Improving the quality of washed and buffy coat-free erythrocyte concentrates]

Washing buffy-coat free erythrocyte concentrates three times in bottles used for blood storage will diminish their leukocyte content to 0.22 +/- 0.11 x 10(9) per TE (= 9% of the initial value in whole blood, and the thrombocyte content to 0.3 +/- 0.5 x 10(9) per day (= 2% of the initial value in whole blood). Even 50% of leukocytes (mainly lymphocytes) and 80% of thrombocytes are eliminated simply by buffy coat separation. 30% of erythrocytes are lost by the washing process. Due to increasing haemolysis (0.22%) a subsequent storage of 24 hours should not be exceeded for washed erythrocyte concentrates. Further quality parameters, such as morphological index, pH, ATP, 2,3-P2G and K+ and Na+, were investigated. As far as selected quality parameters are concerned, washing erythrocyte concentrates three times in bottles for blood storage may be compared with washing them once in blood bags. The present findings confirm the conclusion that the washing of erythrocyte concentrates with a solution of sodium chloride in order to eliminate leukocytes may for the most part exclude non-haemolytic febrile transfusion reactions, but not immunization. More effective procedures of eliminating leukocytes, such as filtration, TTK or even glycerin, treatment of erythrocyte concentrates without cryoconservation, are indispensable.     

A novel device for the non-invasive measurement of free hemoglobin in blood bags.

The production of red blood cell concentrates from human donors is a very expensive procedure and human resources are in short supply. Under perfect storage conditions at a temperature of 2-6 degrees C, a blood bag must be used within 35-49 days (in Germany). Visual inspection of the bag for apparent hemolysis by a blood bank physician is a crucial but subjective quality control assessment. Since an interruption of the cold chain cannot be definitely ruled out, bags are often disposed of prematurely for safety reasons. There is currently no method of testing a closed blood bag with respect to hemolysis for its suitability to be used in a transfusion. The proposed optical measuring device is a hemoglobin sensor which determines the free hemoglobin in standard erythrocyte concentrates without opening the bag. The optical measurements are done on the flexible tube connected to the main bag. The optical measurements were evaluated using standard hemoglobin solutions with an accuracy of 0.005 g/dL. These investigations show that in the future each blood bag can be tested non-invasively for its content of free hemoglobin. This will contribute to decreasing the wastage rate of red blood cell concentrates.     

Storage-induced changes in erythrocyte membrane proteins promote recognition by autoantibodies

Physiological erythrocyte removal is associated with a selective increase in expression of neoantigens on erythrocytes and their vesicles, and subsequent autologous antibody binding and phagocytosis. Chronic erythrocyte transfusion often leads to immunization and the formation of alloantibodies and autoantibodies. We investigated whether erythrocyte storage leads to the increased expression of non-physiological antigens. Immunoprecipitations were performed with erythrocytes and vesicles from blood bank erythrocyte concentrates of increasing storage periods, using patient plasma containing erythrocyte autoantibodies. Immunoprecipitate composition was identified using proteomics. Patient plasma antibody binding increased with erythrocyte storage time, while the opposite was observed for healthy volunteer plasma, showing that pathology-associated antigenicity changes during erythrocyte storage. Several membrane proteins were identified as candidate antigens. The protein complexes that were precipitated by the patient antibodies in erythrocytes were different from the ones in the vesicles formed during erythrocyte storage, indicating that the storage-associated vesicles have a different immunization potential. Soluble immune mediators including complement factors were present in the patient plasma immunoprecipitates, but not in the allogeneic control immunoprecipitates. The results support the theory that disturbed erythrocyte aging during storage of erythrocyte concentrates contributes to transfusion-induced alloantibody and autoantibody formation.     

