Red blood cell storage lesion

Comparative evaluation of oxidative and biochemical parameters of red cell concentrates (RCCs) prepared from G6PD deficient donors and healthy donors during RCC storage

INTRODUCTION

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common inherited enzyme disorder in red blood cell (RBC). Due to the importance of G6PD enzyme as an antioxidant in RBC, we tried to investigate the oxidative damage in red cell concentrates (RCCs) prepared from donors with G6PD enzyme deficiency in comparison with healthy donors.

MATERIAL METHOD

This cross-sectional study was conducted on 20 male donors. Ten of the donors had G6PD deficiency (as a case) and the others had normal enzyme activity (as a control). Biochemical and oxidative damage parameters were examined in RCCs prepared from two groups on days 0, 7, 14, 21, 28 and 35 of RCCs storage; data comparison was analyzed by SPSS statistical software.

RESULTS

According to the result, lactate concentration increased significantly from the 7th day to the 35th day of RCC storage in G6PD-deficient donors compared to the control (P < 0.05). In addition, malondialdehyde (MDA) concentration in G6PD-deficient RCC showed a significant increase compared to the control in all days of storage (P < 0.05). Among the hematological parameters, mean corpuscular volume (MCV) and mean cell hemoglobin (MCH) increased significantly in all days of RCC storage in G6PD-deficient donors compared to the control (P < 0.05).

CONCLUSION

Our study showed that oxidative changes in G6PD-deficient donors were significantly increased compared to the healthy donors, which probably leads to RCC storage lesion and an increase in blood transfusion complications. Due to the high prevalence of G6PD enzyme deficiency in pandemic areas, it seems that enzyme screening should be included in donor screening programs.

Effect of leukoreduction on the omics phenotypes of canine packed red blood cells during refrigerated storage

BACKGROUND

Red blood cell (RBC) storage promotes biochemical and morphological alterations, collectively referred to as storage lesions (SLs). Studies in humans have identified leukoreduction (LR) as a critical processing step that mitigates SLs. To date no study has evaluated the impact of LR on metabolic SLs in canine blood units using omics technologies.

OBJECTIVE

Compare the lipid and metabolic profiles of canine packed RBC (pRBC) units as a function of LR in fresh and stored refrigerated (up to 42 days) units.

ANIMALS

Packed RBC units were obtained from 8 donor dogs enrolled at 2 different Italian veterinary blood banks.

STUDY DESIGN AND METHODS

Observational study. A volume of 450 mL of whole blood was collected using Citrate-Phosphate-Dextrose-Saline-Adenine-Glucose-Mannitol (CPD-SAGM) transfusion bags with a LR filter to produce 2 pRBC units for each donor, without (nLR-pRBC) and with (LR-pRBC) LR. Units were stored in the blood bank at 4 ± 2°C. Sterile weekly samples were obtained from each unit for omics analyses.

RESULTS

A significant effect of LR on fresh and stored RBC metabolic phenotypes was observed. The nLR-pRBC were characterized by higher concentrations of free short and medium-chain fatty acids, carboxylic acids (pyruvate, lactate), and amino acids (arginine, cystine). The LR-pRBC had higher concentrations of glycolytic metabolites, high energy phosphate compounds (adenosine triphosphate [ATP]), and antioxidant metabolites (pentose phosphate, total glutathione).

CONCLUSION AND CLINICAL IMPORTANCE

Leukoreduction decreases the metabolic SLs of canine pRBC by preserving energy metabolism and preventing oxidative lesions.

Comparison between Hematology and Serum Biochemistry of Qinling and Sichuan Giant Panda (Ailuropoda melanoleuca qinlingensis and sichuanensis)

Giant pandas are the flagship species in world conservation, and include two subspecies, Ailuropoda melanoleuca qinlingensis (A. m. qinlingensis) and Ailuropoda melanoleuca sichuanensis (A. m. sichuanensis). Hematology and serum biochemistry studies are crucial to protecting giant pandas. Even though research on hematology and serum biochemistry are well-established in A. m. sichuanensis, research in A. m. qinlingensis is scarce. The study aimed to (1) establish a baseline for hemogram and reference intervals (RIs) for hematological and serum biochemical parameters in A. m. qinlingensis, (2) assess the possible variations in these parameters of A. m. qinlingensis based on age, gender, and storage condition of blood samples, and (3) compare the parameters to those of A. m. sichuanensis. Blood samples (n = 42) were collected from healthy A. m. qinlingensis (n = 21) housed in Shaanxi (Louguantai) Rare Wildlife Rescue and Breeding Research Center, and hematological (n = 25) and serum biochemical parameters (n = 18) were analyzed in March and December of 2019. The results showed no significant abnormality in the blood smears of all individuals in this study, except for a few serrated red blood cells, platelet aggregations, and occasionally giant platelets. Between sub-adult and adult A. m. qinlingensis, there were significant differences in five hematological and one serum biochemical parameter (p < 0.05), whereas six serum biochemical parameters were present when α = 0.1 (p < 0.1). Gender influenced % NEU, % LYM, % EOS, LYM, EOS, GGT, and CHOL of A. m. qinlingensis. The majority of the hematological and serum biochemical parameters of A. m. qinlingensis were different from those of A. m. sichuanensis regarding age and gender. The anticoagulant whole blood samples of A. m. qinlingensis stored at 2-8 °C for 24 h and the serum samples stored at -18 °C for 48 h had little influence on the values of hematological and serum biochemical parameters. In conclusion, this study provided a baseline of hemogram and established RIs for hematological and serum biochemical parameters of A. m. qinlingensis. RIs of A. m. sichuanensis reported before were not completely fit for A. m. qinlingensis, and age, gender, or the storage condition of blood samples influenced some of the parameters of A. m. qinlingensis. To the authors' knowledge, this is the first report of a hemogram baseline and RIs for hematological and serum biochemical parameters of A. m. qinlingensis.

Cardiopulmonary bypass in a rat model may shorten the lifespan of stored red blood cells by activating caspase-3

BACKGROUND

Red blood cell transfusion is required for many types of surgery against cardiovascular disease, and the function of transfused cells appears to decline over time. The present study examined whether transfusion also reduces red blood cell lifespan in a rat model.

MATERIAL AND METHODS

Bypass in rats were established by connecting a roll pump to the femoral artery and vein. Then FITC-labeled stored red blood cells from rats were transfused in the animals, and the cells in circulation were counted after transfusion. In separate experiments, stored red blood cells were incubated with bypass plasma in vitro, and the effects of incubation were assessed on cell morphology, redox activity, ATP level, caspase-3 activity, and phosphatidylserine exposure on the cell surface. These in vivo and in vitro experiments were also performed after pretreating the stored red blood cells with the caspase-3 inhibitor Z-DEVD-FMK.

RESULTS

Bypass significantly decreased the number of circulating FITC-labeled stored red blood cells and increased the proportions of monocytes, neutrophils and splenic macrophages that had phagocytosed the red blood cells. In vitro, bypass plasma altered the morphology of red blood cells and increased oxidative stress, caspase-3 activity and phosphatidylserine exposure, while decreasing ATP level. Pretreating stored red blood cells with Z-DEVD-FMK attenuated the effects of bypass on caspase-3 activity, but not oxidative stress, in stored red blood cells.

DISCUSSION

Bypass appears to shorten the lifespan of stored red blood cells, at least in part by activating caspase-3 in the cells.

A comparative study of stored arterial versus venous blood collected using the acute normovolemic hemodilution method in coronary artery bypass grafting patients in Iran

BACKGROUND

In the present study, arterial and venous blood was collected from patients who were candidates for elective coronary artery bypass grafting (CABG); the blood was stored for 28 days and cellular, biomechanical, and hematological changes in blood were compared to determine whether stored arterial blood is superior to stored venous blood.

METHODS

The present follow-up comparative study included 60 patients >18 years of age, with hemoglobin >14 mg/dl and ejection fraction >40% who were candidates for CABG. After induction of anesthesia, 250 ml of arterial or venous blood was drawn from patients (arterial blood group and venous blood group). Laboratory blood samples were taken at specified times from the collected blood and re-injected into the patients after CABG.

RESULTS

Significant differences were observed in pH, partial pressure of carbon dioxide (PCO2), partial pressure of oxygen (PO2), bicarbonate (HCO3), and glucose values at several time points between the groups. Other parameters such as urea and creatinine did not show any significant differences between the groups.

CONCLUSIONS

Twenty-eight days of storage can have a negative effect on some of the cellular, biochemical, and hematological components of arterial and venous blood; however, the quality of stored arterial blood and venous blood does not differ significantly.

Blood Transfusion Complications and Associated Factors Among Blood-Transfused Adult Patients at Debre Markos Comprehensive Specialized Hospital, Ethiopia: A Cross Sectional Study

Background

Blood transfusion is the infusion of whole blood or its components into the veins of the patient to improve tissue oxygenation and maintain hemostasis. Besides its clinical use, it can pose a risk of transfusion complications with different factors.

Purpose

The aim of this study was to assess blood transfusion complications, and associated factors among transfused adult patients at Debre Markos Comprehensive Specialized Hospital, North West Ethiopia, 2022.

Materials and Methods

An institution-based cross-sectional study design was conducted on a total of 182 patients from March 20 to June 15, 2022. Patients were enrolled in the study using consecutive sampling method. The socio-demographic and clinical data were collected using a structured questionnaire and data extraction sheet, respectively. About 3 ml of anti-coagulated blood and 30 ml of urine samples were collected to assess transfusion complications. CBC and Coombs test were performed from blood and urinalysis from urine, respectively. Chi-square, Fisher's exact test, and binary logistic regression were done using SPSS version 25. P-values less than 0.05 are declared as statistically significant.

