concentrations depend on the storage time [27]. High venous pCO 2 and lactate concentrations also led to the decrease of venous pH, BE, and HCO 3 − compared to reference intervals.…”

“…Compared to reference intervals, arterial and venous K + is significantly higher, possibly caused by damage to blood cells. At 240 min venous K + is even significantly higher than arterial K + , possibly a sign of commencement of cell damage in the perfused organ at this time point [27]. Increased venous glucose as well as Na + , Ca 2+ , and Cl − compared to arterial samples demonstrate the uptake through the serosa of the ileum either via diffusion or active uptake by mesothelial cells out of the peritoneal replacement fluid [29, 30].…”