IN VIVO SURVIVAL IN THE HUMAN SUBJECT OF TRANSFUSED ERYTHROCYTES AFTER STORAGE IN VARIOUS PRESERVATIVE SOLUTIONS

Abstract

The results of the commonly accepted in vitro tests, made upon samples of stored blood, are fallacious indicators of the state of preservation of biological activity, as judged by the subsequent in vivo survival of the erythrocytes. In the selection of preservative solutions, however, in vitro tests may have a negative value. For instance, if blood hæmolyses rapidly in a given solution, that solution may safely be rejected. If, however, a solution is found to be successful in inhibiting hæmolysis, it will not necessarily succeed in prolonging in vivo survival. The degree to which stored erythrocytes resist vigorous shaking in the presence of glass beads is not correlated with their survival time in vivo. Although the osmotic fragility of stored erythrocytes, as usually measured, has led to many fallacious conclusions as to the value of different blood preservatives, a revised test in which the erythrocytes are first treated with fresh plasma may be found more useful. The in vivo survival of blood stored without carbohydrate is almost as good as that of fresh blood when the period of storage is 6 days or less. I. H. T., sodium citrate, and heparin all seem to have a similar effect upon subsequent survival; defibrinated blood seems to survive slightly better. In the treatment of anæmia it is suggested that the limit of 6 days is not exceeded when using blood stored in one of these solutions. Blood stored for 14 days without carbohydrate is almost useless to the recipient as a source of biologically active erythrocytes, although it usually does not contain sufficient free hæmoglobin at this time to be actually a source of danger. Dextrin and sucrose, although they delay the onset of hæmolysis in vitro almost as well as glucose, have very little effect in prolonging the in vivo survival of blood. The effect of glucose in prolonging the survival of erythrocytes is very definite, and varies with alterations in the amount and concentration of glucose that is added. When approximately one volume of citrate‐glucose solution is added to four volumes of blood, variation of the concentration of glucose in the final mixture from 0·6 to 2·2 per cent, makes little difference to subsequent survival. If a larger volume of citrate‐glucose solution is added, however, and a final concentration of 2·7 per cent. in the final mixture is attained, survival is very definitely prolonged. Thus, whereas blood stored in the standard citrate‐glucose solution (VI) for periods of 11‐15 days already shows some falling off in survival, blood stored with the Rous‐Turner solution (X) for periods up to 21 days has a survival which is very little inferior to that of fresh blood. Although the Rous‐Turner solution is thus a better preservative than the citrate‐glucose solution in general use, the advantage is not obvious with blood stored for less than 10 days at least. Moreover, the large relative volume of diluent in the Rous‐Turner solution is a definite disadvantage both from the administrative and transfusion points of view. Thus for blood banks i...

Dimensional, Osmotic, and Chemical Changes of Erythrocytes in Stored Blood. I. Blood Preserved in Sodium Citrate, Neutral, and Acid Citrate-Glucose (Acd) Mixtures 1

“…The High concentrations of sucrose and dextrin (2 to 4), and decrease in blood pH (2, 4 to 6), have been shown to have similar effects. Some authors have used spontaneous hemolysis as a decisive criterion of the preservation of stored blood (7 to 9), while others have stressed the variability of this criterion and have emphasized the fallaciousness of conclusions based on its use (4,5,10). Particularly misleading results have been obtained with bloods preserved in electrolyte-poor carbohydrate-rich media, where the observed hemolysis after prolonged storage was incongruently slight when compared with the state of the cells determined by their survival in vivo.…”

“…In electrolyte-poor media variable alterations have been found; while cells in RousTurner's and De Gowin's solution increase progressively to almost hemolytic (bursting) volumes, they swell only transiently and to a minor degree or may even shrink in solutions which contain dextrin, sucrose or other non-permeating carbohydrates (2,4,11,17). Changes in shape and surface of erythrocytes during storage have been described (18,19), the cells becoming more spheroidal in shape, and crenated.…”

“…In electrolyte-poor media, fragility is often altered peculiarly, depending on the character of the preservative fluid. In De Gowin's or Rous-Turner solutions there is noted early an increased fragility which may revert to normal if the cells are washed free of excess glucose (4,7,10). In solutions of sucrose, dextrins, or corn syrup, substances which do not permeate the erythrocytic membrane, the cells exhibit an exceedingly low fragility, which does not change in a uniform manner during storage (1,2,4,7,10).…”

“…Changes in shape and surface of erythrocytes during storage have been described (18,19), the cells becoming more spheroidal in shape, and crenated. The increase in the mechanical fragility of erythrocytes during storage apparently bears no constant relationship to osmotic fragility, spontaneous hemolysis, or survival in zdvo ( 1,4,7,9).…”

“…Particularly misleading results have been obtained with bloods preserved in electrolyte-poor carbohydrate-rich media, where the observed hemolysis after prolonged storage was incongruently slight when compared with the state of the cells determined by their survival in vivo. Some observers have stressed the "negative" value of the test as means of excluding rather than selecting preservative solutions (4,11).…”