In vitro hemolysis of stored units of canine packed red blood cells

Abstract

Background -Hemolysis is an important quality parameter of packed red blood cells (pRBCs) that is used to assess the cellular integrity of stored blood units. According to human standards, hemolysis at the end of storage must not exceed 1%, as otherwise it may be responsible for decreased transfusion effectiveness and acute life-threatening reactions.Objectives -This prospective study was designed to evaluate the hemolysis of canine pRBCs stored in an additive solution containing adenine, dextrose, mannitol, and sodium chloride, and to assess its associations with storage time, duration of the collection process, collection disturbances, and with the final volume and PCV of the pRBCs units. Methods -One hundred eighty pRBCs units were collected from canine donors. Hemolysis of the pRBCs units was determined immediately after processing (t = 0). The units were then stored and retested (t = 1) either before administration (during weeks 2, 3, 4, 5, or 6 of storage) or at the end of the storage period (42 d) if not used. Results -Mean hemolysis at t = 0 was 0.09% (SD 0.06) and increased during storage, at a more pronounced rate from the 5th (mean values of 0.52%, SD 0.29) to the 6th week (1.2%, SD 0.72). Almost 51% of the units with 36-42 days of shelf-life showed more than 1% hemolysis. Disturbances in the collection process, the volume of the whole blood units, and the volume of stored pRBCs units or their PCV were not related to pRBCs hemolysis. Conclusions -According to human blood bank recommendations regarding acceptable hemolysis, canine pRBCs stored for more than 35 days should be tested to ensure <1% hemolysis prior to administration. (J Vet Emerg Crit Care 2018; 28(6): 512-517)

In vitro iatrogenic hemolysis of canine packed red blood cells during various rapid transfusion techniques

“…However, hemolysis reached a maximum within the first 7 days of storage in 1 report in people, 29 suggesting that damage to RBCs may occur earlier than first recognized. Older blood poses a risk as well; a recent veterinary study showed up to 51% of stored canine pRBCs were unacceptably hemolyzed by 36–42 days 17 . The authors in that study recommended testing pRBCs units stored >35 days to ensure <1% hemolysis prior to administration.…”

“…Also, the trials were done on minimally aged stored blood, which may have been more resilient to hemolysis than blood stored for a longer period. Numerous studies have shown that hemolysis of stored blood increases over time 13–17 due to decreased deformability and increased fragility of the RBC membrane 18 . As membrane fragility increases, damage from mechanical stress may also increase.…”

“…Over time, RBC fragility leads to hemolysis and release of plasma free hemoglobin (fHb) and formation of microparticles 13–18 . The biochemical and biomechanical changes that occur over time are known as the RBC storage lesion, which is characterized by increasing concentrations of plasma fHb, microparticles, % hemolysis, osmotic fragility, serum potassium, total bilirubin, and lactate dehydrogenase and decreased nitric oxide availability, hematocrit, average corpuscular volume, total hemoglobin, and number of erythrocytes 5–7,9,10,12–18 . Hemolysis of blood products that occurs during the storage or transfusion process is a known risk factor for adverse transfusion‐related patient outcomes in people 13,14,19,20 .…”

Effect of Leukoreduction on Hematobiochemical Parameters and Storage Hemolysis in Canine Whole Blood Units

“…A blood bank allows the immediate availability of whole blood and blood components, and this translates into a timelier intervention in all those situations in which it is necessary to transfuse patients within a short time. Blood bags can be stored for a period of time between 35 (whole blood units-WB) and 42 (packed red blood cells-pRBC) days depending on the product [2,3]. To date, the studies carried out have been aimed at finding the best storage conditions through the addition of appropriate maintenance solutions, in order to extend the storage times and maintain the stored cells' viability and functionality [4].…”

“…SLs are responsible for negative post-transfusion effects in recipients, particularly in critically ill patients, and are classified into three categories: biochemical, biomechanical or morphological, and immunological changes [4]. Particularly, biochemical changes include the increase of potassium and sodium and hemolysis and oxidative injury [1,2,[5][6][7][8]; biomechanical or morphological modifications include shape alterations and a reduction of RBC deformability. The modifications related to the corpuscular components of blood units could relate to RBC, white blood cells (WBCs) and platelets (PLTs).…”