Results

An acute transfusion reaction (ATR) was encountered in 12 (6.6%) patients. It was 4.13, 7.78 and 3.96 times more likely to occur among patients with a previous history of transfusion, abortion, and transfused blood stored for more than 20 days compared to their counterparts, respectively. In addition, the odds of developing ATR increase by 2.07 as the number of transfused blood units increases by 1 unit.

Conclusion

The incidence of acute transfusion reactions was high. During transfusion, clinicians should closely monitor patients who had history of transfusion, abortion, transfused old blood and more than 1 unit.

Viability of erythrocytes in canine packed red blood cells stored in CPDA-1 is related to the presence of Mycoplasma haemocanis

Hemotropic mycoplasmas are associated with subclinical disease in dogs and should be identified in blood donors. The objective was to investigate the presence and effect of M. haemocanis in units of packed red blood cells (pRBC) during storage. Canine donors (n = 10) were screened for M. haemocanis by quantitative real-time PCR. pRBCs were obtained from 5 hemoplasma negative dogs and 5 hemoplasma positive dogs. Each pRBC was aliquoted into two 100 mL transfer bags and stored at 4 °C. M. haemocanis loads and biochemical variables (pH, bicarbonate, potassium, sodium, chlorite, glucose, lactate, ammonia, PCV, and % hemolysis) were evaluated on days 1, 7, 18, and 29. M. haemocanis loads increased in pRBC from day 1-29 of storage. Glucose decreased and lactate increase faster in pRBC with M. haemocanis. This study contributes to understand hemoplasma metabolism and reinforces that dog donors should be tested for hemoplasmas.

Effects of Transfusion of Stored Red Blood Cells on Renal Ischemia-Reperfusion–Induced Hepatic Injury in Rats

BACKGROUND

Renal ischemia-reperfusion (IR) injures the liver as well as the kidneys. Transfusion of stored red blood cells (RBCs) triggers inflammatory responses, oxidative stress, and activation of innate immunity. In the present study, we investigated the effect of transfusion of stored RBCs on renal IR-induced hepatic injury.

METHODS

Sprague-Dawley rats were randomly divided into 3 groups based on the following treatments: rats subjected to sham operation (sham group), rats subjected to the induction of renal IR only (RIR group), and rats transfused with stored RBCs 1 hour after the start of reperfusion (RIR-TF group). Renal ischemia was induced for 1 hour, and reperfusion was allowed for 24 hours. After reperfusion, blood and liver tissue samples were obtained.

RESULTS

Serum levels of aspartate and alanine aminotransferase were increased in the RIR-TF group compared with those in the RIR and sham groups. The hepatic mRNA expression levels of heme oxygenase-1 and neutrophil gelatinase-associated lipocalin were increased in the RIR-TF group compared with those in the RIR and sham groups. The mRNA expression level of high mobility group box-1 was also increased in the RIR-TF group compared with that in the RIR group.

CONCLUSION

The transfusion of stored RBCs exacerbates renal IR-induced liver damage. Oxidative stress may be responsible for hepatic injury.

MicroRNAs as Quality Assessment Tool in Stored Packed Red Blood Cell in Blood Banks

Micro-ribonucleic acids are control gene expression in cells. They represent the changed cellular states that occur can be employed as biomarkers. Red blood cells alter biochemically and morphologically while they are being stored, which could be detrimental to transfusion. The effect of storage on the erythrocyte transcriptome is not mostly investigated. Because adult erythrocytes lack a nucleus, it has long been assumed that they lack deoxyribonucleic acid and ribonucleic acid. On the other hand, erythrocytes contain a diverse range of ribonucleic acids, of which micro-ribonucleic acids are key component. Changes in this micro-ribonucleic acid protect cells from death and adenine triphosphate depletion, and they are linked to specific storage lesions. As a result, changes in micro-ribonucleic acid in stored erythrocytes may be used as a marker to assess the quality and safety of stored erythrocytes. Therefore, this review ams to review the role of microRNA in stored packed red blood cells as quality indicator. Google Scholar, PubMed, Scopus, and Z-libraries are used for searching articles and books. The article included in this paper was written in the English language and had the full article. During long storage of RBCs, miR-16-2-3p, miR-1260a, miR-1260b, miR-4443, miR-4695-3p, miR-5100, let-7b, miR-16, miRNA-1246, MiR-31-5p, miR-203a, miR-654-3p, miR-769-3p, miR-4454, miR-451a and miR-125b- 5p are up regulated. However, miR-96, miR-150, miR-196a, miR-197, miR-381 and miR-1245a are down regulated after long storage of RBCs. The changes of this microRNAs are linked to red blood cell lesions. Therefore, micro-ribonucleic acids are the potential quality indicator in stored packed red blood cells in the blood bank. Particularly, micro-ribonucleic acid-96 is the most suitable biomarker for monitoring red blood cell quality in stored packed red blood units.

Erythrocyte Storage Lesion Improvements Mediated by Naringin Screened from Vegetable/Fruit Juice Using Cell Extract and HPLC-MS

In blood banking, storage at 4°C for weeks is known to cause damages to erythrocytes, called storage lesions that may later cause transfusion-related adverse events. In previous experiments, we found that vegetable/fruit juices can effectively reduce the storage lesion. Currently, we attempt to analyze the potential bioactive components and test whether the compounds can improve the storage lesions of erythrocytes. Equal portions in wet weight of 20 fresh vegetables and fruits were blended with phosphate buffered solution (PBS), and clear solutions were produced as additive to the packed erythrocytes from consented blood donors at 1 : 10 ratio (ml : gram). The blood samples were stored for 35 days at 4°C, and the supernatants were performed high liquid chromatography-mass spectrometry (HPLC-MS) analysis at 0 days, 14 days, and 35 days. The blood bags supplemented with identified bioactive components were stored in a refrigerator for 35 days, and the morphology, complete blood count (CBC), phosphatidylserine (PS) extroversion, hemolysis, and reactive oxygen species (ROS) levels were measured at the end of storage. Five potential bioactive components from vegetable/fruit juices contributed to the improvements of storage lesion. One of the compounds was unequivocally identified as naringin, and two were tentatively assigned as vitexin 6″-O-malonyl 2″-O-xyloside and luteolin 7-(6″-malonyl neohesperidoside). Naringin alleviated the storage lesion of red blood cells (RBCs) by reducing ROS levels and living cell extraction with HPLC-MS is a simple, reliable, and effective method for screening potential bioactive components.

Red Blood Cell Cryopreservation with Minimal Post-Thaw Lysis Enabled by a Synergistic Combination of a Cryoprotecting Polyampholyte with DMSO/Trehalose

From trauma wards to chemotherapy, red blood cells are essential in modern medicine. Current methods to bank red blood cells typically use glycerol (40 wt %) as a cryoprotective agent. Although highly effective, the deglycerolization process, post-thaw, is time-consuming and results in some loss of red blood cells during the washing procedures. Here, we demonstrate that a polyampholyte, a macromolecular cryoprotectant, synergistically enhances ovine red blood cell cryopreservation in a mixed cryoprotectant system. Screening of DMSO and trehalose mixtures identified optimized conditions, where cytotoxicity was minimized but cryoprotective benefit maximized. Supplementation with polyampholyte allowed 97% post-thaw recovery (3% hemolysis), even under extremely challenging slow-freezing and -thawing conditions. Post-thaw washing of the cryoprotectants was tolerated by the cells, which is crucial for any application, and the optimized mixture could be applied directly to cells, causing no hemolysis after 1 h of exposure. The procedure was also scaled to use blood bags, showing utility on a scale relevant for application. Flow cytometry and adenosine triphosphate assays confirmed the integrity of the blood cells post-thaw. Microscopy confirmed intact red blood cells were recovered but with some shrinkage, suggesting that optimization of post-thaw washing could further improve this method. These results show that macromolecular cryoprotectants can provide synergistic benefit, alongside small molecule cryoprotectants, for the storage of essential cell types, as well as potential practical benefits in terms of processing/handling.

Effect of microaggregate filter passage on feline whole blood stored for 35 days

OBJECTIVES

The aim of this study was to compare the characteristics of fresh and stored feline red blood cells (RBCs) after passage through an 18 μm microaggregate filter.

METHODS

Nine cats were recruited for a single blood donation using an open collection system. A simulated transfusion using a syringe driver and microaggregate filter was performed over 2 h with half the blood on the day of donation and the other half after 35 days of storage. Differences in haematological parameters, haemolysis percentage and osmotic fragility (OF) were compared on the day of donation pre-filter passage (D0-) vs day of donation post-filter (D0+) or day 35 storage pre-filter (D35-) and post-filter (D35+). Blood was cultured at D0+ and D35+.

RESULTS

There were no statistically significant differences in the D0- vs D0+ comparisons. There were statistically significant (P <0.05) increases in haemolysis percentage, red cell distribution width (RDW) percentage and mean OF, and decreases in packed cell volume (PCV), RBC count, haemoglobin and haematocrit for D0- vs D35-. The same was found for D0- vs D35+ with the addition of a significant increase in mean cell haemoglobin (MCH). For D35- vs D35+ only MCH significantly increased. At day 35, 6/9 units had haemolysis percentages that exceeded 1%. This increased to 8/9 of stored units post-filter passage. All blood units cultured negative.

CONCLUSIONS AND RELEVANCE

Fresh RBCs exhibited no in vitro evidence of injury following passage through an 18 μm microaggregate filter. Increased MCH was observed in the stored blood and may represent haemolysis induced by the filter. All other changes can be explained by storage lesion rather than filter passage. The findings highlight the importance of blood banking quality controls and the need for further research to assess the effects of transfusion technique, specifically filter passage, on storage lesion-affected feline blood.

