Reduction of exposure to plasticizers in stored red blood cell units

Abstract

Introduction: Plastic can be toxic and hazardous to an organism’s health, but it is being widely used in our daily lives. Di-2-ethylhexyl-phthalate is the most common plasticizer in medical devices made of polyvinylchloride and is commonly found in soft bags storing red blood cell units. Di-2-ethylhexyl-phthalate and its degradation product mono-2-ethylhexyl-phthalate can migrate into human body fluids, for example, blood and tissues. The aim of the study was to assess the concentration of plasticizers in red blood cell units according to storage time and after mechanical rinsing using a cell salvage device. Methods: Levels of di-2-ethylhexyl-phthalate and mono-2-ethylhexyl-phthalate were analysed in 50 unwashed red blood cell units using liquid chromatography coupled with tandem mass spectrometry. In addition, phthalate concentrations were measured before and after mechanical rinsing in six more washed red blood cell units with storage times ranging between 36 and 56 days. A linear regression model was determined by the daily increase of di-2-ethylhexyl-phthalate and mono-2-ethylhexyl-phthalate in the stored red blood cell units subject to their storage time (range = 4-38 days), and the effect of mechanical rinsing on their phthalate concentration was calculated. Results: A linear correlation was found between storage time of unwashed red blood cell units and the concentration of di-2-ethylhexyl-phthalate (p < 0.001) or mono-2-ethylhexyl-phthalate (p < 0.001). Stored red blood cell units older than 14 days had significantly higher concentrations of both contaminants than red blood cell units of shorter storage time (p < 0.001). Mechanical rinsing in washed red blood cell units attained a reduction in the di-2-ethylhexyl-phthalate and mono-2-ethylhexyl-phthalate concentration by a median of 53% (range = 18-68%; p = 0.031) and 87% (range = 68-96%; p = 0.031), respectively. Conclusion: Leaching of di-2-ethylhexyl-phthalate and mono-2-ethylhexyl-phthalate into red blood cell units depends on the duration of storage time. Plasticizers can be significantly reduced by mechanical rinsing using cell salvage devices, and thus, red blood cell units can be regenerated with respect to chemical contamination.

Exposure of patients to di(2-ethylhexy)phthalate (DEHP) and its metabolite MEHP during extracorporeal membrane oxygenation (ECMO) therapy

“…In the present study, DEHP and MEHP blood levels were determined in one patient before and after dialysis but rather consistent levels were observed. In contrast, a considerable reduction of the DEHP and MEHP contamination in blood products was achieved in a recent study by cell saver treatment including a washing procedure [36]. However, this prevention strategy was not applied during the ECMO treatment of our patients.…”

“…On the other hand, we did not measure the DEHP-levels in the blood products. Former studies indicated a high contamination of the blood products with DEHP, which may have contributed to the DEHP-blood levels in those patients [5,36].…”

Verbesserte Qualität gelagerter Erythrozytenkonzentrate durch maschinelle Autotransfusion

“…Erythrozyten Konzentrate werden in der Regel in weichmacherhaltigen PVC-Lagerbeuteln bei 4 °C aufbewahrt. Mehrere Studien konnten nachweisen, dass durch das Waschen von EK mittels MAT unabhängig von der Waschlösung der primäre Weichmacher (DEHP) sowie sein direkter Metabolit (MEHP) signifikant reduziert werden konnten [34,35] Beim Beimpfen der Kulturflaschen zur mikrobiologischen Beurteilung der MAT-Waschung kam es in 4,4 % der Fälle zu laborpersonalbedingten Verunreinigungen.…”

Bisphenols and phthalates: Plastic chemical exposures can contribute to adverse cardiovascular health outcomes

“…In addition to tubing circuits, substantial phthalate leaching into stored blood products has also been reported (Cole, Tocchi, Wye, Villeneuve, & Rock, 1981;Luban, Rais-Bahrami, & Short, 2006;Peck et al, 1979;van der Meer et al, 2014). In red blood cell units, phthalate concentrations range from 5,300 to 38,100 μg/L for DEHP and 800 to 14,800 μg/L for its primary metabolite, mono-2-ethylhexyl phthalate (MEHP) (Münch et al, 2020). Notably, phthalate concentrations accumulate over time in stored red blood cell units-with DEHP levels increasing from 34.3 μM (±20.0 SD) on Day 1 to 433.2 μM (±131.2 SD) on Day 42, a 12.6-fold increase (Rael et al, 2009).…”

“…In the final product, DEHP can contribute up to 40% of the finished weight of plastic medical products (e.g., intravenous fluid bags, blood storage bags), and up to 80% of the weight of flexible medical tubing (Halden, 2010; Jaeger & Rubin, 1973, 2010; Plonait, Nau, Maier, Wittfoht, & Obladen, 1993). Since phthalates are not covalently bound to PVC, these chemical additives are known to leach or migrate into surrounding solutions, including blood (Table 2) (Barry et al, 1989; D'Alessandro et al, 2019; Demirel et al, 2016; Gaynor et al, 2018; Green et al, 2005; Kaestner et al, 2020; Karle et al, 1997; Mallow & Fox, 2014; Münch et al, 2020; Peck et al, 1979; Rael et al, 2009; Sjöberg, Bondesson, Sedin, & Gustafsson, 1985; Sjoberg et al, 1985; Stroustrup et al, 2018; Su et al, 2012; Takatori et al, 2008; van der Meer et al, 2014). Moreover, DEHP leaching is exacerbated under conditions of prolonged use, mechanical stress, higher temperature and/or in the presence of lipid‐containing fluids.…”