Adele L. Hansen

A quality monitoring program for red blood cell components: in vitro quality indicators before and after implementation of semiautomated processing

Canadian Blood Services has been conducting quality monitoring of red blood cell (RBC) components since 2005, a period spanning the implementation of semiautomated component production. The aim was to compare the quality of RBC components produced before and after this production method change.

The effect of processing method on the in vitro characteristics of red blood cell products

While the clinical impact of differences in red blood cell (RBC) component processing methods is unknown, there are concerns they may be confounding variables in studies such as the ongoing ‘age of blood’ investigations. Here, we compare the in vitro characteristics of red cell concentrates (RCCs) produced by several different processing methods.

Evaluating the 4‐hour and 30‐minute rules: effects of room temperature exposure on red blood cell quality and bacterial growth

BACKGROUND: A 30‐minute rule was established to limit red blood cell (RBC) exposure to uncontrolled temperatures during storage and transportation. Also, RBC units issued for transfusion should not remain at room temperature (RT) for more than 4 hours (4‐hour rule). This study was aimed at determining if single or multiple RT exposures affect RBC quality and/or promote bacterial growth.

The effect of timing of gamma-irradiation on hemolysis and potassium release in leukoreduced red cell concentrates stored in SAGM

While irradiation of red cell concentrates (RCC) prevents graft‐versus‐host disease in susceptible transfusion recipients, it also damages red blood cells (RBC). To understand the ability of irradiation regulations to prevent transfusion of inferior units, we irradiated 980 RCC in saline‐adenine‐glucose‐mannitol (SAGM) using various combinations of pre‐irradiation age and post‐irradiation storage times, and measured hemolysis and extracellular potassium levels. We observed unacceptably high hemolysis (>0·8%) in some RCC and elevated extracellular potassium levels in all gamma‐irradiated RCC. This suggests that more restrictive storage times should be considered for RCC in SAGM.

Quality of red blood cells washed using an automated cell processor with and without irradiation

Sterile washing of red blood cells (RBCs) and use of an additive solution permits longer postwash storage. The effect of irradiation during this extended storage time is unclear.

Feasibility and transport of packed red blood cells into Special Forces operational conditions.

BACKGROUND Transfusing packed red blood cells (PRBCs) into Special Forces may provide a survival advantage from hemorrhage-induced battlefield injuries; however, the effect of the unique operational stressors on RBC integrity is not known. METHODS Pooled PRBCs (20 U) (7 days old), stored in Golden Hour containers, were exposed to the following simulated operational stressors: High-Altitude Low-Opening parachute descent from 30,000 ft, followed by a simulated soldier presence patrol in a climatic chamber set to 48°C and 9% humidity for 12 hours (test). Biochemical (pH, lactate, potassium, and adenosine triphosphate) and biomechanical (percent hemolysis, deformability, and morphology) were measured to determine the integrity of PRBCs. RESULTS The simulated parachute descent significantly raised pH (p = 0.025) and potassium (p = 0.014) levels compared with the control; however, this was not clinically significant. Lactate (mmol/L) and adenosine triphosphate levels (0 &mgr;mol/g Hgb) were unaffected (p > 0.05). Potassium and pH levels increased with time but not significantly compared with controls. Lactate levels were unaffected with time. Mechanical agitation of PRBCs from the simulated soldier presence patrol did not significantly affect the biochemical (p ≥ 0.08) or biomechanical (p ≥ 0.33) parameters compared with control. Hemolysis was found to be less than 0.8% at the end of 12 hours. No significant difference in RBC morphology and RBC deformability were noted. CONCLUSION Carrying PRBCs into the austere Special Forces environment is feasible as biochemical and biomechanical markers of RBC stress remain within published transfusion safety parameters when PRBCs were stored in new cold technology containers for 12 hours at 48°C during a simulated Special Forces operation.

Quality of red blood cells washed using a second wash sequence on an automated cell processor

Washed red blood cells (RBCs) are indicated for immunoglobulin (Ig)A‐deficient recipients when RBCs from IgA‐deficient donors are not available. Canadian Blood Services recently began using the automated ACP 215 cell processor (Haemonetics Corporation) for RBC washing, and its suitability to produce IgA‐deficient RBCs was investigated.

An investigation of red blood cell concentrate quality during storage in paediatric‐sized polyvinylchloride bags plasticized with alternatives to di‐2‐ethylhexyl phthalate (DEHP)

Di‐2‐ethylhexyl phthalate (DEHP) is a blood bag plasticizer. It is also a toxin, raising concerns for vulnerable populations, for example, neonates and infants. Here, the in vitro quality of red cell concentrates (RCC) stored in paediatric bags formulated with alternative plasticizers to DEHP was compared.

Coinfusion of dextrose-containing fluids and red blood cells does not adversely affect in vitro red blood cell quality.

Transfusion guidelines advise against coinfusing red blood cells (RBCs) with solutions other than 0.9% saline. We evaluated the impact of coinfusion with dextrose‐containing fluids (DW) on markers of RBC quality.

Process improvement by eliminating mixing of whole blood units after an overnight hold prior to component production using the buffy coat method.

The elimination of a thorough manual mixing of whole blood (WB) which takes place following the overnight hold, but before the first centrifugation step, during buffy coat component production at Canadian Blood Services (CBS) was investigated. WB was pooled after donation and split. Pairs of platelet, red blood cell (RBC), and plasma components were produced, with half using the standard method and half using a method in which the mixing step was eliminated. Quality assessments included yield, pH, CD62P expression and morphology for platelets, hemoglobin, hematocrit, hemolysis, and supernatant K+ for RBCs, and volume and factor VIII activity levels for plasma. All components, produced using either method, met CBS quality control criteria. There were no significant differences in platelet yield between components produced with and without mixing. A significant difference was seen for RBC hemolysis at expiry (P = 0.03), but for both groups, levels met quality control requirements. Noninferiority of components produced without mixing was confirmed for all parameters. Manual mixing is laborious and has a risk of repetitive strain for production staff and its significance is unclear. Elimination of this step will improve process efficiencies without compromising quality.