The effect of position and frequency of mixing on canine packed red blood cell units during storage

OBJECTIVE

Hemolysis is an indicator of storage lesion that occurs in stored packed red blood cells (pRBCs) over time. Intermittent mixing of red blood cells in the additive solutions may be beneficial but may also result in iatrogenic injury. Position of units in storage may also affect the quality of the pRBCs. This prospective study was designed to evaluate hemolytic effect of mixing frequency and storage position on canine pRBCs over a period of 28 days.

DESIGN

Prospective in vitro study SETTING: Private practice referral hospital with an internal blood bank ANIMALS: Thirty-two healthy prescreened dogs enrolled in a volunteer blood banking program INTERVENTIONS: None MEASUREMENTS AND MAIN RESULTS: A total of 160 samples were evaluated. Forty canine pRBC units were split into 4 daughter bags and stored in varying positions with different mixing frequencies. Samples were stored upright and mixed daily, upright and mixed weekly, horizontally and mixed daily, or horizontally and mixed weekly for a period of 28 days. At days 0, 7, 14, and 28, samples from the units were analyzed to calculate percent hemolysis. No differences were found in any hemolytic indicators investigated (total hemoglobin, free plasma hemoglobin, and packed cell volume) until day 28 in all test groups. Canine pRBCs stored upright and mixed weekly or stored horizontally and mixed weekly resulted in less hemolysis and free plasma hemoglobin when compared to units stored horizontally and mixed daily only at day 28.

CONCLUSIONS

Statistically significant hemolysis was not evident amongst canine pRBC groups less than 28 days old suggesting that positioning and mixing frequency was irrelevant until day 28. Beyond 28 days despite the presence of hemolysis, no definitive recommendation could be made with respect to best practice for storage position or mixing frequency of stored canine pRBCs.

Effect of washing units of canine red blood cells on storage lesions

Background

In humans, washing stored blood products before transfusion reduces storage lesions and incidence of transfusion reactions, but the effectiveness of washing canine blood is unknown.

Objectives

The objective was to determine if manually washing units of stored blood would reduce storage lesions without adversely affecting erythrocytes. We hypothesized that washing stored units would reduce concentrations of storage lesions and cause minimal erythrocyte damage.

Animals

Eight healthy research dogs.

Methods

Repeated measure cohort study. Units of whole blood were stored for 28 days and washed 3 times with 0.9% NaCl. Blood samples were collected before and after storage, after each wash, and after being held at a simulated transfusion temperature. Variables measured included CBC variables, blood gas analysis, erythrocyte morphology, mean corpuscular fragility (MCF), and eicosanoid concentrations. A Friedman's test was used to evaluate changes in variables (P < .05 was considered significant).

Results

After the first wash, compared to values after storage, there was a significant decrease in potassium (4.3 mmol/L [4.0‐4.7] to 1.2 mmol/L [1‐1.6]; P < .0001, median [range]), lactate (1.45 mmol/L [1.07‐1.79] to 0.69 mmol/L [0.39‐0.93]; P = .002), and partial pressure carbon dioxide (102 mm Hg [80.2‐119.2] to 33.7 mm Hg [24.5‐44.5]; P < .0001), and increase in MCV (69.3 fL [65.7‐72.3] to 74 fL [69.6‐79.5]; P = .0003), and MCF (0.444 fL [0.279‐0.527] to 0.491 fL [0.43‐0.616]; P = .0006).

Conclusions and Clinical Importance

A single wash of stored whole blood significantly reduces most extracellular storage lesions, and additional washing might cause hemolysis.

Quantitative assessment of infusion pump-mediated haemolysis in feline packed red blood cell transfusions

OBJECTIVES

Haemolysis caused by the use of peristaltic infusion pumps (PIPs) has been described in human and canine packed red blood cells (pRBCs). The aim of this study was to evaluate the effects of two different linear PIPs on the haemolysis of feline pRBC units stored for a long time.

METHODS

Feline pRBC units stored with adenine, dextrose, mannitol and sodium chloride (SAGM) were manufactured. After 35-42 days of storage at 2-4°C, a line administration system with a 180 µm filter was attached to every pRBC bag, the system was drained by gravity alone (8 drops/min) and a 1.3 ml sample was collected (G). A NIKI V4 pump was then used at a flow rate of 25 ml/h, the flow was stopped when the infusion system was filled with blood coming from the infusion pump and another 1.3 ml sample was collected (NK). Finally, an Infusomat FmS pump was evaluated, collecting another 1.3 ml sample (IM). Packed cell volume (PCV) was measured in all samples by microhaematocrit centrifugation, total haemoglobin (HGB) was measured using a specific haemoglobin analyser and, after centrifugation, free HGB was determined by spectrophotometry. The percentage of haemolysis was calculated. Friedman's test was used to compare the samples.

RESULTS

Fifteen feline pRBC units were evaluated. The average degree of haemolysis for sample G (gravity-assisted) was 1.12%. Comparison of the degree of gravity-assisted haemolysis with haemolysis in PIP NK (1.13%) and IM (1.14%) samples revealed no significant differences, with differences of only 0.01% and 0.02%, respectively.

CONCLUSIONS AND RELEVANCE

The results of this study demonstrate that the use of two common PIPs in veterinary hospitals does not produce levels of haemolysis that are significantly different than that caused by gravity alone during transfusion of feline pRBCs at a rate of 25 ml/h.

Blood Demand and Challenges for Patients With Beta-Thalassemia Major in Eastern Saudi Arabia

Background

β-thalassemia major is a hereditary disorder of hemoglobin (Hb) that results in defective Hb synthesis, leading to severe chronic anemia. The mainstay of its treatment is lifelong regular packed red cell transfusions associated with iron-chelating therapy. Globally, there is a gap between blood donation and the actual needs of the patients who depend on transfusion. Patients with β-thalassemia major are no exception and have limited access to regular and safe blood transfusions. This study aimed to assess the gap between the demand and supply of blood for transfusion-dependent patients with β-thalassemia major treated at the Hereditary Blood Diseases Center, Al Ahsa, Eastern Saudi Arabia.

Methodology

This was a retrospective, cross-sectional study conducted at the Hereditary Blood Disease Center, Al Ahsa, Saudi Arabia, including patient data from January 2017 to December 2019. We used Excel 365 from Microsoft Office 2016, version 1706.

Results

A total of 158 patients were on chronic transfusion. Of the total patients, 65% were adults, while the remaining 35% comprised the pediatric population. The total number of units requested and received during the three-year period was 14,509 and 9,530, respectively, indicating a gap of 4,979 (34%) units. The age of most of the units received was more than 14 days: 36% of those in 2017, 49.9% in 2018, and 61.5% in 2019. Rare blood groups and alloimmunization accounted for <8% of the patients. Prestorage filtration was the policy for all units.

Conclusions

There was a gap between the demand and supply of blood for patients with β-thalassemia major treated at our center. We suggest raising awareness regarding the high demands for fresh red blood cell components in patients with thalassemia major, encouraging voluntary blood donations, enhancing national blood-banking policies, and reducing the fragmentation of blood services to reduce the gap between demand and supply.

An Evaluation of Morphological Changes and Deformability of Suspended Red Blood Cells Prepared Using Whole Blood with Different Hemoglobin Levels of Tibetans

Background

The hypoxic environment stimulates the human body to increase the levels of hemoglobin (HGB) and hematocrit and the number of red blood cells. Such enhancements have individual differences, leading to a wide range of HGB in Tibetans' whole blood (WB).

Study Design

WB of male Tibetans was divided into 3 groups according to different HGB (i.e., A: >120 but ≤185 g/L, B: >185 but ≤210 g/L, and C: >210 g/L). Suspended red blood cells (SRBC) processed by collected WB and stored in standard conditions were examined aseptically on days 1, 14, 21, and 35 after storage. The routine biochemical indexes, deformability, cell morphology, and membrane proteins were tested.

Results

Mean corpuscular volume, adenosine triphosphate, pH, and deformability were not different in group A vs. those in storage (p > 0.05). The increased rate of irreversible morphology of red blood cells was different among the 3 groups, but there was no difference in the percentage of red blood cells with an irreversible morphology after 35 days of storage. Group C performed better in terms of osmotic fragility and showed a lower rigid index than group A. Furthermore, SDS-PAGE revealed similar cross-linking degrees of cell membrane protein but the band 3 protein of group C seemed to experience weaker clustering than that of group A as detected by Western Blot analysis after 35 days of storage.

Conclusions

There was no difference in deformability or morphological changes in the 3 groups over the 35 days of storage. High HGB levels of plateau SRBC did not accelerate the RBC change from a biconcave disc into a spherical shape and it did not cause a reduction in deformability during 35 days of preservation in bank conditions.

Randomized double-blinded clinical trial on acute transfusion reactions in dogs receiving leukoreduced versus nonleukoreduced packed red blood cells

Background

Leukoreduction of blood products is commonly performed in human medicine, but its effect on outcome or incidence of transfusion reactions (TRs) in dogs is unknown.

Objectives

To prospectively evaluate the incidence of acute TRs in, and the outcome of, dogs receiving either leukoreduced (LR) or nonleukoreduced (N‐LR) packed red blood cells (PRBC).

Animals

Dogs (n = 194) administered PRBC between August 2017 and June 2020.

Methods

Prospective randomized double‐blinded clinical trial. Dogs were randomized to receive either LR or N‐LR PRBC and clinicians, nurses and investigators were blinded to the group allocations. The incidence of TRs, change in PCV, hospitalization duration, and survival to discharge were recorded.

