Metabolic effects occurring in irradiated and non-irradiated red blood cellular components for clinical transfusion practice: An in vitro comparison

Abstract

BackgroundStorage lesions occur in red blood cell products when potassium ions, haemoglobin and lactate dehydrogenase are released into the extracellular plasma due to post-irradiation storage or cellular degeneration. The South African blood transfusion establishments do not comply with the universal leucocyte-reduction policy due to cost and the current HIV pandemic. Various studies regarding storage lesions have been completed in well-developed countries but not in Cape Town, South Africa.ObjectiveThis study aimed to determine cellular degeneration occurring in non-irradiated and irradiated red blood cells (RBC) by comparing the measured biochemical and haematological indices during storage of up to 42 days.MethodEighty whole blood units were collected from voluntary, non-remunerated donors. Blood components tested weekly until expiry were whole blood, RBC concentrate, leucocyte-reduced RBC concentrate (pre-storage) and paediatric RBC concentrate (n = 20). Ten units per product were irradiated and 10 were not. Evaluations included potassium, sodium, glucose, lactate dehydrogenase, phosphate, haemoglobin, haematocrit, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentrate, mean cell volume and plasma haemoglobin. Plasma haemolysis levels were calculated using an approved formula.ResultsThe haemolysis levels evaluated on Day 35 and Day 42 were higher than the recommended 0.8%, whereas results for the non-irradiated components up to expiry were all below 0.8%.ConclusionThis study confirms that gamma irradiation aggravates the RBC storage lesions. The products tested yielded similar results to other studies in developed countries, however the South Africa transfusion medicine policy should remain unchanged.

The Effect of Long Storage of Whole Blood Components on the Level of 2,3 Diphosphoglycerate and Lactic Acid in the Blood Bank, Dr. Soetomo General Hospital, Surabaya, Indonesia

“…13 The normal level of lactic acid in the blood is 0.6-1.5 mmol/l or 0-20 mg/dl and the level of lactic acid that can be accepted by the body is around >2,0-5 mmol/l or >18.02-45.05 mg/dl. 17,18…”

Irradiating stored blood and storing irradiated blood: Is it different? - A study of serial changes in biochemical parameters of red blood cell units

“…Glucose is used by red cells for their metabolism leading to a fall in their levels during storage. [ 11 ] LDH levels fall due to a fall in pH as they are released due to oxidative stress injury. [ 12 ] The homeostatic mechanism missing in the storage bag may increase enzyme formation with no scope for clearance.…”

Hypothermic storage of leukoreduced red blood cells for greater than 21 days is a safe alternative to irradiation

“…Irradiation, being the gold standard method for prevention of TA-GVHD, is not always available in most developing countries. 3,34 In this case, ordering an inventory of irradiated components is required to ensure availability for urgent transfusions for those at risk for TA-GVHD. This secondary inventory of irradiated units has a shorter shelf life with increased supernatant potassium levels making it unsuitable for some recipients, such as children, neonates, and individuals with renal insufficiency who are at higher risk for hyperkalemia.…”

“…Irradiation, being the gold standard method for prevention of TA‐GVHD, is not always available in most developing countries 3,34 . In this case, ordering an inventory of irradiated components is required to ensure availability for urgent transfusions for those at risk for TA‐GVHD.…”