The oxygen transport function of the blood and of the erythrocyte concentrate during storage and its importance for blood transfusion

The property of oxygen transport function was investigated in blood which had been stored in solutions of "glugizir" and "zitroglucophosphate" and in erythrocyte concentrates gained from it on the noughth, 7th, 14th und 21st day of storage at -4 +/- 2 degrees C. The parameters of the oxygen binding function (oxygen content of erythrocytes, half time of haemoglobin saturation with oxygen, concentration of organic phosphate [2.3 diphosphoglycerate and adenosine triphosphate] and those of inorganic phosphorus were determined in erythrocytes. During storage for more than 21 days no significant differences could be detected in the property of oxygen transfer between erythrocytes of stored blood and erythrocyte concentrate, with the values for storing in zitroglucophosphate being somewhat higher. Problems of applying all components of donor blood efficiently are discussed. In performing an adequate haemotherapy with blood components the importance of a functional condition of erythrocytes and oxygen balance in the organism of the receiver should be considered. The necessity of transfusing erythrocyte concentrate in the therapy of anaemias of different genesis is emphasized and the differences in applying concentrates in different plasma solutions are referred to. By transfusing concentrates the effectiveness of hemotherapy are elevated and the rate of complications and side-effects of whole blood are diminished.     

Time-related shape control modifications during erythrocyte storage with additive solutions

To obtain more detailed information on the reversibility of shape alterations in blood bank stored erythrocytes, we have studied shape recovery after chemical crenation and rheological properties in 8 PAGGS-sorbitol preserved erythrocyte concentrates during a five week storage period under blood bank conditions. Our results show that red cell capability to regain a normal discoid shape after chemical crenation decreases during storage but is not lost over a five week period. Moreover there is a significant but weak correlation between red cell ATP content and both shape recovery capability and viscosity. Our results confirm suspicious that red cell shape perturbations following blood bank storage are widely reversible. Two different mechanisms may be involved in reducing shape recovery capability during storage, namely an ATP-dependent mechanism and an energy-independent one. The energy dependent mechanism may be preserved by the previous addition of solutions which maintain higher energy levels during storage.     

Time course of the age-related alterations in stored blood

The extent and time course of the impairments occurring in whole blood and erythrocyte cells stored under blood bank conditions were studied by monitoring the reduction of MAL-6 spin label added to the media containing whole blood or erythrocyte cells using electron spin resonance (ESR) technique. Impairments forming in the erythrocyte cells incubated for various times at 37 degrees C were also studied. Erythrocyte cells were found to undergo changes during the storage or incubation, leading to fast decay of MAL-6 spin labels signal height. The extent of the changes depends on storage or incubation time. However, the reduction in incubated or artificially aged erythrocyte (AAE) cells was faster than the reduction in whole blood (WB) and aged erythrocyte (AE) cells stored under blood bank conditions. Two exponential curves attributed to the liquid and cellular parts of a given samples were found to be described best in the reduction of MAL-6 spin label in WB, AE and AAE.     

The effect of the AcD-AG stabilizer on the survival time and surface properties of fluid preserved platelet concentrates compared to concentrates from fresh blood]

In the present investigations the storage effect the AcD-AG stabilizer on thrombocytes is examined. The thrombocytokinetic parameters of 9 fresh blood concentrates and 15 concentrates of AcD-AG plasma containing platelets were determined. Storage time amounted to three days. The results show that storage with AcD-AG is only possible to a limited degree. On an average the survival time of the platelets was reduced to 2.7 +/- 1.1 days compared with 9.0 +/- 1.0 days of fresh blood concentrates. The recovery of the stored platelets amounted to 25.3 +/- 16.1%, that of the fresh blood concentrates to 63.3 +/- 23.6%. The spleen-heart quotients and those of the liver-heart or the surplus impulses over the spleen and liver respectively indicate that there is a predominant destruction in the spleen for those thrombocytes stored for three days. The liver is scarcely involved in this sequestration process. With 36.1% platelet yield was very low in concentrates gained from AcD-AG plasma containing platelets and having been stored for 3 days. In cases of emergency a clinical application of concentrates prepared in this way should not be given up. If being used, the greater requirement has to be taken into account. If the substitution therapy is continued, however, fresh blood concentrates have to be used as soon as possible.     

Changes in the rheologic properties of various samples of blood preserved at +4 degrees C

Apparent stationary viscosity, viscoelasticity and thixotropy measured with a Couette viscosimeter have been determined on blood samples stored in eight anticoagulant and/or preservative solutions. All the results as well as those obtained in a previous morphological study show clearly the advantages of the SAG or PAGGS storage processes. It is observed that the rheological parameters of RBC stored in protein poor media are, between the 30 th and 35 th days, identical on CPD at the first week and with that measured in CPD concentrates between second and third week (for a same hematocrit value). We want to emphasize that the erythrocytes stored in these new media retain for a long time their ability to circulate in the capillary system.     