Results

Out of the 194 dogs, 96 received LR and 98 received N‐LR PRBCs. The mean 12‐hour change in PCV value was +9.22% (SD 5.27%) for dogs that received N‐LR and +10.69% (SD 6.44%) for dogs that received LR PRBC (effect size 0.26, 95% confidence interval [CI] −0.02 to 0.55), which was not significantly different (P = .08). TRs were documented in 16/194 (8.24%) dogs, with 1/194 (0.51%) being a mild allergic reaction, while 15/194 (7.73%) had suspected febrile nonhemolytic TRs (FNHTRs). FNHTR incidence was not significantly different between the LR (6/96, 6.25%, 95% CI 2.8‐13.56) and N‐LR (9/98, 9.18%, 95% CI 4.92‐17.11) groups (P = .81). Of the 156 dogs that survived to discharge, 80/156 received N‐LR PRBC and 76/156 received LR PRBC which was not significantly different (P = .66).

Conclusions and Clinical Importance

A clinical advantage of using LR over N‐LR PRBC in terms of TRs and increase in PCV after transfusion was not detected.

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

Simple Summary

During the storage of blood units, cells undergo many changes, defined as storage lesions; these are biochemical, morphological and immunological modifications and seem to be responsible for adverse post-transfusion effects in recipients. The pre-storage leukoreduction seems to reduce them. The aims of this study are both to evaluate the human filter effectiveness and the effect of pre-storage leukoreduction in stored canine whole blood units. We tested whole blood units, leukoreduced and not, obtained from seven enrolled subjects, until the 42nd day. The white blood cell (WBC) and platelet (PLT) counts are reported to express the leukoreduction effectiveness. As indicators of storage-induced hemolysis, the lactate dehydrogenase activity (LDH) and sodium, potassium, and chlorine electrolytes were measured in plasma, and the red blood cell (RBC) count, hemoglobin concentration (Hgb), and hematocrit (Hct) were obtained with the complete blood count (CBC). The mean corpuscular volume (MCV) values and morphological index obtained from blood smear evaluation were used as indices of morphological changes. We observed that the leukoreduction filter for human use is equally effective on canine whole blood and that leukoreduction has a partially protective role to prevent some storage lesions.

Abstract

Storage lesions (SLs) occur when the red blood cell quality is altered during the preservation of blood units. Pre-storage leukoreduction would limit the number of SLs. The aims of this study were to evaluate the effectiveness of a leukoreduction filter for human use and the effect of pre-storage leukoreduction on some ematobiochemical parameters in stored canine whole blood. Seven canine blood units were tested. Each one was divided into two units—one leukoreduced (LRWB) and one non-leukoreduced (nLRWB). On each unit, we determined the complete blood count (CBC), lactate-dehydrogenase (LDH), electrolytes (Na⁺, K⁺, Cl⁻), morphological index (MI) and hemolysis, on storage days 0, 7, 14, 21, 28, 35, and 42. Leukoreduction allowed a 98.30% recovery of the RBC count, retaining 99.69% and 94.91% of WBCs and PLTs, respectively. We detected a significant increase of LDH and MI with strongly higher values in nLRWB compared to LRWB. A progressive increase in electrolytes and LDH concentrations was observed as indices of stored hemolysis. LDH showed significantly lower values in LRWB units compared to nLRWB, suggesting its release from leukocytes. In the majority of units, hemolysis reached 1% on the 42nd day of storage. We assert the human leukoreduction filter effectiveness on canine whole blood, and we recommend using nLRWB before day 14, especially for critically ill patients. The difference of the basal hemolysis (day 0) percentages observed between subjects suggests that more studies should be performed to confirm a possible inter-individual donor biological variability of RBC membrane resistance, as happens in humans.

Biochemical and blood gas alterations in buffalo (Bubalus bubalis) whole blood stored in CPDA-1 and CPD/SAG-M bags

OBJECTIVE

The objective of this study was to evaluate the biochemical and blood gas alterations of whole blood of buffaloes that was stored in citrate-phosphate-dextrose with adenine (CPDA-1) and CPD/SAG-M blood bags for 42 days.

DESIGN

Prospective study.

INTERVENTIONS

Ten male buffaloes were used in this study. A total volume of 900 mL of blood was collected from each buffalo so that 450 mL was stored in CPDA-1 and 450 mL was stored in CPD/SAG-M bags at 2-6°C for 42 days. The stored blood was evaluated at 7 time points (D): D0 (immediately after blood collection) and 7 (D7), 14 (D14), 21 (D21), 28 (D28), 35 (D35), and 42 (D42) days after collection. Blood gas, biochemical, and microbiological parameters were monitored.

MEASUREMENTS AND MAIN RESULTS

The overall blood pH decreased from 6.997 ± 0.05 at D0 to 6.784 ± 0.09 at D42, differing from baseline from D14 onward (P < 0.05). There were increases in partial pressure of oxygen (pO₂ ), partial pressure of carbon dioxide (pCO₂ ), lactate, and potassium (K) and decreases in the concentrations of sodium, bicarbonate, glucose, and pH (P < 0.05) during storage in both bags but no alterations in total protein concentration. Most of the variables were consistently similar between the 2 types of blood bags (P > 0.05) evaluated, with the exception of pCO₂ , HCO_3, cholesterol, and total protein, which had higher values in the CPDA-1 bag (P < 0.05). The K, pO₂ , and lactate had the highest alterations during storage, with increases from baseline to D42 of 563%, 317%, and 169%, respectively.

CONCLUSION

In general, no significant changes of clinical importance were observed after storage of whole blood samples from buffaloes for 42 days in the 2 types of blood bags that are indicated for use with this species.

Effects of storage and leukocyte reduction on the concentration and procoagulant activity of extracellular vesicles in canine packed red cells

OBJECTIVES

To characterize the size and procoagulant activity of extracellular vesicles (EV) that accumulate in canine packed red blood cells (pRBCs) over time and the effect of leukocyte reduction on these characteristics.

DESIGN

Prospective cohort study.

SETTING

Private small animal specialty referral hospital and university research laboratories.

ANIMALS

Ten healthy blood donor dogs.

INTERVENTIONS

Five pRBCs units were obtained according to standard protocols, and 5 were leukocyte-reduced prior to processing. Platelet-free supernatant from the pRBC units was collected on days 0, 10, 20, 32, and 42.

MEASUREMENTS AND MAIN RESULTS

Nanoparticle tracking analysis was performed to determine the size and concentration of EVs. Thrombin generation associated with phosphatidylserine-positive EVs was determined using a capture assay. Factor Xa generation associated with phosphatidylserine-positive EVs and tissue factor-positive EVs was measured in a subset of EVs isolated by centrifugation of the supernatant at 20,000 × g. R package nparLD and the Mann-Whitney U-test were used to determine the effect of duration of storage and the effect of leukocyte reduction, respectively. Small (mean < 125 nm) procoagulant EVs accumulated over time, with significant increases occurring on or after day 20 in both non-leukocyte reduced and leukocyte-reduced units. The procoagulant activity of the EVs was due to phosphatidylserine, not tissue factor. Increases in EV concentration and procoagulant activity occurred earlier in non-leukocyte reduced units. Extracellular vesicle accumulation and procoagulant activity were not decreased at any individual time point by leukocyte reduction.

CONCLUSIONS

Further studies characterizing and determining the clinical relevance of small procoagulant EVs in pRBCs are warranted.

Role of glucose in the repair of cell membrane damage during squeeze distortion of erythrocytes in microfluidic capillaries

The rapid development of portable precision detection methods and the crisis of insufficient blood supply worldwide has led scientists to study mechanical visualization features beyond the biochemical properties of erythrocytes. Combined evaluation of currently known biochemical biomarkers and mechanical morphological biomarkers will become the mainstream of single-cell detection in the future. To explore the mechanical morphology of erythrocytes, a microfluidic capillary system was constructed in vitro, with flow velocity and glucose concentration as the main variables, and the morphology and ability of erythrocytes to recover from deformation as the main objects of analysis. We showed the mechanical distortion of erythrocytes under various experimental conditions. Our results showed that glucose plays important roles in improving the ability of erythrocytes to recover from deformation and in repairing the damage caused to the cell membrane during the repeated squeeze process. These protective effects were also confirmed in in vivo experiments. Our results provide visual detection markers for single-cell chips and may be useful for future studies in cell aging.

Effects of leukoreduction on storage lesions in whole blood and blood components of dogs

Background

Leukoreduction is a routine procedure in human transfusion medicine but is uncommon in veterinary.

Objectives

To evaluate the effect of leukoreduction on the quality of canine whole blood (WB) and blood products during storage.

Animals

Ten canine blood donors.

Methods

This is a case series study. An amount of 450 mL of blood was collected from each dog. Five WB and 5 packed red blood cells (pRBC) bags were divided into 2 units each: leukoreduced (LR) and non‐leukoreduced (nLR). RBC count, erythrocytes' mean osmotic fragility (MOF), 2,3‐diphosphoglycerate (2,3‐DPG), adenosine triphosphate (ATP), percentage of hemolysis, potassium (K), lactate, glucose, and cytokines were measured weekly from day of donation (T0) to day 35 (T35); pH, coagulation times, and clotting factors were evaluated at T0 and T35 from WB and in fresh frozen plasma after 1 year of storage.

Results

Leukoreduction showed positive effects on lactate (T35: LR WB 14.42 mmol/L SD 2.71, nLR WB 22.42 mmol/L SD 1.86, LR pRBC 20.88 mmol/L SD 2.65, nLR pRBC 36.81 mmol/L SD 2.34; P < .0001), pH (T35: LR WB 6.88 SD 0.16, nLR WB 6.69 SD 0.20, P = .02; LR pRBC 6.57 SD 0.23, nLR pRBC 6.22 SD 0.11; P < .001), and K (LR pRBC 4.08 mmol/L SD 0.88, nLR pRBC 5.48 mmol/L SD 0.90; P < .001). Increasing values of IL8 were observed in nLR units during storage (T0: 4167 ± 11 888 pg/mL; T35: 6367 ± 11 612 pg/mL).

