AS‐1 cells: N = 13; volume = 325 + 29 mL; hematocrit = 58% + 4%; mean red cell mass = 188 mL; mean supernatant volume = 136 mL; mean total hemoglobin = 19.3 g%.ATP, adenosine triphosphate; DPG, diphosphoglycerate; Hgb, hemoglobin; RBC, red blood cell.
Red blood cells
Description of component
RBCs are the cells remaining after most of the plasma has been removed from WB. They must have a final hematocrit of less than 80% [24]. This blood component is often called “packed red cells” or “packed cells.” Usually the red cells and plasma are separated within 8 hours of collection, because for the plasma to be used as a source of factor VIII it must be placed in the freezer less than 8 hours after collection.Centrifugation is used when the red cells are being prepared within a few hours after collection, because usually this is done as part of a large‐scale operation, and speed is important. The centrifugation conditions (time and speed) are determined by the method being used to prepare the platelets or plasma. If platelets or fresh frozen plasma (FFP) are not being produced from the original unit of WB, the red cells can be separated from the plasma at any time during the storage period of the blood. If the unit of WB is allowed to remain undisturbed for several hours, the red cells sediment and the plasma can be removed. When sedimentation is used, the red cells are not as concentrated; as a result, the red cell unit has a lower hematocrit and less plasma is recovered. Because the plasma is valuable as a source for production of plasma derivatives, it is desirable to recover the maximum amount of plasma; therefore, sedimentation currently is not usually used to separate WB into its components. However, sedimentation can be used quite effectively when equipment for centrifugation is not available, such as in developing countries.
The unit of red cells has a volume of about 300 mL and will contain a minimum of 154 mL of red cells (405 mL × 38% hematocrit). Usually the red cell unit contains about 190 mL of red cells (450 mL × 42% hematocrit) and has a hematocrit of about 60%. The fluid portion of the unit (approximately 130 mL) is primarily the additive preservative solution, although about 20 mL of plasma remains from the original unit of WB. The characteristics of a unit of red cells stored in an additive are listed in Table 5.6 and the general changes in Table 5.7. Considerable emphasis has been put to understanding these changes and the potential clinical impact (see Chapters 11 and 16). One unit of red cells will increase the hemoglobin concentration and hematocrit in an average‐size adult (70 kg) by about 1 g/dL and 3%, respectively.
Studies of biochemical and morphologic alterations that occur during storage of RBCs have expanded to investigate not only the correlation between storage lesion and anticoagulant–preservative solutions but also donor‐to‐donor variability. In 2013, RBC‐Omics Recipient Epidemiology Donor Evaluation (REDS)‐III study was lunched [25]. One of the main objectives of the study was to determine whether genetic and biological variability of blood donors defines the quality of RBCs and their capacity to withstand cold storage temperatures. The study demonstrated an association between donor characteristics, such as sex, age, race/ethnicity, iron intake, and donation frequency, and in vitro hemolysis in RBC product [26–28]. A genome‐wide association study provided additional information on gene loci and association with hemolysis [27, 29]. Overall, the new way of thinking about “storage lesion” and RBC‐Omics paves the way for future studies.
Storage conditions and duration
Red cells are stored at 1–6°C for 21–42 days depending on the anticoagulant–preservative solution used. For optimum inventory management, most blood centers use preservatives that allow 42‐day storage. The end of the storage period is referred to as the expiration date or the “outdate.” The cells must be stored in refrigerators with good air circulation and that are designed for blood storage. Household refrigerators are not suitable. The temperature in the refrigerator must be monitored and should be recorded periodically (continuously is preferable), at least every 4 hours. There should be an alarm system to warn staff if the temperature moves outside the acceptable limits. When blood is transported to the patient care area for transfusion, it may be allowed to warm to 10°C and still be suitable for return to the blood bank and reissue to other patients [24, 30].
Table 5.7 Changes that occur during red cell storage: the storage lesion.
Source: Adapted from Hess JR. Measures of stored red blood cell quality. Vox Sang 2014; 107:1–9.
| Increase | Decrease |
| Lactate | ATP |
| Pyruvate | 2,3‐DPG |
| Ammonia | Intracellular potassium |
| Intracellular sodium | pH |
| Membrane vesicles | Intravascular recovery |
| Plasma hemoglobin | Oxygen release |
| Free iron | Nitric oxide secretion |
ATP, adenosine triphosphate; 2,3‐DPG, 2,3‐diphosphoglycerate.
Blood components must be maintained under proper storage conditions during transportation from the blood center to the hospital transfusion service. Various containers are available for this purpose, and these processes are standard and work well in developed countries. However, in developing or undeveloped parts of the world, usually these kinds of containers are not available and red cells may not be refrigerated or stored properly during this transportation. This is also an issue in military settings, where it also important that these containers be lightweight.
Frozen or deglycerolized red blood cells
Description of component
RBCs, frozen or deglycerolized, are the cells that have been stored in the frozen state at optimal temperatures in the presence of a cryoprotective agent, which is removed by washing before transfusion [24, 31]. The red cells must be frozen within 6 days after collection, and they can be stored for up to 10 years, although the AABB (formerly American Association of Blood Banks) Standards [24] do not include a standard for storage duration, and acceptable postthaw results have been found after storage at −80°C for 37 years [32–35]. The cryoprotectant commonly used is glycerol, which must be removed before transfusion to avoid osmotic hemolysis when the cells are transfused. The method of freezing and storage must preserve at least 80% of the original red cells,
