1
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Stark CM, Juul SE. New frontiers in neonatal red blood cell transfusion research. J Perinatol 2023; 43:1349-1356. [PMID: 37667005 DOI: 10.1038/s41372-023-01757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/06/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023]
Abstract
Red blood cell (RBC) transfusions are common in neonates requiring intensive care. Recent studies have compared restricted versus liberal transfusion guidelines, but limitations exist on evaluations of outcomes in populations that never required a transfusion compared to those receiving any transfusion. Although there are well-established risks associated with RBC transfusions, new data has emerged that suggests additional clinically relevant associations, including adverse neurodevelopmental outcomes, donor sex differences, and inflammation or immunosuppression. Further research is needed to delineate the magnitude of these risks and to further improve the safety of transfusions. The goal of this review is to highlight underappreciated, yet clinically important risks associated with neonatal RBC transfusions and to introduce several areas in which neonates may uniquely benefit from alterations in practice.
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Affiliation(s)
- Christopher M Stark
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | - Sandra E Juul
- Institute on Human Development and Disability (IHDD) and the Intellectual and Developmental Disabilities Research Center (IDDRC), Department of Pediatrics, University of Washington, Seattle, WA, USA
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2
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Shikhooun MA, Abdulhadi LA, Yafes WM, Saleh MR, Corsentino SA, Pantin EJ. High-Dose Insulin for Hyperkalemic Cardiac Arrest. Am J Ther 2023; 30:e426-e432. [PMID: 37713686 DOI: 10.1097/mjt.0000000000001571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
ABSTRACT Hyperkalemic cardiac arrest diagnosis can be elusive and management difficult as the cardiac rhythm restoration is often not achieved until the potassium level decreases to a relatively normal level for the patient who suffers the arrest. Current treatment modalities can take hours to achieve this goal. We describe two patients who survived a witnessed hyperkalemic cardiac arrest after being managed with conventional advanced cardiac life support and unconventionally high doses of intravenous insulin.
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Affiliation(s)
- Mohammed A Shikhooun
- Department of Anesthesia, El Galaa Military Medical Complex, El-Orouba, Sheraton Al Matar, El Nozha, Cairo Governorate, Egypt
| | - Loai A Abdulhadi
- Intensive Care, National Heart Institute, Agouza, Giza Governorate, Egypt
| | - Wael M Yafes
- Cardiothoracic Surgery Department, El Galaa Military Medical Complex, El-Orouba, Sheraton Al Matar, El Nozha, Cairo Governorate, Egypt
| | - Moataz R Saleh
- Intensive Care, Mahalla Cardiac Center, El Mahalla El Kobra, El Gharbeya, Egypt
| | - Sue Anne Corsentino
- Cardiovascular Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ; and
| | - Enrique J Pantin
- Department of Anesthesiology and Perioperative Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ
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3
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Meli A, Linger R, Stevens-Hernandez CJ, Gyongyver G, Marks DC, Aung HH, Tan JCG, Cardigan R, Bruce LJ, New HV. The compound effect of irradiation and familial pseudohyperkalemia on potassium leak from red blood cells. Transfusion 2022; 62:2587-2595. [PMID: 36285891 DOI: 10.1111/trf.17159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Familial pseudohyperkalemia (FP) is a rare asymptomatic condition characterized by an increased rate of potassium leak from red blood cells (RBC) on refrigeration. Gamma irradiation compromises RBC membrane integrity and accelerates potassium leakage. Here, we compared the effect of irradiation, applied early or late in storage, on FP versus non-FP RBC. STUDY DESIGN Five FP and 10 non-FP individuals from the National Institute for Health Research Cambridge BioResource, UK, and three FP and six non-FP individuals identified by Australian Red Cross Lifeblood consented to the study. Blood was collected according to standard practice in each center, held overnight at 18-24°C, leucocyte-depleted, and processed into red cell concentrates (RCC) in Saline Adenine Glucose Mannitol. On Day 1, RCC were split equally into six Red Cell Splits (RCS). Two RCS remained non-irradiated, two were irradiated on Day 1 and two were irradiated on Day 14. RBCs were tested over cold storage for quality parameters. RESULTS As expected, non-irradiated FP RCS had significantly higher supernatant potassium levels than controls throughout 28 days of storage (p < .001). When irradiated early, FP RCS released potassium at similar rates to control. When irradiated late, FP RCS supernatants had higher initial post-irradiation potassium concentration than controls but were similar to controls by the end of storage (14 days post-irradiation). No other parameters studied showed a significant difference between FP and control. DISCUSSION FP does not increase the rate of potassium leak from irradiated RBCs. Irradiation may cause a membrane defect similar to that in FP RBCs.