Conclusion and Clinical Importance

LR blood units are recommended to critically ill dogs with marked inflammatory conditions.

The Effects of Pre-Storage Leukoreduction on the Conservation of Bovine Whole Blood in Plastic Bags

Simple Summary

Blood transfusion is a life-saving veterinary therapeutic procedure. While fractionated blood components are used in humans, whole blood is most commonly used in animals, especially for farm animals. Whole blood contains white blood cells that can cause a transfusion reaction in animals. Here, we proposed that using a blood bag with leukocyte filtration is sufficient for blood conservation under field conditions and thus can be an option for transfusion medicine in the case of farm animals. The filtered bag was efficient in removing white cells from cattle whole blood and could be used under field conditions. Blood stored after white blood cells were removed showed less acidic load. Further experimental studies are required to prove that blood without white cells results in a decrease in transfusion reactions in cattle.

Abstract

Leukoreduction (LR) is a technique that consists of reducing the number of leukocytes in whole blood or blood components that can contribute to decreasing storage lesions and the occurrence of post-transfusion complications. We propose that using a blood bag with pre-storage leukocyte filtration is sufficient for blood conservation under field conditions. Ten healthy Nelore cows were used. Whole blood was sampled from each animal and stored at 2 to 6 °C in CPD/SAG-M (citrate phosphate dextrose bag with a saline, adenine, glucose, mannitol satellite bag) triple bags (Control) and in CPD/SAG-M quadruple bags with a leukocyte filter (Filter). At baseline and after 7, 14, 21, 28, 35, and 42 days (D0, D7, D14, D21, D28, D35, and D42, respectively), complete hematological, blood gas, and biochemical evaluations were determined. The filtered bag removed 99.3% of white blood cells from cattle blood, and the entire filtration process was performed in the field. There was a reduction in the number of red blood cells (RBCs) in both groups from D14 onward, with a decrease of 19.7% and 17.1% at D42 for the Control and Filter bags, respectively. The hemoglobin (Hb) concentration had variation in both groups. Potassium, pO₂, pCO₂, and sO₂ increased, and sodium, bicarbonate, and pH decreased during storage. The filtered bag was efficient in removing white cells from cattle whole blood and could be used under field conditions. Blood stored after LR showed differences (p < 0.05) in blood gas analysis towards a better quality of stored blood (e.g., higher pH, lower pCO₂, higher sO₂). Further experimental studies are required to prove that blood without white cells results in a decrease in transfusion reactions in cattle.

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

OBJECTIVE

To evaluate which rapid blood administration technique causes the least iatrogenic hemolysis in canine packed red blood cells (pRBCs) as determined by plasma free hemoglobin (fHb) and percent hemolysis (% hemolysis).

DESIGN

Prospective in vitro randomized study.

SETTING

Private referral center.

ANIMALS

None.

INTERVENTIONS

Thirteen units of canine pRBCs were divided equally into 5 aliquots, resulting in 65 trials. The aliquots of each unit were subjected to the following administration techniques: gravity-driven (control), an infusion pump at maximal rate, application of a pressure bag, manual compression, and syringe bolus. Plasma fHb and % hemolysis were recorded before and after each trial. Rate of administration (mL/s) was calculated for each method.

MEASUREMENTS AND MAIN RESULTS

Compared to the control, there were no significant increases in % hemolysis or plasma fHb noted among any of the trial methods. The manual compression and syringe bolus methods resulted in the fastest transfusion rates, whereas the infusion pump was not faster than the gravity-driven method. Despite a storage time of ≤14 days, 15% of pRBC units had unsuitable (>0.8%) hemolysis before even being subjected to the trials.

CONCLUSIONS

Commonly used rapid infusion techniques in small animal transfusion medicine do not cause significant iatrogenic hemolysis of canine pRBCs in vitro, although a significant risk is present in stored blood. This suggests that if an expedited transfusion is needed, any method described in this study could be considered, although stored pRBCs should be tested for unsuitable levels of hemolysis prior to transfusion.

The relationship of membrane stiffness, cytoskeleton structure and storage time of pRBCs

BACKGROUND AND OBJECTIVES

In clinical practice, it has been shown that transfusion of packed red blood cells (pRBCs) with late shelf life increases the risk of post-transfusion complications.

OBJECTIVE

To study relationship of membrane stiffness, cytoskeleton structure and storage time of pRBCs.

MATERIALS AND METHODS

pRBCs were processed and stored according to blood bank procedure, for 42 days, at +4°C; pRBC samples were taken on days 3, 12, 19, 21, 24, 28, 35 and 42. Cytoskeleton images and membrane stiffness were studied using atomic force microscope.

RESULTS

In the course of the pRBC storage, the cytoskeleton network configuration underwent structural changes. Simultaneously, pRBC membrane stiffness was increasing, with the correlation coefficient 0·88. Until 19 days, the stiffness grew slowly, in 19-24 days there occurred a transition period, after which its growth rate was three times higher than the initial. A chain of pathological processes developed in pRBC during long storage: pH reduction (linked to increased oxidative stress), then cytoskeletal destruction and an associated increase in pRBC membrane stiffness.

CONCLUSION

During prolonged storage of pRBCs and their acidification, there is a progression of pRBC cytoskeletal changes and associated increase of membrane stiffness, observed to increase in rate after days 19-24. Mutual measurements of cytoskeletal integrity and membrane stiffness may be useful quality assessment tool to study the molecular mechanisms of RBC structural degradation during storage.

Inter-donor variability in deformability of red blood cells in blood units

OBJECTIVE

This study aimed to examine the donor-to-donor variability in the deformability of red blood cells (RBCs) from freshly collected blood donations (F-RBC) and packed RBCs.

BACKGROUND

Packed RBCs are supplied for transfusion by the first-in-first-out (FIFO) criterion, assuming that their quality is the same for packed RBCs with equal storage duration. To challenge this notion, we determined the deformability of F-RBC and packed RBCs stored for different durations.

METHODS

Three RBC groups were employed: A. 79 samples of F-RBC; B. 76 samples of packed RBC units, randomly used for transfusion at different storage durations; and C. 65 samples of outdated packed RBCs stored for 35 to 37 days. All packed RBC units were non-leukofiltrated and stored in Citrate-phosphate-dextrose solution with adenine (CPDA-1). RBC deformability was determined using a computerised cell-flow properties analyser, which monitors the shape change of cells directly visualised in a narrow-gap flow chamber and provides the cells' deformability distribution in a large RBC population.

RESULTS

The F-RBC deformability exhibited a wide-range inter-donor variability. The cold storage of packed RBCs exerted a mild reduction of deformability, which became significant, compared to the initial inter-donor variability, only after 3 weeks of storage.

CONCLUSION

Packed RBCs are generally supplied for transfusion by the FIFO criterion based on the assumption that the storage duration is a key factor of RBC quality. This study demonstrates that the deformability of red blood cells is significantly different in donors, and substantial variability persists throughout the entire process of their storage. Therefore, the FIFO criterion is not sufficient for assessing the RBC deformability, which should, therefore, be specifically characterised for each unit.

Exploration of risk factors for non-survival and for transfusion-associated complications in cats receiving red cell transfusions: 450 cases (2009 to 2017)

OBJECTIVES

To describe red blood cell transfusion practices and short-term outcomes in anaemic cats. To determine clinical variables associated with non-survival and transfusion-related complications.

MATERIAL AND METHODS

In this retrospective study, blood bank records from the Ontario Veterinary College Health Science Centre (OVC-HSC) were reviewed to identify cats that received packed red blood cells or whole blood from 2009 to 2017. We extracted cause of anaemia, history of previous transfusion, pre- and post-transfusion packed cell volume, pre-transfusion compatibility testing, volume and dose of blood product, age of red blood cell unit, transfusion-associated complications and patient survival.

RESULTS

A total of 450 transfusion events were recorded in 267 cats. Blood loss was the most common indication for blood transfusion (44.9%), followed by ineffective erythropoiesis (37.5%) and red blood cell destruction (22.5%). Transfusion-associated complications occurred in 10.2% events and there was a 20.2% mortality after transfusion. Mean increase in packed cell volume 24-hours after transfusion was greater in cats undergoing major cross-match testing before transfusion (7.2%) versus those that did not (4.0%). Non-survival was associated with higher packed cell volume before transfusion, low patient body temperature before transfusion, anaemia due to blood loss and number of transfusions administered. Older age of transfused blood units was associated with non-survival and transfusion-related complications.

CLINICAL IMPORTANCE

This study was observational and so our analyses were exploratory, but suggest that major cross-match before transfusion tended to have greater transfusion efficacy and transfusion of older blood products might have detrimental effects on survival.

