Evaluation of internationally used blood stabilizers for effective erythrocyte substitution]

Haemotherapy developed in the direction of transfusing pure blood cell preparations, if possible and enlarging the therapy with plasma fraction considerably. Quality losses of haemotherapeutics will already occur when they are prepared. This is mainly due to the conditions of blood collecting, blood stabiliser, duration and storage temperature from the blood collecting to further processing as well as biological variability of the composition of the donor's blood. The amount of substrate available to erythrocytes differs in various blood stabilisers. Deplasmatized erythrocyte concentrates can be used after several weeks of storage, if a high glucose concentration is present in the blood stabiliser. In CPD media the function of erythrocytes, the oxygen supply of the tissue, will remain intact a week longer than in ACD media. This effect will be increased by xylitol and pyruvate as well as by adding bicarbonate simultaneously. In future a primary importance will have to be attached to an improved storage of erythrocytes in the form of resuspended buffy coat-free erythrocyte concentrates.     

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.     

Clinical use of blood,blood components and blood products.

The goal of modern transfusion therapy is to provide appropriate replacement therapy with blood components as opposed to whole blood for patients with specific hematologic deficiencies. A prerequisite of component therapy is, therefore, correct identification of the deficiency. Appropriate use of components avoids many of the hazards associated with the use of whole blood, and at the same time makes maximal use of this valuable resource. Blood components separated from whole blood soon after collection and appropriately stored can, in combination, provide all the factors present in fresh whole blood. Red cell concentrates prepared from multiple packs have a hematocrit of approximately 70%. They may be stored for up to 3 weeks at 4 degrees C and are recommended for most situations requiring red cell transfusions. Platelet concentrates, which can be stored for up to 72 hours at 22 degrees C, may be used for thrombocytopenic patients. Fresh frozen plasma, stored plasma, cryoprecipitated factor VIII, factor VIII concentrate and factor IX complex concentrate are available for the proper treatment of patients with hemorrhagic disorders due to coagulation factor deficiencies. Similarly, albumin and immune serum globulin are available for their oncotic and antibody properties respectively. Thus, the availability and appropriate use of the various blood products allows not only optimal transfusion therapy for each patient, but also fuller utilization of national blood resources.     

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.     

Deformability of stored erythrocytes as a criteria for their in vivo survival rate

The loss of deformability observed in erythrocytes stored as whole blood for 36 days (ACD-AG) or as buffy-coat free erythrocyte concentrate (EK) was characterized by measuring their filterability. During the first 3 weeks the index of filterability for ACD-AG erythrocytes increased only slightly and rose to about 140% of its initial value on the 36th day. In contrast, a heavy loss of deformability (increase of the filterability index to more than 600%) was detected for erythrocytes from EK, which, from a rheological point of view, is apt to raise doubts of using this stored blood. An incubation of 1 hour at 37 degrees C in fresh plasma did not result in improving the deformability. A cell volume loss of more than 20% connected with an increase of the inner viscosity to more than 400% was found to be the cause of this decrease of deformability. These rheological differences are also reflected in the 24 hours in vivo survival rate (SR), if the "early loss" of damaged erythrocytes immediately after transfusion is taken into account. Whereas the SR values of 80% for whole blood erythrocytes do not change significantly, the SR values for EK values can be found to reach 54% approximately.     

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.     

Elimination of saccharose from the blood and its renal excretion following transfusion of buffy coat-free erythrocyte concentrates containing disaccharides

The elimination of sucrose from the blood and its renal excretion was analysed in 108 patients after applying a total of 394 transfusion units (TE), resuspended, buffy-coat-free erythrocyte concentrates (EK) containing 23 mmol of sucrose per TE. In transfusing 3 TE even 90% of the sucrose were eliminated from the blood during the application time and up to 99% within 3 h, nearly 80% were excreted through the kidneys within 12 h. Elimination and excretion were delayed with impaired kidney function. With respect to intravasal elimination of sucrose bilaterally nephrectomized patients have to rely on hemodialysis. Side-effects of sucrose due to extended intravasal and interstitial duration could not be observed in those patients affected with decreased kidney efficiency and after massive transfusions.     

Further improvement of the ACD-AG protective solution for blood. II. Behavior of the oxygen affinity of preserved blood in ACD-AG medium and in a protective solution with addition of pyruvate and xylitol and elevated Ph values]

The present paper deals with the behaviour of the oxygen transport function as well as the 2.3 DPG and ATP levels of erythrocytes during the storage in an ACD-AG solution. In the ACD-AG blood in P 50 fell from 20mm of Hg to values of 12 mm of Hg within 4 weeks of storage. The 2.3 DPG content had already fallen to values below 10% within a fortnight. Additions of xylitol (10 mM in the blood) and pyruvate (0.3 mM in the blood) will delay the decrease of P 50 and the 2.3 DPG content. Concerning the ATP behaviour there was no significant difference between ACD-AG blood and that with additions of xylitol and pyruvate. Up to a storage of a fortnight stored blood in the ACD-AG solution of xylitol and pyruvate will be equal to ACD-AG fresh blood as far as the parameter of oxygen transport function is concerned.     