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Affiliation(s)
- Athinoula Meli
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK
| | - Rachel Linger
- National Institute for Health Research BioResource-Rare Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christian J Stevens-Hernandez
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK.,Bristol Institute for Transfusion Sciences, NHS Blood and Transplant, Bristol, UK.,School of Biochemistry, University of Bristol, Bristol, UK
| | - Gyorffy Gyongyver
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK.,Bristol Institute for Transfusion Sciences, NHS Blood and Transplant, Bristol, UK
| | - Denese C Marks
- Research and Development, Australian Red Cross Lifeblood, Alexandria, Australia
| | - Htet Htet Aung
- Research and Development, Australian Red Cross Lifeblood, Alexandria, Australia
| | - Joanne C G Tan
- Research and Development, Australian Red Cross Lifeblood, Alexandria, Australia
| | - Rebecca Cardigan
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK.,Department of Haematology, University of Cambridge, Cambridge, UK
| | - Lesley J Bruce
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK.,Bristol Institute for Transfusion Sciences, NHS Blood and Transplant, Bristol, UK
| | - Helen V New
- Clinical Directorate, NHS Blood and Transplant, London, UK
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4
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Winter KM, Webb RG, Marks DC. Red cells manufactured from lipaemic whole blood donations: Do they have higher haemolysis? Vox Sang 2022; 117:1351-1359. [PMID: 36214384 DOI: 10.1111/vox.13366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/29/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Lipaemia in blood donations is thought to influence haemolysis in stored red blood cell (RBC) components. Higher lipid concentrations are believed to increase red cell fragility, exacerbating haemolysis during collection and subsequent red cell storage. This study aimed to investigate associations between lipoproteins in plasma and haemolysis of red cells stored in saline-adenine-glucose-mannitol (SAGM). MATERIALS AND METHODS Fifty-four plasma and matched RBCs were obtained from lipaemic whole blood donations. Plasma was tested for coagulation factors, triglycerides and cholesterol. Haemolysis, glucose, lactate, extracellular potassium, lactate dehydrogenase and adenosine triphosphate (ATP) were measured in RBC on Days 7, 21 and 42 of storage. Additionally, 20 plasma and matched RBCs from non-lipaemic donations were tested as controls. RESULTS Lipaemic plasma had significantly higher triglyceride concentrations compared with non-lipaemic plasma. However, there was no significant difference in plasma cholesterol between the two groups. There were no significant differences in glucose, extracellular potassium or ATP concentrations in RBC from either group. There was no significant difference in haemolysis at expiry in lipaemic-derived and control RBC, with a weak correlation between haemolysis and either triglycerides or cholesterol. CONCLUSION There was no significant difference in haemolysis in RBC manufactured from lipaemic and non-lipaemic whole blood donations when stored in SAGM; however, the proportion of RBC from lipaemic donations with higher haemolysis was greater than in the controls. There was a weak correlation between red cell haemolysis and plasma triglycerides. Therefore, RBCs derived from lipaemic donations are suitable for blood bank inventories.
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Affiliation(s)
- Kelly M Winter
- Research and Development, Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia
| | - Rachel G Webb
- Research and Development, Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia
| | - Denese C Marks
- Research and Development, Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
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5
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Olafson C, William N, Howell A, Beaudin L, Gill B, Clarke G, Stephens S, Lopes‐Carvalho D, Lane D, Schubert P, McTaggart K, Acker JP. Preparing
small‐dose
red cell concentrates (
RCCs
) for neonatal and pediatric transfusions: Impact of
RCC
volume, storage, and irradiation. Transfusion 2022; 62:1506-1510. [DOI: 10.1111/trf.17027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Carly Olafson
- Innovation and Portfolio Management Canadian Blood Services Edmonton Alberta Canada
| | - Nishaka William
- Department of Laboratory Medicine and Pathology University of Alberta Edmonton Alberta Canada
| | - Anita Howell
- Innovation and Portfolio Management Canadian Blood Services Edmonton Alberta Canada
| | - Lynnette Beaudin
- Supply Chain Testing Canadian Blood Services Calgary Alberta Canada
| | - Balkar Gill
- Supply Chain Testing Canadian Blood Services Calgary Alberta Canada
| | - Gwen Clarke
- Innovation and Portfolio Management Canadian Blood Services Edmonton Alberta Canada
- Medical, Laboratory and Stem Cell Services Canadian Blood Services Ottawa Ontario Canada