Reduced deformability of stored red blood cells is associated with generation of extracellular vesicles

Throughout storage, red blood cells (RBCs) undergo detrimental changes in viability and their ability to effectively transport oxygen. RBC storage lesions are mediated, in part, by a progressive loss of cell deformability, and associated with the release of extracellular vesicles (EVs). Accumulation of EVs during the storage of RBCs correlates with a decrease in RBC surface area to volume ratio. Similarly, the loss of RBC-deformability is associated with loss of RBC surface area to volume ratio. In this study we thus tested whether loss of RBC-deformability is associated with increased RBC-EV production during blood storage. EVs obtained by differential centrifugation of stored RBCs (non-leukoreduced non-irradiated or leukoreduced γ-irradiated RBCs stored 35 or 28 days respectively) were enumerated by high-sensitivity flow cytometry. RBC deformability was quantified, using a cell-flow-properties-analyzer, by measuring the median cell elongation ratio (MER) and percentage of low and high deformable cells in the population (%, LDFC, and HDFC, respectively). The number of EVs was inversely correlated with the MER and positively correlated with the %LDFC with both measures showing highly significant logarithmic dependence with EV levels in stored RBCs. Considering how highly deformable cells did not correlate with EV formation as compared with low deformable RBCs we propose that the formation of EVs is a key factor leading to increased RBC-rigidity.

Modelling of Red Blood Cell Morphological and Deformability Changes during In-Vitro Storage

Storage lesion is a critical issue facing transfusion treatments, and it adversely affects the quality and viability of stored red blood cells (RBCs). RBC deformability is a key indicator of cell health. Deformability measurements of each RBC unit are a key challenge in transfusion medicine research and clinical haematology. In this paper, a numerical study, inspired from the previous research for RBC deformability and morphology predictions, is conducted for the first time, to investigate the deformability and morphology characteristics of RBCs undergoing storage lesion. This study investigates the evolution of the cell shape factor, elongation index and membrane spicule details, where applicable, of discocyte, echinocyte I, echinocyte II, echinocyte III and sphero-echinocyte morphologies during 42 days of in-vitro storage at 4 °C in saline-adenine-glucose-mannitol (SAGM). Computer simulations were performed to investigate the influence of storage lesion-induced membrane structural defects on cell deformability and its recoverability during optical tweezers stretching deformations. The predicted morphology and deformability indicate decreasing quality and viability of stored RBCs undergoing storage lesion. The loss of membrane structural integrity due to the storage lesion further degrades the cell deformability and recoverability during mechanical deformations. This numerical approach provides a potential framework to study the RBC deformation characteristics under varying pathophysiological conditions for better diagnostics and treatments.

Storability of porcine blood in forensics: How far should we go?

Previous studies on the storability of porcine blood for bloodstain pattern analysis (BPA) focused on abattoir blood only and did not include measurements of viscoelasticity. Although known to provoke echinocyte formation, EDTA is widely used for BPA issues. We compared ageing samples taken from live pigs with abattoir blood and detected considerable differences in hematocrit (HCT), total protein and shear viscosity that even worsened with time. Upon storage, high shear viscosity continuously increased, resulting in a partial loss of the typical shear thinning property of blood. Furthermore, we explored CPDA-1, the gold standard in preserving red blood cells (RBCs), for storage of forensic samples. We found it to be a superior choice for anticoagulation, as the rise of high shear viscosity was attenuated compared to EDTA. When performing oscillation measurements, we found a sudden change of viscoelasticity of blood after 22 days, providing a cut-off for storage time. To highlight the importance of hematological and hemorheological changes upon cold storage, we performed simple drip pattern experiments. These tests revealed a tendency to smaller stain diameters and higher numbers of satellite spatter. While this contradicts expectations from elevated viscosity values, we associate this trend to microscopic inhomogeneities due to storage. We recommend CPDA-1 for prolonged storage of BPA samples and suggest the use of comprehensive test protocols including viscoelasticity for determination of the maximum shelf life of pig blood.

The Contribution of Storage Medium and Membranes in the Microwave Dielectric Response of Packed Red Blood Cells Suspension

During cold storage, packed red blood cells (PRBCs) undergo slow detrimental changes that are collectively termed storage lesion. The aging of the cells causes alterations in the composition of the storage-medium in the PRBC unit. In this paper, we present the comparison of the dielectric response of water in the primary (fresh) storage medium (citrate phosphate dextrose adenine solution, CPDA-1) versus the storage medium from three expired units of PRBCs. Dielectric response of the water molecules has been characterized by dielectric spectroscopy technique in the microwave frequency band (0.5–40 GHz). The dominant phenomenon is the significant increase of the dielectric strength and decrease the relaxation time τ for the samples of the stored medium in comparison with the fresh medium CPDA-1. Furthermore, we demonstrated that removing the ghosts from PRBC hemolysate did not cause the alteration of the dielectric spectrum of water. Thus, the contribution associated with water located near the cell membrane can be neglected in microwave dielectric measurements.

Hematological, biochemical and microbiological evaluation of feline whole blood units collected using an open system and stored for 35 days

Despite the increasing availability of feline blood, which is collected and stored for transfusion purposes, few studies have assessed the effect of storage on feline whole blood (WB) units. The purpose of this study was to investigate selected hematologic and biochemical changes during storage of feline WB units and to determine when they occurred. Data from a quality control program for WB units was used in this study. Twelve feline WB units, collected using an open system, were sampled every 7 days from the point of collection to the end of storage at 35 days (D0, D7, D14, D21, D28, and D35). Measurements at each time point were: (1) hematologic parameters; (2) percentage hemolysis; (3) morphologic index scored at 0-3, based on echinocyte transformation of the erythrocytes; and (4) selected biochemical parameters. Aerobic and anaerobic culture was performed at D0 and D35. Results were compared statistically to D0 (statistical significance set at <0.01). Storage did not result in statistically significant changes in measured hematological parameters. There were statistically significant increases in percentage hemolysis and morphologic index, starting from D21 (P=0.000 and P=0.004, respectively). Glucose decreased significantly from D21 (P=0.003); potassium increased significantly from D7 (P=0.001); and sodium increased significantly, starting from D28 (P=0.009). Bacteria were not isolated. Blood in feline WB units collected using an open system underwent some significant storage changes that were time-dependent. As these changes could affect the quality and the utility of stored WB used in feline transfusion medicine, further study is required to determine their clinical importance.

The effects of storage at 4°C and 20°C on the hemograms of C57BL/6 mice and Wistar rats using the IDEXX ProCyte Dx and blood smear evaluations

BACKGROUND

Delayed blood analysis might be unavoidable in laboratory practice, but little is known about rodent blood stability, especially cell morphology and scattergram results.

OBJECTIVES

This study aimed to evaluate the stability of rodent blood cell counts and morphologies at different temperatures using the ProCyte Dx analyzer and performing manual observations.

METHODS

Ten Wistar rats and 10 C57bl/6 mice were sampled on EDTA tubes and aliquoted for storage (4°C, 20°C). Hematologic analyses were performed immediately and at T6h, T24h, T48h (rats and mice), and T72h (rats only) after storage.

RESULTS

In rats, at any temperature, red blood cell counts, hemoglobin concentrations (HGB), mean corpuscular hemoglobin (MCH) levels, and reticulocyte, white blood cell (WBC), eosinophil, and impedance platelet counts remained stable over time. The main changes were observed at 20°C for hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), and WBC differential counts. Optical platelet counts (PLT-O) and platelet variables underwent changes at both temperatures from T24h. In mice, red blood cell counts by impedance (RBC-I), MCH, and WBC, lymphocyte, eosinophil, and platelet counts, and plateletcrit (PCT) were stable over time and at all temperatures. As in rats, the most significant changes were observed at 20°C and concerned the optical RBC (RBC-O) counts, HCTs, MCVs, MCHCs, and reticulocyte, neutrophil, and monocyte counts. For both species, blood cell morphologies were altered from T24h at all temperatures, and platelet clumps were more numerous at 4°C.

CONCLUSIONS

When rodent blood analyses need to be delayed, storage at 4°C is preferred and should not exceed 24 hours. PLT counts should be interpreted cautiously in refrigerated specimens with mandatory blood smear evaluations when abnormal scattergrams are observed.

Haematological and morphological evaluation of feline whole blood units collected for transfusion purposes

OBJECTIVES

Despite the increasing availability of feline blood collected and stored for transfusion purposes, few studies have been performed on feline blood units. The aim of this prospective in vitro study was to evaluate haematological and morphological changes in feline blood cells in whole blood units between collection and end of storage.

METHODS

Haematological examination (red blood cells [RBCs], haemoglobin, haematocrit, red cell distribution width, mean cell volume, mean cell haemoglobin concentration, mean cell haemoglobin, white blood cells [WBCs] and platelet [PLT] count) was performed on 40 non-leukoreduced feline whole blood units at the time of collection (day[D]0) and after storage (D35). The blood was collected into citrate-phosphate-dextrose-adenine anticoagulant-preservative solution using an open system in a veterinary blood bank and stored for 35 days at 4 ± 2°C. Twenty of these feline whole blood units were also analysed for blood cell morphology (normal RBCs, macrocytes, echinocytes, spherocytes, schistocytes, lysed RBCs, RBCs with Heinz bodies and recognisable WBC and PLT count). Differences between the two examination times were statistically analysed.

RESULTS

There was a statistically significant decrease in WBC and PLT counts after storage at D35 (P <0.0001 for both). The most significant cellular morphological changes after storage were an increase in echinocyte count (P = 0.0001), and lysed RBCs (P <0.0001), and a decrease in normal RBCs (P <0.0001). Recognisable WBCs - mainly lymphocytes - were present at the end of storage.

CONCLUSIONS AND RELEVANCE

This study showed that significant morphological changes occur in RBCs in feline blood units during storage for 35 days. In vivo studies are required to establish if these changes could affect the ability of stored RBCs to circulate and provide adequate oxygen delivery after transfusion.

