Summary
Background: The blood center of the German Armed Forces in
Koblenz provides not only military and civilian hospitals across Germany
but also field hospitals of the German Armed Forces engaged
in international peace-keeping missions worldwide with red blood
cell concentrates (RBCs). Consequently, long lasting transport on
extreme surrounding temperature has to be managed without any
limitation in quality of the drugs as defined by standards of the German
and European authorities. Material and Methods: Several
commercially available transport box systems of different capacity
with either efficient isolation technique or active electric refrigeration
were investigated in a climatic chamber. A couple of packaging
protocols were tested, and two approaches of temperature measurement
(usual inter-product versus intra-product logger) were examined.
The established combined transport by military van and
aircraft over 2 days to Afghanistan was used to confirm the practicability
and reliability of the evaluated performance. Results: Actively
cooled boxes did not appear to be suitable since no permanent
power supply could be ensured and supervised. The isolation
box RCB 25 E (Elektrolux) containing up to 40 RBC units permitted
loading and handling by a single person. A standardized packaging
protocol from top to bottom was composed of distinct layers of ice
packs (-30 °C, the number of which was dependent on the target
country’s climatic zone), polystyrene, cold storage accumulators (+4
°C), knob film, RBCs, and identical components without ice packs in
reverse order. Conventional temperature logger measuring every
10 min facilitated a sufficient monitoring compared with an in-product
instrument. Conclusion: If the presented preparation protocol is
followed, temperature stability can be ensured for at least 48/56 and
72/96 h provided that the environmental temperature does not decrease
below -10 and exceed +40 °C, respectively. Additional parameters
such as temperature increase by sun radiation, damage of
the erythrocytes by air pressure change, effects of vibration or humidity
on the cell stability, and the maximum carriage temperature
of 10 versus 6 °C have to be validated to further optimize the transport
conditions with regard to the therapeutic quality of the blood
products.