| | - Stephanie Stephens
- Quality and Regulatory Affairs Canadian Blood Services Ottawa Ontario Canada
| | | | - Debra Lane
- Medical, Laboratory and Stem Cell Services Canadian Blood Services Ottawa Ontario Canada
| | - Peter Schubert
- Innovation and Portfolio Management Canadian Blood Services Edmonton Alberta Canada
| | - Ken McTaggart
- Innovation and Portfolio Management Canadian Blood Services Edmonton Alberta Canada
| | - Jason P. Acker
- Innovation and Portfolio Management Canadian Blood Services Edmonton Alberta Canada
- Department of Laboratory Medicine and Pathology University of Alberta Edmonton Alberta Canada
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6
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Sowemimo-Coker SO, Fast LD. Effects of hypoxic storage on the efficacy of gamma irradiation in abrogating lymphocyte proliferation and on the quality of gamma-irradiated red blood cells in additive solution 3. Transfusion 2021; 61:3443-3454. [PMID: 34671985 DOI: 10.1111/trf.16683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/25/2021] [Accepted: 09/03/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Gamma irradiation of blood products is used to prevent transfusion-associated graft-versus-host disease by inhibiting the proliferation of lymphocytes that are implicated in the disease. Gamma irradiation also damages the red blood cells (RBCs). It is unknown whether hypoxia reduces the efficacy of gamma irradiation in inhibiting lymphocyte proliferation (LP). The objectives of the study were to investigate the effects of hypoxia on gamma irradiation-induced inhibition of LP and on the in vitro properties of RBCs. MATERIALS AND METHODS Forty-four units (300-340 ml each) of less than 8-h-old ABO-matched leukocyte reduced red cell concentrates (LR-RCC) in additive solution 3 were pooled in pairs. Peripheral blood mononuclear cells were isolated from non-leukocyte reduced RCCs and added back to the pool at a final concentration of 2 × 105 /ml. The pool was divided equally into a conventional storage bag A and a hypoxic processing and storage bag B. The units were gamma-irradiated at 25Gy on day 7 for the LP experiment and on either day 7 or 14 for the RBC quality experiments. LP was measured using a limiting dilution assay, and several in vitro metrics of RBCs were measured. RESULTS Gamma irradiation inhibited T-lymphocyte proliferation by 4.7 × 104 -fold reduction in both hypoxic and conventional storage. The in vitro metrics of RBC quality were better preserved in hypoxic storage. DISCUSSION T lymphocytes present in hypoxic RBC are equally susceptible to gamma irradiation as conventional storage. Hypoxic storage also reduces the deleterious effects of gamma irradiation on RBCs.
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Affiliation(s)
| | - Loren D Fast
- Department of Medicine, Rhode Island Hospital and Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
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7
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Marks DC, Webb RG, Linnane C, Aung HH, Dennington PM, Tan JCG. X- and gamma-irradiation have similar effects on the in vitro quality of stored red cell components. Transfusion 2021; 61:3214-3223. [PMID: 34510450 DOI: 10.1111/trf.16656] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/05/2021] [Accepted: 08/24/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Blood components are irradiated to inactivate lymphocytes to prevent transfusion-associated graft versus host disease. As there are little data regarding the effects of X-irradiation on red blood cell components (RBCs), the in vitro quality of stored red cells (standard, pediatric, washed, and intra-uterine transfusion [IUT]) following X- or gamma-irradiation was compared. STUDY DESIGN AND METHODS RBCs were pooled, split, and processed to produce standard (<14 days and < 5 days post-collection), pediatric (<5 days post-collection), washed (<14 days post-collection), or IUT RBCs (<5 days post-collection). Standard RBCs were either X- or gamma-irradiated (n = 10 pairs). A further 10 replicates were prepared by pooling and splitting three matched RBCs (X-, gamma-, and non-irradiated). All other RBCs were either X- or gamma-irradiated (n = 20 pairs). Red cell indices, hemolysis, potassium release, metabolism, microparticles, ATP, and 2,3-DPG were measured pre-irradiation and 6 h, 1, 2, 3, 7, 10, and 14 days post-irradiation, depending on the component type. Data were analyzed using two-way repeated measures ANOVA. RESULTS There were no significant differences in any in vitro quality measurements, with the exception of marginally higher potassium release in washed, IUT, and RBCs <5 days old (p < .0001) following X-irradiation. Both irradiation types increased generation of microvesicles, particularly in components that were older at the time of irradiation or stored for longer post-irradiation. CONCLUSION X- and gamma-irradiation have similar effects on the in vitro quality of RBCs, indicating that either technology is suitable for blood component irradiation.
