Measurement of Posttransfusion Red Cell Survival With the Biotin Label

Abstract

The goal of this review is to summarize and critically assess information concerning the biotin method to label red blood cells (RBC) for use in studies of RBC and transfusion biology — information that will prove useful to a broad audience of clinicians and scientists. A review of RBC biology, with emphasis on RBC senescence and in vivo survival is included, followed by an analysis of the advantages and disadvantages of biotin labeled RBC (BioRBC) for measuring circulating RBC volume, post-transfusion RBC recovery, RBC lifespan, and RBC age-dependent properties. The advantages of BioRBC over 51Cr RBC labeling, the current reference method, are discussed. Because the biotin method is straightforward and robust, including the ability to follow the entire lifespans of multiple RBC populations concurrently in the same subject, BioRBC offers distinct advantages for studying RBC biology and physiology, particularly RBC survival. The method for biotin labeling, validation of the method, and application of BioRBCs to studies of sickle cell disease, diabetes, and anemia of prematurity are reviewed. Studies documenting the safe use of BioRBC are reviewed; unanswered questions requiring future studies, remaining concerns, and regulatory barriers to broader application of BioRBC including adoption as a new reference method are also presented.

Quality Assessment of Established and Emerging Blood Components for Transfusion

“…As most damaged RBCs will be removed by circulation within 24 h, those cells that remain in circulation would be expected to be viable and functioning [331]. Efforts to develop biotin-labeling techniques and other methods to identify RBCs in circulation have been pursued as replacements to the use of radionucleii in in vivo survival testing [332]; indeed, most countries in Western Europe prohibit the administration of radiolabeled substances to healthy volunteers [333]. However, the ability to remain in circulation may not be a true measure of whether a red cell can deliver oxygen or not.…”

Research Opportunities to Improve Neonatal Red Blood Cell Transfusion

“…Their immature organ functions require modification for optimal blood banking practices (e.g., aliquoting, washing, volume reduction and irradiation), and yet there are few direct studies upon which to base optimized practices. Biotin labelling of populations of red cells (BioRBCs) has been used to determine RBC lifespan and time-dependent changes in RBC populations [54]. Because BioRBCs can track several different cell populations at the same time, they have also been used to simultaneously determine the survival characteristics of both autologous neonatal and allogeneic adult donor RBCs in very low birth weight infants, with resulting observations substantially at odds with current assumptions about autologous and allogeneic RCS in neonates [55, 56].…”

A Mass Balance-Based Semiparametric Approach to Evaluate Neonatal Erythropoiesis

“…This linear rate of decline arises from assuming normal hematologic steady-state conditions and a constant RBC life span in the adult RBC donor subjects (19). Thus, the behavior of the transfused RBCs is given by: 1.65×10…”