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 blood oxygen binding properties of hypoxicSalmo gairdneri

Summary The blood oxygen binding properties of rainbow trout responded to environmental hypoxia (the oxygen saturation of water 30% at 11°C) in three ways. The quickest response was a moderate acidosis, leading to slightly lowered blood oxygen loading due to the Bohr effect. The second response, an increase of blood oxygen carrying capacity, was completed with 6 h from the onset of hypoxia. The speed of the response suggests that the formation of new haemoglobin played no practical role, the increase being caused either by a decrease of plasma volume or the liberation of erythrocytes from a storage organ. The slowest response, a 25% increase of the blood oxygen affinity within a week of hypoxia, was probably caused by the concurrent decrease of the erythrocyte ATP concentration from 4.45 to 2.51 mol/ml erythrocytes.     

Alterations in rheologic properties of stored blood as criterion of the functional state of erythrocytes in haemocarboperfusion

Rheologic studies performed on rotational viscometers "Rheotest-2" and "VIR-78" within shear rates gamma interval of 0.1 s-1 less than gamma less than 1,312 s-1, revealed a substantial reduction in dynamic viscosity of the blood subjected to sorption treatment on activated charcoal. The importance of volume concentration of erythrocytes proper for dynamic viscosity is analysed. Special emphasis is placed on the necessity to take into account the dispersion of electrophoretic mobility of erythrocytes in analyzing surface properties of erythrocytes from stored blood before and after hemocarboperfusion. In addition, the normalization of electrosurface characteristics of erythrocytes and associated with them the aggregational property of blood after its purification by sorption is demonstrated. The restoration of the explored physical and chemical characteristics of blood, perfused through the sorbent, permits its more valuable transfusional medium to be considered in comparison to conventional stored blood with identical times of preservation.     

Lysis of erythrocytes from stored human blood by phospholipase C (Bacillus cereus).

The ability of phospholipase C (Bacillus cereus) to lyse erythrocytes from human blood that had been stored under Transfusion Service conditions for up to 16 weeks has been examined. When incubated at 20 degrees C with enzyme (0.03 mg/ml, 55 units/ml) for up to 1 h fresh erythrocytes were not lysed. After about 4 weeks of storage a population of very readily lysed erythrocytes appeared. The morphological changes in erythrocytes from blood stored up to 16 weeks were examined by scanning electron microscopy. The proportion of very readily lysed erythrocytes correlated well with the proportion of spheroechinocytes I. This morphological form was shown to be preferentially removed by phospholipase C and before lysis a transient appearance of smooth spheres occurred. The decrease in blood ATP concentrations on storage was measured and found to correlate with the disappearance of discoid erythrocyte forms, but not directly with the increased susceptibility of the erythrocytes to lysis by the enzyme. However, erythrocytes of up to at least 15 weeks of age could be made less susceptible to lysis by pre-incubation in a medium designed to cause intracellular regeneration of ATP. During the lysis of spheroechinocytes I by electrophoretically pure recrystallized phospholipase C a rapid degradation of phosphatidylcholine, phosphatidylethanolamine and phosphatidylserine + phosphatidylinositol) occurred together with a slower degradation of sphingomyelin.     

Further improvement of the ACD-AG protective solution for blood. III. Improvement of the oxygen transport function of erythrocytes in sorbitol xylitol pyruvate solutions with elevated Ph]

If the pH value in the ACD or in the ACD-AG storage solution is enhanced, the glucose in the autoclaving with undergo a caramelizing process. For this reason glucose was replaced by sorbite in the storage solutions with a pH value of 6.0 and additions of xylitol and pyruvate. The initial pH value in the blood amounted to 7.3. The content of 2.3 DPG of the erythrocytes remained fully preserved in the blood with sorbitol and additions of xylitol and pyruvate during the first 2 weeks of storage and decreased to 30% only in the third week. There were only slight amounts of 2.3 DPG in the ACD-AG blood at that time of storage. Up to the third week of storage the ATP content of erythrocytes as well as the haemoglobin level in the plasma revealed no essential differences between stored blood with sorbitol and xylitol as a substrate or glucose + xylitol respectively. The quick decrease of the ATP level to zero and the simultaneous strong increase of haemolysis in the sorbitol blood within the fourth week of storage is discussed in connection with a lowering of the NAD/NADH2 quotient. For the purpose of keeping the 2.3 DPG level of erythrocytes a storage solution with sorbite and xylitol (ASCX-AG-Pyr 10mM) seems to be well suited for a storing time of 2---3 weeks at first.     