Transformations of glycolysis control characteristics in human erythrocytes during blood storage

Changes in glycolysis control characteristics (dependence of glycolysis rate on ATP concentration) in erythrocytes were studied during the storage of donors blood with glucose citrate hemoconservant. During the first two weeks of storage the shape of glycolysis control characteristics in the erythrocytes could be shown to remain practically unchanged, which was represented by a bell-shaped curve such as in fresh erythrocytes. During this period the physiological point of glycolysis will move along the glycolysis control characteristics towards the maximum of the curve. Once the maximum of the physiological point has been reached, the shape of the curve can be seen to change. The maximum on the curve becomes less evident, moving down and to the left from its initial position. These changes will occur after two to four weeks of storage. In some cases the maximum on glycolysis control characteristics will disappear at the latest stages of storage. The changes observed will occur in blood of different donors at different moments of storage. The nature of the changes observed and their influence on erythrocyte viability are discussed.     

Effect of dihydroxyacetone on metabolic parameters and survival of resuspended erythrocytes after storage at 25 degrees and 4 degrees]

Erythrocyte concentrates from CPD blood were resuspended after separating the leukocyte-thrombocyte layer and stored at 4 degrees C and 25 degrees C. The solutions for resuspension differed in the content of substrate, pH, condition of sterilization and the resuspension volume used, 1 or 4 volumes of cell concentrate to 1 volume of resuspension solution. At 4 degrees C, there was no effect of DHA on the the 2.3 bisphosphoglycerate content (P2G content). The decreased activity of triokinase at low temperature, phosphate deficiency and a partial disintegration of DHA during the autoclave as well as the difference of the commercial DHA preparations are discussed as underlying causes. At 25 degrees C DHA delayed the P2G decrease during storage. The enhanced triokinase activity above 15 degrees C is principally considered to be the cause for it. High rates of haemolysis, rapid ATP decrease, survival rates of 56% after a storage of three weeks for erythrocyte resuspensions with DHA in used compositions render a clinical application impossible at present. It could be well suitable as a substrate for resynthesizing P2G. An addition of ascorbate + nicotinamid + adenin at a storage temperature of 4 degrees C had no influence on the P2G content. A resuspension solution on the basis of xylitol with additions of sorbitol, bicarbonate, inorganic phosphate, pyruvate, adenine and guanosine showed the best properties in the content of P2G and ATP, lactate formation and survival rate during a storage at 4 degrees C.     

Comparison of posttransfusion recoveries achieved with either fresh or stored platelet concentrates

The effectiveness of platelet concentrate transfusion depends on such variables as blood bag material, donor--recipient compatibility, and time elapsed between donation and transfusion. To study the latter a corrected thrombocyte increment for recovery in the recipients was evaluated with 108 platelet transfusions in 31 patients. In 83 treatment programs, the mean recovery at the one-hour post-transfusion time point was 8.6 X 10(9) platelets/l with fresh platelets and 5.9 X 10(9) platelets/l with stored platelets. Significantly better recovery was achieved with freshly prepared platelet over the total of platelet concentrates stored for up to 96 hours; however, if the recoveries in different patient groups given stored platelets were considered separately in terms of storage times of up to 48 h or 48-96 h, the good recovery with fresh platelets was significantly better only when compared to the older (p = 0.034) but not to the younger group of stored platelets. In patients with signs indicating enhanced platelet destruction (fever, splenomegaly, disseminated intravascular coagulation) the transfusion with fresh platelet concentrates gave a significantly better recovery compared to stored platelet concentrates (p = 0.028), whereas in the absence of such signs the recovery produced by fresh concentrates was not significantly higher than with stored concentrates. These findings may be relevant for the logistics in blood banking.     