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Affiliation(s)
- Denese C Marks
- Research and Development, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Rachel G Webb
- Research and Development, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
| | - Claire Linnane
- Research and Development, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
| | - Htet Htet Aung
- Research and Development, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
| | - Peta M Dennington
- Clinical Services and Research, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
| | - Joanne C G Tan
- Research and Development, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
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8
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Eshghifar N, Maghsudlu M, Amini Kafi-Abad S. The Effect of Pre-Storage Irradiation Blood on Quality of Red Blood Cells. Int J Hematol Oncol Stem Cell Res 2021; 15:1-6. [PMID: 33613895 PMCID: PMC7885131 DOI: 10.18502/ijhoscr.v15i1.5244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Irradiation leads to increased storage lesions that may have harmful effects if transfused. Various storage lesions research has been carried out, and only very few articles are available on the impact of gamma irradiation on RBC storage lesions. Since there has been no study about finding the best time for irradiation, we decided to investigate the effect of irradiation on Red blood cells at different storage times after blood collection Materials and Methods: A total of 40 units of red blood cells divided into two groups, irradiated and non-irradiated. Irradiated RBCs were divided into three groups and each group containing ten units. The remaining ten units were considered as non-irradiated controls. Sampling from these irradiated and non-irradiated blood units was performed weekly to evaluate biochemical parameters and free plasma hemoglobin/Hemolysis index levels. Results: A significant increase in the mean values of plasma potassium, plasma Hb/Hemolysis index, and LDH, as well as a significant reduction in the mean value of 2,3 DPG and plasma sodium, were observed in both groups. Although the reduction of 2,3 DPG is extremely remarkable, it is compensated 24-48 hours after transfusion. Hence, the clinical result of 2,3-DPG-depleted RBC transfusion is known to be negligible. The irradiation group alteration was more notable than the non-irradiated one and the changes in the parameters were most significant in the group having been stored for a longer period after irradiation. Conclusion: Our investigation on the impact of gamma irradiation on RBCs makes it possible to suggest a storage time up to 28 days after irradiation is permissible and the best time for irradiation after blood collection is up to 14 days. It is pointed out that the blood unit should be transfused as soon as possible after the irradiation.
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Affiliation(s)
- Nahal Eshghifar
- Department of Cellular and Molecular Biology, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mahtab Maghsudlu
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Sedigheh Amini Kafi-Abad
- Department of Pathology, Iranian Blood Transfusion Organization, Research Centre, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
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9
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Burke M, Sinha P, Luban NLC, Posnack NG. Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients. Front Pediatr 2021; 9:765306. [PMID: 34778153 PMCID: PMC8586075 DOI: 10.3389/fped.2021.765306] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/29/2021] [Indexed: 01/05/2023] Open
Abstract
Red blood cell (RBC) transfusions are a life-saving intervention, with nearly 14 million RBC units transfused in the United States each year. However, the safety and efficacy of this procedure can be influenced by variations in the collection, processing, and administration of RBCs. Procedures or manipulations that increase potassium (K+) levels in stored blood products can also predispose patients to hyperkalemia and transfusion-associated hyperkalemic cardiac arrest (TAHCA). In this mini review, we aimed to provide a brief overview of blood storage, the red cell storage lesion, and variables that increase extracellular [K+]. We also summarize cases of TAHCA and identify potential mitigation strategies. Hyperkalemia and cardiac arrhythmias can occur in pediatric patients when RBCs are transfused quickly, delivered directly to the heart without time for electrolyte equilibration, or accumulate extracellular K+ due to storage time or irradiation. Advances in blood banking have improved the availability and quality of RBCs, yet, some patient populations are sensitive to transfusion-associated hyperkalemia. Future research studies should further investigate potential mitigation strategies to reduce the risk of TAHCA, which may include using fresh RBCs, reducing storage time after irradiation, transfusing at slower rates, implementing manipulations that wash or remove excess extracellular K+, and implementing restrictive transfusion strategies.
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Affiliation(s)
- Morgan Burke
- School of Medicine, George Washington University, Washington, DC, United States
| | - Pranava Sinha
- Department of Pediatrics, School of Medicine, George Washington University, Washington, DC, United States.,Division of Cardiac Surgery, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States
| | - Naomi L C Luban
- Department of Pediatrics, School of Medicine, George Washington University, Washington, DC, United States.,Department of Pathology, School of Medicine, George Washington University, Washington, DC, United States.,Division of Hematology and Laboratory Medicine, Children's National Hospital, Washington, DC, United States
| | - Nikki Gillum Posnack
- Department of Pediatrics, School of Medicine, George Washington University, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States.,Department of Pharmacology & Physiology, School of Medicine, George Washington University, Washington, DC, United States.,Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States
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10
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Villeneuve A, Arsenault V, Lacroix J, Tucci M. Neonatal red blood cell transfusion. Vox Sang 2020; 116:366-378. [PMID: 33245826 DOI: 10.1111/vox.13036] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 10/06/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023]
Abstract
Transfusions are more common in premature infants with approximately 40% of low birth weight infants and up to 90% of extremely low birth weight infants requiring red blood cell transfusion. Although red blood cell transfusion can be life-saving in these preterm infants, it has been associated with higher rates of complications including necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity and possibly abnormal neurodevelopment. The main objective of this review is to assess current red blood cell transfusion practices in the neonatal intensive care unit, to summarize available neonatal transfusion guidelines published in different countries and to emphasize the wide variation in transfusion thresholds that exists for red blood cell transfusion. This review also addresses certain issues specific to red blood cell processing for the neonatal population including storage time, irradiation, cytomegalovirus (CMV) prevention strategies and patient blood management. Future research avenues are proposed to better define optimal transfusion practice in neonatal intensive care units.
