BACKGROUND: During hypothermic storage, a substantial fraction of red blood cells (RBCs) transforms from flexible discocytes to rigid sphero-echinocytes and spherocytes. Infusion of these irreversibly-damaged cells into the recipient during transfusion serves no therapeutic purpose and may contribute to adverse outcomes in some patients. In this proof-of-concept study we describe the use of hypotonic washing for selective removal of the irreversibly-damaged cells from stored blood. MATERIALS AND METHODS: Stored RBCs were mixed with saline of various concentrations to identify optimal concentration for inducing osmotic swelling and selective bursting of spherical cells (sphero-echinocytes, spherocytes), while minimising indiscriminate lysis of other RBCs. Effectiveness of optimal treatment was assessed by measuring morphology, rheological properties, and surface phosphatidylserine (PS) exposure for cells from several RBCs units (n=5, CPD>AS-1, leucoreduced, 6 weeks storage duration) washed in hypotonic vs isotonic saline. RESULTS: Washing in mildly hypotonic saline (0.585 g/dL, osmolality: 221.7±2.3 mmol/kg) reduced the fraction of spherical cells 3-fold from 9.5±3.4% to 3.2±2.8%, while cutting PS exposure in half from 1.48±0.86% to 0.59±0.29%. Isotonic washing had no effect on PS exposure or the fraction of spherical cells. Both isotonic and hypotonic washing increased the fraction of well-preserved cells (discocytes, echinocytes 1) substantially, and improved the ability of stored RBCs to perfuse an artificial microvascular network by approximately 25%, as compared with the initial sample. DISCUSSION: This study demonstrated that washing in hypotonic saline could selectively remove a significant fraction of the spherical and PS-exposing cells from stored blood, while significantly improving the rheological properties of remaining well-preserved RBCs. Further studies are needed to access the potential effect from hypotonic washing on transfusion outcomes.
BACKGROUND: During hypothermic storage, a substantial fraction of red blood cells (RBCs) transforms from flexible discocytes to rigid sphero-echinocytes and spherocytes. Infusion of these irreversibly-damaged cells into the recipient during transfusion serves no therapeutic purpose and may contribute to adverse outcomes in some patients. In this proof-of-concept study we describe the use of hypotonic washing for selective removal of the irreversibly-damaged cells from stored blood. MATERIALS AND METHODS: Stored RBCs were mixed with saline of various concentrations to identify optimal concentration for inducing osmotic swelling and selective bursting of spherical cells (sphero-echinocytes, spherocytes), while minimising indiscriminate lysis of other RBCs. Effectiveness of optimal treatment was assessed by measuring morphology, rheological properties, and surface phosphatidylserine (PS) exposure for cells from several RBCs units (n=5, CPD>AS-1, leucoreduced, 6 weeks storage duration) washed in hypotonic vs isotonic saline. RESULTS: Washing in mildly hypotonicsaline (0.585 g/dL, osmolality: 221.7±2.3 mmol/kg) reduced the fraction of spherical cells 3-fold from 9.5±3.4% to 3.2±2.8%, while cutting PS exposure in half from 1.48±0.86% to 0.59±0.29%. Isotonic washing had no effect on PS exposure or the fraction of spherical cells. Both isotonic and hypotonic washing increased the fraction of well-preserved cells (discocytes, echinocytes 1) substantially, and improved the ability of stored RBCs to perfuse an artificial microvascular network by approximately 25%, as compared with the initial sample. DISCUSSION: This study demonstrated that washing in hypotonicsaline could selectively remove a significant fraction of the spherical and PS-exposing cells from stored blood, while significantly improving the rheological properties of remaining well-preserved RBCs. Further studies are needed to access the potential effect from hypotonic washing on transfusion outcomes.
Authors: Vassilis L Tzounakas; Hara T Georgatzakou; Anastasios G Kriebardis; Effie G Papageorgiou; Konstantinos E Stamoulis; Leontini E Foudoulaki-Paparizos; Marianna H Antonelou; Issidora S Papassideri Journal: Transfusion Date: 2015-07-14 Impact factor: 3.157
Authors: Chenell Donadee; Nicolaas J H Raat; Tamir Kanias; Jesús Tejero; Janet S Lee; Eric E Kelley; Xuejun Zhao; Chen Liu; Hannah Reynolds; Ivan Azarov; Sheila Frizzell; E Michael Meyer; Albert D Donnenberg; Lirong Qu; Darrel Triulzi; Daniel B Kim-Shapiro; Mark T Gladwin Journal: Circulation Date: 2011-07-11 Impact factor: 29.690
Authors: Walter H Reinhart; Nathaniel Z Piety; Jeremy W Deuel; Asya Makhro; Thomas Schulzki; Nikolay Bogdanov; Jeroen S Goede; Anna Bogdanova; Rajaa Abidi; Sergey S Shevkoplyas Journal: Transfusion Date: 2015-03-06 Impact factor: 3.157
Authors: Jose M Sosa; Nathan D Nielsen; Seth M Vignes; Tanya G Chen; Sergey S Shevkoplyas Journal: Clin Hemorheol Microcirc Date: 2014 Impact factor: 2.375
Authors: Hui Xia; Naze G Avci; Yasemin Akay; Yoshua Esquenazi; Lisa H Schmitt; Nitin Tandon; Jay-Jiguang Zhu; Metin Akay Journal: IEEE Open J Eng Med Biol Date: 2020-02-17
Authors: Camille Roussel; Sylvain Monnier; Michael Dussiot; Elisabeth Farcy; Olivier Hermine; Caroline Le Van Kim; Yves Colin; Matthieu Piel; Pascal Amireault; Pierre A Buffet Journal: Front Med (Lausanne) Date: 2018-05-30