Carcinoma of the nasopharynx; treatment with radioactive cobalt

A specific and characteristic type of anemia is not a feature of all malignant disease. To the contrary, the nature of the anemia will depend upon the causative mechanism, of which blood loss and accelerated erythrocyte removal appear to be the most frequently seen and the most clearly defined. Recognition of anemia due to loss of blood is relatively simple if the subtlety of blood loss in the stool is borne in mind and persistent testing to demonstrate it is carried out. Indeed, anemia characterized by chronic loss of blood in men can only mean chronic gastrointestinal bleeding if certain rare hemoglobin abnormalities can be ruled out. Anemia due to accelerated erythrocyte removal may also be recognized by simple measures. After transfusions raise hemoglobin values to near normal levels, the disappearance of the transfused blood and the rapid return of the pretransfusion severity of anemia are good evidence of the presence of such a mechanism, if blood loss can be ruled out.Adequate management of the anemia of malignant disease depends upon a clear understanding of the various mechanisms involved. It is highly probable that attention to this feature will, in many instances, significantly prolong the productive life of persons with malignant disease.     

Preservation of red cell concentrates. Dependence on storage time of IgG binding, osmotic fragility, MCV, and surface area index

In a comparative study of red cells from concentrates preserved in SAG medium without and with 30 mM sucrose, mannitol or sorbitol, resp., we determined the variation of IgG binding, osmotic fragility, MCV and the surface area index with storage time. IgG binding gave no conclusive results. Osmotic fragility turned out to be increased in simple SAG in comparison to the sugar-supplemented media. From measurements of microhematocrit and pH, the mean cellular volume (MCV), standardized to the initial pH value, turned out to decrease in all the media tested by not more than about 5 per cent after 3 weeks, and 10 per cent after 6 weeks. This is in advantageous contrast to the strong decrease in microhematocrit formerly observed in red cell concentrates in CDS-AG medium. Cells resuspended in simple SAG medium exhibited the smallest decrease in MCV. However, as inferred from data on hemolysis and vesiculation (D. Stibenz, accompanying paper), in these cells the loss of surface area proved to be maximal.     

Human T lymphocyte differentiation antigens: effects of blood sample storage on Leu antibody binding

Current studies of human T lymphocytes and their subsets often use quantitative immunofluorescence analysis with monoclonal antibodies against cell surface antigens. With storage of whole blood or separated mononuclear cells for more than a few hours we have found marked changes in lymphocyte analysis using a fluorescence activated cell sorter (FACS). Experiments were done to determine if these lymphocyte changes were influenced by storage temperature and if lymphocytes could be made more stable by addition of culture media RPMI 1640 to whole blood. Optimal conditions found for blood storage were with with addition of 50% RPMI 1640 and with samples held at room temperature (22 degrees C). With these storage conditions, delay on FACS analysis up to 24 hours did not result in spurious results. When blood samples are collected in places remote from the laboratory or when batch analysis of serially collected samples is desirable, excessive storage times should be avoided.     

The character of growth of mycobacterium tuberculosis in vitro in dependence on peripheral human blood's components

Blood plasma, cell mass, white blood cells (WBC) and erythrocytes were investigated for their relation to cord formation of M. tuberculosis, cultivated in blood according to Pryce's method. It was found that cord formation was related to blood cell and followed the zone of sedimentation of WBC. In lysed blood cord formation could be revealed on the whole glass surface, but disappeared if the lysed blood was filtered through Seitz filter - evidences which were accepted as indications that cord formation was dependent on WBC. However, destroying WBC in lysed blood by freezing and thawing or eliminating them by centrifugation did not disturb cord formation and addition of WBC to simple media did not result in cord formation. It was concluded that cord formation was called forth by lysed erythrocytes and this was confirmed through adding erythrocytes stromata to simple media, where cord formation appeared. The practical value of the technique applied and the eventual role of erythrocyte stromata's lipids in cord formation are discussed.     