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Affiliation(s)
- Andréanne Villeneuve
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC, Canada.,Department of Pediatrics, Université de Montréal, Montréal, QC, Canada
| | - Valérie Arsenault
- Department of Pediatrics, Université de Montréal, Montréal, QC, Canada.,Division of Haematology, CHU Sainte-Justine, Montréal, QC, Canada
| | - Jacques Lacroix
- Department of Pediatrics, Université de Montréal, Montréal, QC, Canada.,Division of Pediatric Intensive Care, CHU Sainte-Justine, Montréal, QC, Canada
| | - Marisa Tucci
- Department of Pediatrics, Université de Montréal, Montréal, QC, Canada.,Division of Pediatric Intensive Care, CHU Sainte-Justine, Montréal, QC, Canada
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11
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Moncharmont P. Adverse transfusion reactions in transfused children. Transfus Clin Biol 2019; 26:329-335. [PMID: 31563446 DOI: 10.1016/j.tracli.2019.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/06/2019] [Indexed: 01/28/2023]
Abstract
Transfusion in paediatrics requires specific guidelines, because child physiology and pathology differ significantly as compared to adults. Adverse transfusion reactions in transfused children also vary in type and frequency, but there is a better understanding of these reactions in adults than in children. However, for the most frequent adverse transfusion reactions, the overall prevalence is higher in children than in adults, with the exception of post-transfusion red blood cell alloimmunisation, which is lower, excluding patients with haemoglobinopathies. In several studies, allergic reactions were the most frequently reported adverse transfusion reaction in paediatrics, and the platelet concentrate the most frequently implicated blood product. Early diagnosis of certain adverse transfusion reactions such as haemosiderosis, is essential in order to initiate the best therapy and obtain a good clinical outcome. The prevention of adverse transfusion reactions in children is required, but needs further clinical studies in paediatrics. Lastly, changes in technology, policy and clinical practices will improve transfusion safety in children.
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Affiliation(s)
- P Moncharmont
- Département des vigilances, hémovigilance, établissement français du sang Auvergne Rhône-Alpes, site de Lyon-Décines, 111, rue Élisée-Reclus, CS 20617, 69153 Décines-Charpieu cedex, France.
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12
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Adams F, Bellairs GRM, Bird AR, Oguntibeju OO. Metabolic effects occurring in irradiated and non-irradiated red blood cellular components for clinical transfusion practice: An in vitro comparison. Afr J Lab Med 2018; 7:606. [PMID: 30568891 PMCID: PMC6295826 DOI: 10.4102/ajlm.v7i1.606] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 07/20/2018] [Indexed: 01/31/2023] Open
Abstract
Background Storage lesions occur in red blood cell products when potassium ions, haemoglobin and lactate dehydrogenase are released into the extracellular plasma due to post-irradiation storage or cellular degeneration. The South African blood transfusion establishments do not comply with the universal leucocyte-reduction policy due to cost and the current HIV pandemic. Various studies regarding storage lesions have been completed in well-developed countries but not in Cape Town, South Africa. Objective This study aimed to determine cellular degeneration occurring in non-irradiated and irradiated red blood cells (RBC) by comparing the measured biochemical and haematological indices during storage of up to 42 days. Method Eighty whole blood units were collected from voluntary, non-remunerated donors. Blood components tested weekly until expiry were whole blood, RBC concentrate, leucocyte-reduced RBC concentrate (pre-storage) and paediatric RBC concentrate (n = 20). Ten units per product were irradiated and 10 were not. Evaluations included potassium, sodium, glucose, lactate dehydrogenase, phosphate, haemoglobin, haematocrit, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentrate, mean cell volume and plasma haemoglobin. Plasma haemolysis levels were calculated using an approved formula. Results The haemolysis levels evaluated on Day 35 and Day 42 were higher than the recommended 0.8%, whereas results for the non-irradiated components up to expiry were all below 0.8%. Conclusion This study confirms that gamma irradiation aggravates the RBC storage lesions. The products tested yielded similar results to other studies in developed countries, however the South Africa transfusion medicine policy should remain unchanged.
