Storage of Leukocyte-Poor Red Cell Concentrates: Filtration in a Closed System Using a Sterile Connection Device

Abstract

Storage of leukocyte-poor red cell concentrates (LP-RCC) was investigated after filtration in a closed system that was assembled using a Sterile Connection Device (SCD). The LP-RCC were stored for up to 6 weeks following filtration with either 0.9% saline solution (n = 14) or saline-adenine-glucose-mannitol (SAG M) solution (n = 15) to prime and rinse the cellulose acetate filter. The results were compared with the data of nonfiltered buffy-coat-poor red cell concentrates (BC-poor RCC) stored in SAG M solution (n = 10). All LP-RCC contained less than 10^6 leukocytes whereas the nonfiltered BC-poor RCC contained 675±286x10^6 leukocytes at day 1, decreasing to 83±49x106 at day 42. Although glucose consumption, lactic acid production and decrease in pH was similar from day 7 through 28 in both groups of LP-RCC, a significantly steeper decline of ATP values as well as a higher hemolysis and LDH release was observed in the LP-RCC filtered with saline. During storage of the nonfiltered BC-poor RCC in SAG M, significantly higher glucose consumption (p<0.01), LDH release (p<0.001), rate of hemolysis (p<0.001) and a lower pH (p<0.001) were found, compared to the filtered units. It is postulated that the leukocytes present in the nonfiltered BC-poor RCC were responsible for these differences. The ATP values in the SAG-M-filtered and nonfiltered BC-poor RCC in SAG M were comparable. By comparing the ATP levels and values of the filtered RCC and the nonfiltered BC-poor RCC we conclude that the LP-RCC can be stored for 35 days if SAG M solution is used to prime and rinse the filter.

Comparison of Five Different Filters for the Removal of Leukocytes from Red Cell Concentrates

“…The difference in speed was most outspoken between the Pall RC 50 requiring about 5 min and the cellulose acetate filter needing 15 min (+ the time for the extra rinsing step). We previously described that an inventory of filtered RCC resuspended in SAGM solution can be made, if the filtration procedure is carried out in a closed system assembled with a sterile connection device [21]. In this routine blood bank situation, the time required for filtration is less important, since several filtrations are performed simultaneously.…”

“…Leukocytes have no useful function after collection of donor blood and may induce unwanted side effects following transfusion in patients. It has been postulated that HLA-class-11-bearing cells of the donor can present HLA class I antigens to the recipient [l, 21 and evoke the formation of antibodies against HLA antigens [3][4][5][6], resulting in refractoriness to platelet transfusions, graft rejection and nonhemolytic febrile transfusion reactions. Furthermore, cytomegalovirus, Epstein-Barr virus, and human-T-celllymphotropic-virus type I replicate in granulocytes or lymphocytes, and removal of leukocytes from blood products may prevent viral transmission [7-111.…”

Clinical consequences of red cell storage in the critically ill

“…These corpuscular changes are associated with a multitude of biochemical and biomechanical changes, which have been previously summarized and have been collectively referred to as the storage lesion. [1][2][3]19,20 These biochemical and biomechanical changes associated with RBC storage include a depletion of ATP 21-23 and 2,3-DPG, [22][23][24][25] membrane phospholipid vessiculation [26][27][28][29] and loss, protein oxidation 1,30 and lipid peroxidation of RBC membrane, 31 and, ultimately, loss of deformability. [32][33][34][35] These corpuscular changes may contribute to adverse clinical consequences as a result of altered or diminished oxygen transport.…”

“…The depletion of RBC 2,3-DPG, the major allosteric modifier of oxygen affinity, is a well-characterized event that occurs early during storage. [22][23][24] De novo synthesis of 2,3-DPG occurs after transfusion, restoration of RBC 2,3-DPG can take up to 72 hours. 25,[44][45][46][47][48] In man and nonhuman primates, after transfusion of 2,3-DPG-depleted RBCs, systemic DPG levels, as well as the p50 values (a measure of oxyhemoglobin affinity indicated by the O 2 tension at 50% Hb saturation), decrease significantly and then regenerate at a variable rate 25,49 (Fig.…”

“…The levels of 2,3-DPG have fallen to near zero by the second week. [22][23][24][25] Although the levels are rapidly restored, the ability of these RBCs to deliver oxygen is impaired in the first 24 hours after transfusion. Additionally, the percentage of irreversibly deformed cells and overall deformability remains stable from Storage Day 5 to Storage Day 7 33 but significantly increases by Day 14.…”