Factors that determine stability of highly concentrated chemically defined production media

High cell density perfusion processes for the production of therapeutic antibodies require large volumes of media to meet cellular stoichiometric and energy demands. The use of media concentrates provides a way to reduce the cost of manufacturing. Reducing the number and size of liquid media batches reduces the media footprint in the manufacturing plant and cuts costs associated with single‐use systems for preparation and storage of liquid media. Concentrates that can be stored at room temperature also reduce costs by eliminating the need for refrigerated storage. To meet these economic and operational objectives, we developed a complete concentrated medium system consisting of a 5X medium concentrate that can be used in conjunction with a concentrated supplement of cystine, tyrosine, and folic acid. The effects of pyruvate, bicarbonate, and glutamine on the stability of the 5X concentrates were studied. Pyruvate and bicarbonate were found to have profound impacts on media stability, including media coloration, precipitate formation and ability to support cell culture. Bicarbonate was found to have detrimental effects in 5X concentrated media, resulting in precipitation of pyruvate‐free media and accelerated glutamine degradation. Pyruvate prevented precipitation in bicarbonate‐containing concentrates. Moreover, the presence of pyruvate in bicarbonate‐free, glutamine‐free 5X concentrates resulted in the substantial preservation of the functional activity of the medium for 1 month at room temperature. © 2015 American Institute of Chemical Engineers Biotechnol. Prog., 31:493–502, 2015     

Preparing platelet concentrates from banked blood stored for 1-5 days by using tetracycline antibiotics

It was shown that storage of banked blood up to five days did not change number of platelets and their functional integrity was retained rather well. That made possible the development of a method for preparation of viable platelet concentrates (PC) from stored blood. This method is based on the reversibility of the tetracycline antibiotics inhibitory effect on platelet activation process. According to the results of our in vitro studies PC from stored blood seem to be suitable for clinical usage. This tetracycline method of PC preparation from stored blood may provide a more efficient utilization of available donor blood to meet the ever-expanding needs for PC transfusions.     

Analysis of the shelf life and transfusion life of whole blood and erythrocyte concentrates

The shelf life of 60,000 units of whole blood and red cell concentrates in the blood center were analysed before delivering to hospitals as well as the transfusion age of 18,000 units in relation to the stock-size and the outdated units. The mean transfusion age of whole blood units and red blood cell concentrates amounted to 11 to 12 days and 16 to 17 days, respectively. The shelf life of blood transfused within 24 hours after collection was 1.6% and 3.8% transfused within 48 hours according to the total number of whole blood and red blood cell concentrates. Washed red cell concentrates were prepared from buffy coat-free resuspended red cell concentrates on an average at the 7th day of storage. A high stock-size of about 1,000 units rather than of 600 units in the blood center increased the shelf life and also the number of outdated units from less than 0.5% up to more than 3%.     

Phospholipid composition of packed red blood cells and that of extracellular vesicles show a high resemblance and stability during storage

Red blood cells (RBCs) are stored up to 35–42 days at 2–6 °C in blood banks. During storage, the RBC membrane is challenged by energy depletion, decreasing pH, altered cation homeostasis, and oxidative stress, leading to several biochemical and morphological changes in RBCs and to shedding of extracellular vesicles (EVs) into the storage medium. These changes are collectively known as RBC storage lesions. EVs accumulate in stored RBC concentrates and are, thus, transfused into patients. The potency of EVs as bioactive effectors is largely acknowledged, and EVs in RBC concentrates are suspected to mediate some adverse effects of transfusion. Several studies have shown accumulation of lipid raft–associated proteins in RBC EVs during storage, whereas a comprehensive phospholipidomic study on RBCs and corresponding EVs during the clinical storage period is lacking. Our mass spectrometric and chromatographic study shows that RBCs maintain their major phospholipid (PL) content well during storage despite abundant vesiculation. The phospholipidomes were largely similar between RBCs and EVs. No accumulation of raft lipids in EVs was seen, suggesting that the primary mechanism of RBC vesiculation during storage might not be raft -based. Nonetheless, a slight tendency of EV PLs for shorter acyl chains was observed.     

Proteomics and transfusion medicine: future perspectives

Limited number of important discoveries have greatly contributed to the progresses achieved in the blood transfusion; ABO histo-blood groups, citrate as anticoagulant, fractionation of plasma proteins, plastic bags and apheresis machines. Three major types of blood products are transfused to patients: red cell concentrates, platelet concentrates and fresh frozen plasma. Several parameters of these products change during storage process and they have been well studied over the years. However, several aspects have completely been ignored; in particular those related to peptide and protein changes. This review presents what has been done using proteomic tools and the potentials of proteomics for transfusion medicine.