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Affiliation(s)
- Faieqa Adams
- Western Province Blood Transfusion Service, Cape Town, South Africa
| | | | - Arthur R Bird
- Western Province Blood Transfusion Service, Cape Town, South Africa
| | - Oluwafemi O Oguntibeju
- Department of Biomedical Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
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13
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Red blood cells metabolome changes upon treatment with different X-ray irradiation doses. Ann Hematol 2018; 97:1909-1917. [DOI: 10.1007/s00277-018-3386-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/27/2018] [Indexed: 12/22/2022]
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14
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Meli A, New H, McAndrew M, Wiltshire M, Cardigan R. Laboratory assessment of the quality of adult and neonatal red cell concentrates manufactured from whole blood, exchange transfusion or intrauterine transfusion red cell units. Vox Sang 2018; 113:412-420. [PMID: 29774554 DOI: 10.1111/vox.12662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND We evaluated the quality of red cell components in additive solution over 42 days of storage when re-manufactured from neonatal exchange transfusion (ExTx) or intrauterine transfusion (IUT) units on day 7 for issue to adults, neonates or infants. MATERIALS AND METHODS Red cell concentrates (RCC) manufactured from WB were compared to RCC re-manufactured from ExTx or IUT on day 7, and red cell splits (RCS) manufactured from WB were compared to RCS re-manufactured from ExTx or IUT on day 7. All components were stored at 2-6°C and tested throughout storage until day 42 for in vitro parameters of red cell quality. One RCS manufactured from each of WB, ExTx or IUT, was irradiated on day 14 and tested on day 28 along with a non-irradiated RCS from the same unit. RESULTS All the re-manufactured arms had no worse haemolysis, red cell microvesicle (RCMV) release or ATP over storage compared to controls. All arms complied with the 0·8% haemolysis UK specification, except for re-manufactured RCS from the IUT arm irradiated on day 14 and tested on day 28. Re-manufactured units had significantly decreased potassium levels compared to control over storage (P < 0·001 all). CONCLUSION RCC or RCS re-manufactured from ExTx or IUT units on day 7 are suitable for transfusion up to the standard day 35 of storage. Re-manufactured RCS from ExTx units (but not IUT), may be irradiated up to day 14 and stored for 14 days post-irradiation.
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Affiliation(s)
- A Meli
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK
| | - H New
- Clinical, NHS Blood and Transplant, London, UK
- Department of Haematology, Imperial College, London, UK
| | - M McAndrew
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK
| | - M Wiltshire
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK
| | - R Cardigan
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
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15
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Qadri SM, Chen D, Schubert P, Devine DV, Sheffield WP. Early γ-irradiation and subsequent storage of red cells in SAG-M additive solution potentiate energy imbalance, microvesiculation and susceptibility to stress-induced apoptotic cell death. Vox Sang 2017; 112:480-483. [DOI: 10.1111/vox.12518] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/10/2017] [Accepted: 02/28/2017] [Indexed: 01/06/2023]
Affiliation(s)
- S. M. Qadri
- Centre for Innovation; Canadian Blood Services; Hamilton ON Canada
- Department of Pathology and Molecular Medicine; McMaster University; Hamilton ON Canada
| | - D. Chen
- Centre for Innovation; Canadian Blood Services; Vancouver BC Canada
- Centre for Blood Research; University of British Columbia; Vancouver BC Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver BC Canada
| | - P. Schubert
- Centre for Innovation; Canadian Blood Services; Vancouver BC Canada
- Centre for Blood Research; University of British Columbia; Vancouver BC Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver BC Canada
| | - D. V. Devine
- Centre for Innovation; Canadian Blood Services; Vancouver BC Canada
- Centre for Blood Research; University of British Columbia; Vancouver BC Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver BC Canada
| | - W. P. Sheffield
- Centre for Innovation; Canadian Blood Services; Hamilton ON Canada
- Department of Pathology and Molecular Medicine; McMaster University; Hamilton ON Canada
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16
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Loh YS, Tan S, Kwok M, Stark MJ, Marks DC. Reduction of biological response modifiers in the supernatant of washed paediatric red blood cells. Vox Sang 2016; 111:365-373. [PMID: 27864978 DOI: 10.1111/vox.12442] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 06/01/2016] [Accepted: 07/07/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Washing of red blood cells (RBC) can reduce unwanted biological response modifiers (BRMs) that can mediate transfusion complications in infants. The aim of this study was to examine the in vitro quality and the changes in BRMs following washing in paediatric RBC units. MATERIALS AND METHODS A pool and split design was used to prepare RBC (either 1 or 4 days old; n = 26 pairs). One unit was washed with 0·9% saline by centrifugation and then resuspended in SAG-M, while the other remained unwashed. Each RBC unit was divided to produce four units of paediatric-sized components. Samples were taken after 3 h and subsequently on days 1, 2, 7 and 14 post-wash. RESULTS Washing of RBC resulted in some red cell loss, with a minor increase in haemolysis. Washing effectively reduced supernatant potassium and IgA, as well as cytokines and complement proteins. RBC microparticles were significantly reduced in RBC washed at 1, but not 4 days post-collection. Incubation with supernatant from unwashed but not washed RBC led to endothelial cell activation, with increased cell surface expression of CD62E (E-selectin) and CD106 (VCAM). CONCLUSION Although washing affected some aspects of the in vitro quality of RBC, it effectively reduced the concentration and activity of BRMs in the supernatant of RBC. Such a reduction may be clinically beneficial in selected patient groups.
