Red blood cells intended for transfusion: quality criteria revisited

Abstract

Great variation exists with respect to viability and function of fresh and stored red blood cells (RBCs) as well as of the contents of RBC hemoglobin (Hb) in individual units. Improved technology is available for the preparation as well as the storage of RBCs. The authors raise the question whether it may be time to revise current standards for RBC units. The establishment of a standard unit of blood based on Hb content should be a high-priority goal. It is recommended that a standard RBC unit should contain 50 g of Hb. Major organizations concerned with the collection and distribution of blood components should agree on the criteria for a standard unit of RBCs based on Hb content and for the collection of double units. Manufacturers of blood collection equipment should provide suitable technology for collecting a standard unit with defined contents of RBC Hb. Efforts should be directed at the design of storage solutions acceptable for transfusion that maximize the maintenance of both RBC viability and function during storage. The ideal storage protocol would require sterile, high-pH solutions containing both glucose and electrolytes.

Deformability of Red Blood Cells and Correlation with ATP Content during Storage as Leukocyte-Depleted Whole Blood

“…For example, the hemolysis occurring during storage has recently been proposed as a mechanism for endothelial injury and impaired vascular function [32]. Our data might also explain why studies investigating the association of ATP content with red cell viability have been conflicting [13].…”

“…Several randomized clinical trials are under way to clarify this issue [7]. Since red cell flexibility or deformability are major determinants of red cell viability [13], the aim of this study was to investigate, in addition to established biochemical markers, rheological properties of red cells at different shear rates in leukocyte-depleted whole blood over a 7-week storage period. This study is a post hoc analysis of a randomized experiment comparing different blood collection methods [14].…”

Evolution of adverse changes in stored RBCs

“…RBC-transfused patients had worse outcomes than nontransfused patients matched for clinical variables in several studies (6)(7)(8)(9)(10). Moreover, in randomized clinical trials, a more liberal RBC transfusion strategy failed to benefit pediatric or adult patients with anemia and critical illness (11,12), raising the broader concern that RBC storage is problematic (2,13) and could be improved. This is particularly relevant because, to date, the development of and outcomes with blood substitutes have been disappointing (14)(15)(16).…”

Controle de qualidade na preservação de eritrócitos para transfusão

“…A hemoterapia atual está fundamentada no emprego de bolsas plásticas descartáveis, na transfusão de hemocomponentes e de hemoderivados. [8][9][10] Apesar da padronização necessária, podem ocorrer variações nas unidades eritrocitárias, que devem ser monitoradas periodicamente durante o estoque, constituindo parte do controle de qualidade em hemoterapia, 11 bem como no emprego das unidades transfusionais eritrocitárias. 12 Os eritrócitos, se preservados em soluções aditivas, devem manter a sua integridade e viabilidade por longos perío-dos.…”