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.     

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.     

Improved methods for determining the concentration of 6-thioguanine nucleotides and 6-methylmercaptopurine nucleotides in blood

The conversion of the cytotoxic and immunosuppressive 6-mercaptopurine (6MP) to the active 6-thioguanine nucleotides (6TGN) is necessary for clinical efficacy of 6MP and its prodrug azathioprine. Another metabolite, 6-methylmercaptopurine nucleotide (6MMPN), is formed via a competing pathway by thiopurine methyl transferase. The concentrations of 6TGN and 6MMPN are measured in washed erythrocytes as a surrogate to the intracellular levels of these metabolites in the target tissues. Analysis of 6TGN and 6MMPN in multi-center clinical studies is more complicated because of the requirement to wash erythrocytes. In this investigation, we found no differences in the concentrations of 6TGN and 6MMPN in blood versus washed erythrocytes in samples obtained from patients taking therapeutic doses of oral 6MP or azathioprine for inflammatory bowel disease. We concluded that whole blood could be used for the analysis of these analytes, thus saving sample preparation time. We also found that the erythrocyte 6TGN concentration in blood at ambient temperature declined 2–4% per day, a loss that can be avoided by shipping blood samples frozen. The loss of 6TGN in blood stored at approximately −80°C was 1% after 1 week and 12% after 24 weeks, indicating the analyte was moderately stable. 6MMPN in blood did not significantly change after 24 weeks of storage at approximately −80°C. In addition, the sensitivity of the 6TGN assay was improved by modifying the HPLC conditions, which made the method more suitable for quantifying low levels of 6TGN in human intestinal biopsy samples and blood.     

Quality parameters of cryoprecipitates from stored blood preservation

The investigations of a series of 281 cryoprecipitates produced from blood stored at 10 degrees C for 12-18 hours resulted in equal values as compared with those preparations from a control group of 53 preparations which had been prepared from blood maximally stored for 4 hours. Thus, international experiences could be confirmed. An improvement in the quality of erythrocyte concentrates simultaneously produced can be regarded as an additional advantage with respect to the formation of microaggregates during the time the stored blood can be made use of.     

The cellular composition of the blood and haematopoietic organs of turbot Scophthalmus maximus L.

The cellular composition of the blood, anterior kidney, spleen and thymus of turbot Scophrhalmus maximus L., aged 1 + was determined. Ninety-four per cent of blood cells belonged to the erythrocyte lineage of which 82% were mature erythrocytes. The leucocytes, which represented 4.5% of the blood cells, were mainly lymphocytes (50%). The presence of crythroblasts in the anterior kidney and the spleen demonstrated an erythropoietic activity in both organs. However, this activity appeared to be prevalent in the spleen which also appeared to act as a storage zone for erythrocytes and as the centre point for thrombopoiesis. Although 96% of the anterior kidney cells were leucocytes, the number of white cells per gram of organ was higher in the spleen.     

Liquid preservation of highly purified human granulocytes

Highly purified human granulocytes isolated from continuous flow centrifugation leukapheresis concentrates by counterflow centrifugation-elutriation were stored at 4 °C in concentrations of 6 × 10⁶ to 1 × 10⁷ granulocytes per milliliter for up to 14 days. The in vitro physiological function assays of phagocytosis, oxygen consumption associated with phagocytosis, bacterial growth inhibition, chemotaxis, and five enzyme analyses indicated good storage survival for up to 4 days. Stored granulocytes separated from other blood cells have greater storage stability than granulocytes stored as leukapheresis concentrates. After 14 days of storage a small percentage of granulocytes still maintained all physiological functions, with the exception of chemotaxis. Of the five enzymes assayed, only the enzyme activity of leucine aminopeptidase decreased significantly by the 14th day of storage. The storage stability of each physiological function assayed decreased as follows: bacterial growth inhibition (most stable), phagocytosis, oxygen consumption, and chemotaxis (least stable).     

Erythrocyte volume distribution curves: a parameter for evaluating erythrocyte preparations

The volume distribution of erythrocytes in ACD-AG blood and in human erythrocyte concentrations was investigated by means of computer-assisted techniques of hematological analysis. The storage-dependent distribution was described by the content of discrete class areas. Erythrocytes with a volume below 72 fl are only slightly capable of changing their volume. Their condition predisposes them to selection in the receiver's organism. Their percentage amount correlates with the share of cells ineffective of transfusion. The concentration of cells with a volume above 72 fl is discussed with ACD-AG blood (78% on the 42nd day), with CDS-AG erythrocyte concentrate (66% on the 20th day) and with SAG-M erythrocyte concentrate (74% on the 35th day) together with findings about the transfusional survival rate.