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Affiliation(s)
- Y S Loh
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia
| | - S Tan
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia
| | - M Kwok
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia
| | - M J Stark
- School of Paediatrics and Reproductive Health, The Robinson Institute, University of Adelaide, Adelaide, NSW, Australia
| | - D C Marks
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia
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17
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Cid J, Villegas V, Carbassé G, Alba C, Perea D, Lozano M. Transfusion of irradiated red blood cell units with a potassium adsorption filter: A randomized controlled trial. Transfusion 2016; 56:1046-51. [PMID: 26923301 DOI: 10.1111/trf.13536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/16/2016] [Accepted: 01/18/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND The irradiation of red blood cells (RBCs) causes damage of the RBC membrane with increased potassium (K) leak during storage compared with nonirradiated RBC units of similar age. A previous in vitro study showed a mean reduction of K of 94 ± 5% with a potassium adsorption filter (PAF). STUDY DESIGN AND METHODS A prospective, single-center, nonblinded, randomized controlled trial (RCT) was designed to evaluate the safety and efficacy of transfusing irradiated RBC units with the PAF. Patients 18 years of age or older who received irradiated RBC units due to chemotherapy-induced anemia were randomly assigned to receive irradiated RBC units with the PAF (PAF group) or with the standard blood infusion set (control group). Primary outcome measures were safety and efficacy of the PAF (absolute change in hemoglobin [Hb] and K, respectively, in patient's blood values after transfusing the irradiated RBC units with or without the PAF). RESULTS A total of 63 irradiated RBC units were transfused to 17 patients in the control group, and a total of 56 irradiated RBC units were transfused to 13 patients in the PAF group. The absolute change of Hb (9.3 ± 6.3 g/L vs. 8.1 ± 5.8 g/L; p = 0.3) and the absolute change of K (-0.01 ± 0.4 mmol/L vs. -0.01 ± 0.3 mmol/L; p = 0.2) were comparable between the two groups of the trial. CONCLUSION The transfusion of 1 irradiated RBC unit with the PAF was as safe and efficacious as the transfusion of 1 irradiated RBC unit with the standard blood infusion set in patients with chemotherapy-induced anemia.
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Affiliation(s)
- Joan Cid
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clínic, University de Barcelona, Barcelona, Spain
| | - Vanessa Villegas
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clínic, University de Barcelona, Barcelona, Spain
| | - Gloria Carbassé
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clínic, University de Barcelona, Barcelona, Spain
| | - Cristina Alba
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clínic, University de Barcelona, Barcelona, Spain
| | - Dolores Perea
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clínic, University de Barcelona, Barcelona, Spain
| | - Miguel Lozano
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clínic, University de Barcelona, Barcelona, Spain
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18
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AlZahrani K, Al-Sewaidan HA. Nanostructural Changes in the Cell Membrane of Gamma-Irradiated Red Blood Cells. Indian J Hematol Blood Transfus 2016; 33:109-115. [PMID: 28194066 DOI: 10.1007/s12288-016-0657-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 02/03/2016] [Indexed: 11/30/2022] Open
Abstract
The effect of gamma radiation on the ultrastructure of the cell membranes of red blood cells has been probed using a powerful tool, namely, atomic force microscopy. We used mice erythrocytes as a model. Blood samples withdrawn from mice were gamma-irradiated using a 60Co source unit with doses of 10,15,20,25 and 30 Gy. Structural changes appeared in the form of nanoscale potholes, depressions and alterations of the cell membrane roughness. The roughness of the cell membrane increased dramatically with increasing doses, although at 10 Gy , the cell membrane roughness was less than that of normal red blood cells (controls). Therefore, such modifications at the nano-scale level may affect the biophysical properties of membranes, resulting in impairment of their function.
