Leucocyte depleted whole blood in elective surgery programs

* E-mail: gerda.leitner{at}meduniwien.ac.at

Editor—The preparation of autologous blood components is regulated by rules that are derived from the production of homologous blood components. Whole blood units (WB) are stored and transfused as leucocyte- and plasma-depleted red blood cell concentrates (PRBCs) in order to minimize adverse reactions in the transfused patient. Adverse reactions caused by the plasma fraction are mainly a problem in the homologous setting. We found that leucocyte-depleted whole blood units (LD WB) stored for 35 days meet the quality requirements for transfusion of the European Council1 and is a feasible option, in addition to PRBCs, for autologous transfusion, especially in hospitals without a blood bank.

Standard units (450 ml) of WB were collected from 12 healthy male donors (age range 28–59 yr) using bags with an integrated filter system (MacoPharma, Toucoing, France), containing 70 ml CPDA-1 as anticoagulant/preservative solution. All units were kept at room temperature for at least 4 h to ensure bacterial phagocytosis and were then leucocyte depleted by inline filtration (Lucile, MacoPharma, Toucoing, France). Storage erosion was evaluated by the increase of K+, LDH, free haemoglobin (fHb), haemolysis rate, and the course of intracellular ATP content over the storage period of 35 days as described previously.2

As required by the European Council, leucocyte contamination was less than 1x106 cells per unit, determined by flow cytometry (FACScan, Becton-Dickinson, San Jose, CA, USA) using the Leuco-Count kit (Becton-Dickinson) and the median Hct was 38.8% (range 34–46.9%). Haemolysis, reflected by the increase of K+, LDH and fHb is limited to 0.8% at the end of shelf life.1 In LD WB units a haemolysis of 0.15%±0.11 was measured on day 35 that is clearly below the threshold. Values for K+, LDH and fHb were within the ranges observed in PRBCs (Table 1).2 The mean (SD) intracellular content of ATP rose within 14 days from 112 (27) pmol·106 erythrocytes–1 to 146 (44) pmol·106 erythrocytes–1 and decreased thereafter. At the end of shelf life, 67 (20)% of the initial value was found. As described previously, the 24 h recovery of transfused PRBCs correlates strongly with red cell quality3 and is significantly affected when ATP concentrations fall below 10% of initial values.4


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Table 1 Metabolic parameters, increase of haemolysis, and ATP content in CPDA-1 preserved whole blood. Values are expressed as mean (SD)

 
Erythrocytes stored as LD WB fulfil the requirements for transfusion warranted by the European Guidelines and the in vitro assessed adequate quality of erythrocytes allows the assumption that the 24 h post-transfusion recovery will not be impaired by the storage of erythrocytes as LD WB. Thus storage and transfusion of LD WB is an option in the autologous setting.

Gerda C. Leitner*, Isolde Rach, Michaela Horvath and Paul Hoecker

Vienna, Austria

References

1 Guide to the Preparation, Use and Quality Assurance of Blood Components, 8th edn. Strasbourg: Council of Europe Press, 2002

2 Leitner GC, Neuhauser M, Weigel G, Kurze S, Fischer MB, Hocker P. Altered intracellular purine nucleotides in gamma-irradiated red blood cell concentrates. Vox Sang 2001; 81: 113–18[CrossRef][ISI][Medline]

3 Hess JR, Hill HR, Oliver CK, et al. Twelve-week RBC storage. Transfusion 2003; 43: 867–72[CrossRef][ISI][Medline]

4 Nagy S, Paal M, Koszegi T, Ludany A, Kellermayer M. ATP and integrity of human red blood cells. Physiol Chem Phys Med NMR 1998; 3: 141–8





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