Quality control in the different stages of producing red blood cell concentrate from dogs

ABSTRACT The objective of this study was to perform a quality control assessment of red blood cells after standardization of the blood production stages. For this purpose, separation of the blood components to obtain red blood cells, the storage of the blood packets and an evaluation of blood quality were performed. The mean (± SD) volume, globular volume, hemoglobin and hemolysis percentage of the red blood cell concentrate were 299.77±30.08mL, 60.87±2.60%, 20.57±0.93g/DL and 0.09±0.07%, respectively. The means (± SD) of the volume, globular volume, total hemoglobin percentage of hemolysis and hemoglobin per unit of packed red blood cells after the storage period (8.83±6.73 days) were 57.55±3.01%, 20.30±0.89 0, 20±0.12%, and 60.90±7.65. The red blood cell packets were within the parameters of quality control established by Health Ministry legislation in humans and allow us to conclude that the standardization of blood production stages involves the selection of donors until the end of storage and is necessary to produce quality red blood cells. Quality control aims to find possible flaws in the procedures to be repaired, increasing transfusion safety.

Is It Possible to Reverse the Storage-Induced Lesion of Red Blood Cells?

Cold-storage of packed red blood cells (PRBCs) in the blood bank is reportedly associated with alteration in a wide range of RBC features, which change cell storage each on its own timescale. Thus, some of the changes take place at an early stage of storage (during the first 7 days), while others occur later. We still do not have a clear understanding what happens to the damaged PRBC following their transfusion. We know that some portion (from a few to 10%) of transfused cells with a high degree of damage are removed from the bloodstream immediately or in the first hour(s) after the transfusion. The remaining cells partially restore their functionality and remain in the recipient’s blood for a longer time. Thus, the ability of transfused cells to recover is a significant factor in PRBC transfusion effectiveness. In the present review, we discuss publications that examined RBC lesions induced by the cold storage, aiming to offer a better understanding of the time frame in which these lesions occur, with particular emphasis on the question of their reversibility. We argue that transfused RBCs are capable (in a matter of a few hours) of restoring their pre-storage levels of ATP and 2,3-DPG, with subsequent restoration of cell functionality, especially of those properties having a more pronounced ATP-dependence. The extent of reversal is inversely proportional to the extent of damage, and some of the changes cannot be reversed.

Biochemical changes in stored donor units: implications on the efficacy of blood transfusion

Background

Blood transfusion with allogeneic blood products is a common medical intervention to treat anemia or prepare patients for surgical procedures. Generally, the blood units are secured and stored prior to expected transfusion. During storage, a number of biochemical changes occur (generally known as storage lesion), which can affect the efficacy of blood transfusion. The aim of the study was to evaluate the biochemical changes that occur in blood units during storage and to project the impact of these changes on transfusion.

Methods

The study protocol was approved by the Faculty of Medicine Research Ethics committee of Mbarara University of Science and Technology. A total of 200 blood recipients were categorized into two study arms: group I received fresh blood (n=100) and group II received old blood (n=100), who were formally consented and recruited consecutively. A total of 2 mL of venous blood was collected from each participant in EDTA tubes before transfusion (for pre-transfusion hemoglobin [Hb] estimation) and after transfusion (for post-transfusion Hb estimation). Each crossmatched unit was sampled to collect plasma for pH, lactate and potassium assays. Data were analyzed with STATA version 12.0.

Results

A total of 200 blood transfusion recipients aged 1–60 years were enrolled in the study. Up to 60% of the participants were females. The pH of the stored blood dropped from 7.4 to 7.2 in the first 3 days to ~7.0 by day 11 and to <7.0 by day 35 (p=0.03). The average rise in lactate level was 25 g/dL in blood stored for 0 to 11 days and 32.4 g/dL in blood stored for 21–35 days. The highest increase was encountered in blood stored beyond 28 days: 40–57 g/dL by 35 days (p=0.001). Potassium levels equally increased from ~4.6 mmol/L in the first 5 days of storage to ~14.3 mmol/L by 11 days. From the third week of blood storage and beyond, there was exponential increase in potassium levels, with the highest record in blood units stored from 30 to 35 days (p=0.068).

Conclusion

Whole blood stored for >14 days has reduced efficacy with increased markers of red cell storage lesion such as increased potassium level, lactate and fall in pH. These lesions increase the length of hospital stay.

In vitro quality control analysis after processing and during storage of feline packed red blood cells units

BACKGROUND

During the storage of packed red blood cells (pRBC), packed cell volume (PCV), bacterial contamination and percentage of haemolysis [percentage of free haemoglobin (HGB) in relation to the total HGB] are important quality parameters. Both PCV and haemolysis are indicators of the cellular integrity of stored units. There are no published experimental studies that evaluated these parameters during storage of feline pRBC using SAGM (adenine, dextrose, mannitol and sodium chloride) as the additive solution. The present study aims to (1) evaluate the quality of feline pRBCs stored in SAGM; (2) test for the semi-closed system's suitability for use and risk of bacterial contamination; (3) establish the maximum storage time that may be appropriate to meet the criteria established by the United States Food and Drug Administration (US-FDA) guidelines for human blood banking; and (4) evaluate the need to calculate the percentage of haemolysis prior to the administration of units stored for more than 4 weeks. Four hundred eighty nine feline pRBC units were analyzed. Bacterial culture, PCV and percentage of haemolysis were determined within 6 h after processing (t0). One hundred and eighty units were re-tested for haemolysis and PCV after 29-35 days of storage (t1) and 118 units after 36-42 days (t2).

RESULTS

Bacterial contamination was not detected in any pRBC unit. Mean PCV at t0 was 52.25% (SD: ±5.27) and decreased significantly (p < 0.001) during storage to 48.15% (SD: ±3.79) at t1 and to 49.34% (SD: ±4.45) at t2. Mean percentage of haemolysis at t0 was 0.07% (SD: ±0.06) and increased significantly (p < 0.001) to 0.69% (SD: ±0.40) at t1 and to 0.81% (SD: ±0.47) at t2. In addition, 13.88% and 19.49% of pRBC units exceeded 1% haemolysis at t1 and t2, respectively.

CONCLUSIONS

According to the US-FDA guidelines for human blood banking that recommend a maximum of 1% haemolysis, the results of this study show that all feline pRBC units with less than 24 h of shelf life have low levels of haemolysis. However, units preserved up to 28 days can only be administered if tested for haemolysis before use, since 13.88% units exceeded the 1% limit. The semi-closed system was considered safe for use as bacterial contamination was not detected in any pRBC unit.

In vitro assessment of quality of citrate-phosphate-dextrose-adenine-1 preserved feline blood collected by a commercial closed system

BACKGROUND

Optimal procedure for storage of feline blood is needed. Open-collection systems have been employed in feline medicine, thus limiting the possibility for storage.

OBJECTIVES

To evaluate indicators of quality of feline blood stored for 35 days at +4°C in a closed-collection system specifically designed for cats.

ANIMALS

Eight healthy adult European domestic shorthair cats with a weight of 5-6.8 kg.

METHODS

This is a case series study. A bacteriological test, CBC, blood smear, pH, osmotic fragility, 2,3-diphosphoglycerate (2,3-DPG), and adenosine triphosphate (ATP) measurement were performed weekly on whole blood (WB) units from day 1 to day 35 after donation. The hemolysis index, lactate and potassium concentrations, prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen were measured on plasma aliquots.

RESULTS

One out of eight blood units (BUs) had bacterial growth (Serratia marcescens) at day 35. No significant differences were found regarding CBC, morphology, pH, and osmotic fragility. Despite high inter-individual variability and low starting levels, significant decreases in the mean concentrations of 2,3-DPG (T0 1.99 mmol/g Hb, SD 0.52, T35 1.25 mmol/g Hb, SD 1.43; P = .003) and ATP (T0 1.45 mmol/g Hb, SD 0.71, T35 0.62 mmol/g Hb, SD 0.51; P < .001) were detected during the study, as opposed to an increase in hemolysis (T0 0.11 mmol/L, SD 0.07, T35 0.84 mmol/L, SD 0.19; P < .001), lactate (T0 3.30 mmol/L, SD 0.86, T35 13.36 mmol/L, SD 2.90; P < .001), and potassium (T0 3.10 mmol/L, SD 0.21, T35 4.12 mmol/L, SD 0.35; P < .001) concentrations.

CONCLUSIONS AND CLINICAL IMPORTANCE

The commercial BU kit is appropriate for blood collection and conservation of WB in cats. The maintenance of WB quality indicators during storage is essential for future improvements of feline transfusion medicine.

Hemodynamic Functionality of Transfused Red Blood Cells in the Microcirculation of Blood Recipients

The primary goal of red blood cell (RBC) transfusion is to supply oxygen to tissues and organs. However, due to a growing number of studies that have reported negative transfusion outcomes, including reduced blood perfusion, there is rising concern about the risks in blood transfusion. RBC are characterized by unique flow-affecting properties, specifically adherence to blood vessel wall endothelium, cell deformability, and self-aggregability, which define their hemodynamic functionality (HF), namely their potential to affect blood circulation. The role of the HF of RBC in blood circulation, particularly the microcirculation, has been documented in numerous studies with animal models. These studies indicate that the HF of transfused RBC (TRBC) plays an important role in the transfusion outcome. However, studies with animal models must be interpreted with reservations, as animal physiology may not reflect human physiology. To test this concept in humans, we have directly examined the effect of the HF of TRBC, as expressed by their deformability and adherence to vascular endothelium, on the transfusion-induced effect on the skin blood flow and hemoglobin increment in β-thalassemia major patients. The results demonstrated, for the first time in humans, that the TRBC HF is a potent effector of the transfusion outcome, expressed by the transfusion-induced increase in the recipients' hemoglobin level, and the change in the skin blood flow, indicating a link between the microcirculation and the survival of TRBC in the recipients' vascular system. The implication of these findings for blood transfusion practice and to vascular function in blood recipients is discussed.