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Affiliation(s)
- Khalid AlZahrani
- Physics Department, King Saud University, P.O. Box 2455, Riyadh, 11451 Kingdom of Saudi Arabia.,King Abdullah Institute for Nanotechnology, King Saud University, P.O. Box 2455, Riyadh, 11451 Kingdom of Saudi Arabia
| | - Hamed A Al-Sewaidan
- Physics Department, King Saud University, P.O. Box 2455, Riyadh, 11451 Kingdom of Saudi Arabia
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19
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Morrison A, McMillan L, Campbell JDM, Petrik J. Evaluation of a potassium removal filter on irradiated red cells stored in SAGM. Transfus Med 2015; 25:320-5. [DOI: 10.1111/tme.12227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/29/2015] [Accepted: 06/24/2015] [Indexed: 12/01/2022]
Affiliation(s)
- A. Morrison
- National Science Laboratory, Microbiology & Components Research, Development & Innovation Group; Scottish National Blood Transfusion Service; Edinburgh UK
| | - L. McMillan
- National Science Laboratory, Microbiology & Components Research, Development & Innovation Group; Scottish National Blood Transfusion Service; Edinburgh UK
| | - J. D. M. Campbell
- National Science Laboratory, Microbiology & Components Research, Development & Innovation Group; Scottish National Blood Transfusion Service; Edinburgh UK
| | - J. Petrik
- National Science Laboratory, Microbiology & Components Research, Development & Innovation Group; Scottish National Blood Transfusion Service; Edinburgh UK
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20
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Winter KM, Johnson L, Webb RG, Marks DC. Gamma-irradiation of deglycerolized red cells does not significantly affect in vitro quality. Vox Sang 2015; 109:231-8. [PMID: 25953334 DOI: 10.1111/vox.12282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/11/2015] [Accepted: 03/11/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Red cells frozen with glycerol may require gamma-irradiation after thawing and deglycerolization for transfusion to at-risk patients. Both freezing and irradiation are known to cause red cell damage. However, the effect of irradiation on the quality of deglycerolized red cells and the optimal shelf life of such a component is currently unknown. MATERIALS AND METHODS Red cells (<7 days) were pooled, split and glycerolized using an ACP-215 automated cell washer (n = 12 pairs) and frozen at -80°C. Red cells were thawed, deglycerolized and resuspended in SAG-M. One of each pair was gamma-irradiated, while the other served as a control. Products were stored at 2-6°C and sampled for in vitro testing immediately after irradiation, and at 24 and 48 h postirradiation. RESULTS Irradiation of deglycerolized red cells led to a >1·5-fold increase in extracellular potassium, compared to control units at 24 and 48 h postirradiation. Other parameters, including haemolysis, were not significantly affected by irradiation postdeglycerolization. CONCLUSION Deglycerolized, irradiated red cells had increased supernatant potassium, but remained of acceptable quality for 24 h postirradiation.
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Affiliation(s)
- K M Winter
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia
| | - L Johnson
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia
| | - R G Webb
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia
| | - D C Marks
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia
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21
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Johnson L, Kwok M, Marks DC. Preparation of red blood cell concentrates and plasma units from whole blood held overnight using a hollow-fibre separation system. Transfus Med 2015; 25:13-9. [PMID: 25808374 DOI: 10.1111/tme.12192] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 02/22/2015] [Accepted: 03/10/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The ErySep system represents an alternative to centrifuge-based whole blood (WB) separation, using gravity and filtration through hollow-fibres (0·2 µm pore size) to produce red blood cell (RBC) and plasma components. The aim of this study was to characterise the quality of ErySep RBC and plasma units compared with standard products from WB held overnight. METHODS/MATERIALS Two ABO-compatible WB units (n = 24) were pooled and split to produce matched products. One of the WB units was separated into components using the ErySep system (ErySep; n = 12), whereas the other units were separated by centrifugation (control; n = 12). RBC units were stored at 2-6 °C and assessed for in vitro quality over 42 days of storage. Plasma was frozen at -30 °C and tested upon thawing. RESULTS Processing WB with the ErySep system took longer than controls. The ErySep RBC units were of an appropriate volume (307 ± 17 mL) and contained sufficient Hb (50 ± 2 g unit(-1) ). ErySep RBC components contained more microparticles relative to controls at expiry. The plasma volume, total protein, coagulation factor activity (fibrinogen, FV, FVIII) and number of microparticles was lower in the ErySep units compared with controls. CONCLUSION Following overnight hold of WB, the ErySep system was capable of producing RBC components that met specifications. However, the ErySep plasma components did not meet quality specifications.
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Affiliation(s)
- L Johnson
- Research and Development, Australian Red Cross Blood Service, Sydney, Australia
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