Raman spectroscopy of stored red blood cell concentrate within sealed transfusion blood bags

Spectral information relevant to the quality of stored blood can be obtained in situ through sealed blood transfusion bags using a commercially available instrument.

Biochemical evaluation of storage lesion in canine packed erythrocytes

OBJECTIVES

To describe the biochemical changes - also known as the storage lesion - that occur in canine packed red blood cells during ex vivo storage.

MATERIALS AND METHODS

Ten 125-mL units of non-leuco-reduced packed red blood cells in citrate phosphate dextrose adenine were obtained from a commercial blood bank within 24 hours of donation. Samples were aseptically collected on days 1, 4, 7, 14, 28, 35 and 42 for measurement of sodium, potassium, chloride, lactate, glucose, pH and ammonia concentrations. All units were cultured on day 42. Friedman's repeated measures test with Dunn's multiple comparison test was used for non-parametric data. A repeated-measures analysis of variance with Tukey's multiple comparison test was used for parametric data. Alpha was set to 0·05.

RESULTS

All analytes changed significantly during storage. The mean ammonia on day 1 (58·14 g/dL) was significantly lower (P<0·05) than those on days 28 (1266 g/dL), 35 (1668 g/dL) and 42 (1860 g/dL). A significant increase in median lactate concentration over time was also observed, with day 1 (4·385 mmol/L) being significantly less (P<0·05) than days 14 (19·82 mmol/L), 21 (22·81 mmol/L), 35 (20·31 mmol/L) and 42 (20·81 mmol/L). Median pH was significantly decreased after day 7. All bacterial cultures were negative.

CLINICAL SIGNIFICANCE

Many biochemical alterations occur in stored canine packed red blood cells, although further studies are required to determine their clinical importance.

Effects of Leukoreduction and Storage on Erythrocyte Phosphatidylserine Expression and Eicosanoid Concentrations in Units of Canine Packed Red Blood Cells

Background

Storage of canine packed red blood cells (pRBCs) can increase erythrocyte phosphatidylserine (PS) expression and eicosanoid concentrations.

Hypothesis/Objectives

To determine the effects of leukoreduction on erythrocyte PS expression and eicosanoid concentrations in stored units of canine pRBCs. Our hypothesis was that leukoreduction would decrease PS expression and eicosanoid concentrations.

Animals

Eight healthy dogs.

Methods

In a cross‐over study, units of whole blood were leukoreduced (LR) or non‐LR and stored (10 and 21 days) as pRBCs. Samples were collected at donation, and before and after a simulated transfusion. PS expression was measured by flow cytometry, and concentrations of arachidonic acid (AA), prostaglandin F_2α (PGF_2α), prostaglandin E₂ (PGE₂), prostaglandin D₂ (PGD₂), thromboxane B₂ (TXB₂), 6‐keto‐prostaglandin F_1α (6‐keto‐PGF_1α), and leukotriene B₄ (LTB₄) were quantified by liquid chromatography–mass spectrometry.

Results

There was no change in PS expression during leukoreduction, storage, and simulated transfusion for non‐LR and LR units. Immediately after leukoreduction, there was a significant increase in TXB₂ and PGF_2α concentrations, but during storage, these eicosanoids decreased to non‐LR concentrations. In both LR and non‐LR units, 6‐keto‐PGF_1α concentrations increased during storage and simulated transfusion, but there was no difference between unit type. There was no difference in AA, LTB₄, PGE₂, and PGD₂ concentrations between unit types.

Conclusions and Clinical Importance

Leukoreduction, storage, and simulated transfusion do not alter erythrocyte PS expression. Leukoreduction causes an immediate increase in concentrations of TXB₂ and PGF_2α, but concentrations decrease to non‐LR concentrations with storage. Leukoreduction does not decrease the accumulation of 6‐keto‐PGF_1α during storage.

Exploring the Possibility of Cryopreservation of Feline and Canine Erythrocytes by Rapid Freezing with Penetrating and Non-Penetrating Cryoprotectants

Efficient application of veterinary blood transfusion approaches for small companion animals requires readily available supply of the donor material. This can be achieved by developing of effective biobanking technologies allowing long-term storage of donor blood components via cryopreservation. Transfusion of an erythrocyte concentrate allows the successful correction of various hematological pathologies, severe bleeding, and etc. While in the past there were several approaches to cryopreserve red blood cells of dogs, to our knowledge there is virtually no data on cryopreservation of feline erythrocytes. In this paper, we performed a comprehensive parameter optimization for low temperature storage of RBCs of both species. Here, the efficiency of single-component and multicomponent cryoprotective media as well as necessary time of pre-incubation with penetrating and non-penetrating cryoprotectants prior to rapid freezing is analyzed. This study showed that glycerol was not sufficient for cryopreservation of red blood cells of the studied species under the investigated conditions. Application of 10% (v/v) ME2SO allowed for a significant reduction of canine and feline erythrocytes hemolysis after thawing. 17.5% hydroxyethyl starch demonstrated the highest cryoprotective activity for both species. It was found that dog RBCs should be incubated in cryoprotective media for 30 min at 22°C prior to freezing, while for cat RBCs 20 min is sufficient. Combination of CPAs was less effective. Presented data may be considered in further studies in veterinary transfusion and blood banking optimization.

Long-Term Stored Hemoglobin-Vesicles, a Cellular Type of Hemoglobin-Based Oxygen Carrier, Has Resuscitative Effects Comparable to That for Fresh Red Blood Cells in a Rat Model with Massive Hemorrhage without Post-Transfusion Lung Injury

Hemoglobin-vesicles (HbV), encapsulating highly concentrated human hemoglobin in liposomes, were developed as a substitute for red blood cells (RBC) and their safety and efficacy in transfusion therapy has been confirmed in previous studies. Although HbV suspensions are structurally and physicochemically stabile for least 1-year at room temperature, based on in vitro experiments, the issue of whether the use of long-term stored HbV after a massive hemorrhage can be effective in resuscitations without adverse, post-transfusion effects remains to be clarified. We report herein on a comparison of the systemic response and the induction of organ injuries in hemorrhagic shock model rats resuscitated using 1-year-stored HbV, freshly packed RBC (PRBC-0) and by 28-day-stored packed RBC (PRBC-28). The six-hour mortality after resuscitation was not significantly different among the groups. Arterial blood pressure and blood gas parameters revealed that, using HbV, recovery from the shock state was comparable to that when PRBC-0 was used. Although no significant change was observed in serum parameters reflecting liver and kidney injuries at 6 hours after resuscitation among the three resuscitation groups, results based on Evans Blue and protein leakage in bronchoalveolar lavage fluid, the lung wet/dry weight ratio and histopathological findings indicated that HbV as well as PRBC-0 was less predisposed to result in a post-transfusion lung injury than PRBC-28, as evidenced by low levels of myeloperoxidase accumulation and subsequent oxidative damage in the lung. The findings reported herein indicate that 1-year-stored HbV can effectively function as a resuscitative fluid without the induction of post-transfused lung injury and that it is comparable to fresh PRBC, suggesting that HbV is a promising RBC substitute with a long shelf-life.

Biochemical evaluation of the effects of storage on feline erythrocytes

OBJECTIVE

To describe the biochemical changes that occur during storage of feline packed red blood cells.

METHODS

Feline packed red blood cells were obtained from the manufacturer via overnight delivery immediately following collection. Bag spikes were placed using aseptic technique and samples were drawn on days 1, 4, 7, 14, 21, 28 and 35. Sodium, potassium, chloride, glucose, lactate, pH and ammonia were measured at each time point. Aerobic and anaerobic bacterial cultures were submitted following collection on day 35.

RESULTS

There were statistically significant increases in the median concentrations of lactate and ammonia within the first 2 weeks of storage to a concentration of 12·38 mmol/L and 447·96 µmol/L, respectively. Glucose concentrations decreased significantly by day 28 to a mean of 1·86 mmol/L. Median sodium and chloride concentrations increased throughout the course of storage to a concentration of 158·20 and 131·00 mmol/L, respectively. Mean potassium concentrations decreased to a concentration of 2·40 mmol/L.

CLINICAL SIGNIFICANCE

These results show that biochemical derangements within feline packed red blood cells are progressive, with some alterations, such as lactate and ammonia, occurring early within the storage periods, while others, including glucose and electrolytes, are slower to develop. Additional prospective research evaluating the clinical effects of these biochemical alterations is required.

Sickle cell disease biochip: a functional red blood cell adhesion assay for monitoring sickle cell disease

Sickle cell disease (SCD) afflicts millions of people worldwide and is associated with considerable morbidity and mortality. Chronic and acute vaso-occlusion are the clinical hallmarks of SCD and can result in pain crisis, widespread organ damage, and early movtality. Even though the molecular underpinnings of SCD were identified more than 60 years ago, there are no molecular or biophysical markers of disease severity that are feasibly measured in the clinic. Abnormal cellular adhesion to vascular endothelium is at the root of vaso-occlusion. However, cellular adhesion is not currently evaluated clinically. Here, we present a clinically applicable microfluidic device (SCD biochip) that allows serial quantitative evaluation of red blood cell (RBC) adhesion to endothelium-associated protein-immobilized microchannels, in a closed and preprocessing-free system. With the SCD biochip, we have analyzed blood samples from more than 100 subjects and have shown associations between the measured RBC adhesion to endothelium-associated proteins (fibronectin and laminin) and individual RBC characteristics, including hemoglobin content, fetal hemoglobin concentration, plasma lactate dehydrogenase level, and reticulocyte count. The SCD biochip is a functional adhesion assay, reflecting quantitative evaluation of RBC adhesion, which could be used at baseline, during crises, relative to various long-term complications, and before and after therapeutic interventions.