Stored Red Blood Cells Loss Ability to Transport Oxygen Over Time
Donated red blood cells have a refrigerated shelf-life of up to 42 days. A new study from Duke University Medical Centers has found that donated red blood cells lose a key feature that diminishes their lifesaving power the longer they have been stored.
The 2008 NEJM article showed that cardiac surgery patients who received blood stored more than 2 weeks did not do as well. With the shortage of blood, it is important to find ways to improve the shelf-life.
What happens during storage?
In the article published in the journal Critical Care Medicine, Timothy J. McMahon, M.D., PhD, associate professor of medicine at Duke, and colleagues detail how banked blood undergoes a change during storage that decreases its ability to transport oxygen.
Slowing that process could offer a way to boost the longevity and vitality of stored blood – more than 38000 blood donations are needed every day and more than 14 million units of which are used each year in the United States to treat cancer, acute heart syndromes, trauma and other critical illnesses.
McMahon and colleagues tested the hypothesis that red blood cell storage impairs the ability of red blood cells to release adenosine-5'-triphosphate and that impaired adenosine-5'-triphosphate release was injurious in vivo, in part through increased red blood cell adhesion.
Unlike transfusion of fresh human red blood cells, stored red blood cell transfusion in mice decreased blood oxygenation and increased extravasation of red blood cells into the lung's alveolar air spaces.
Similar findings were seen with transfusion of fresh red blood cells treated with the adenosine-5'-triphosphate release inhibitors glibenclamide and carbenoxolone.
McMahon and colleagues note that as red blood cells’ ability to release ATP diminishes the longer they're stored, they develop a sticky quality. When transfused, these older cells tend to adhere to the blood vessels in the lungs instead of transporting their oxygen payload throughout the body.
When that happens, patients may be at risk for heart attacks, respiratory failure and other complications that have been associated with transfusions.
McMahon and colleagues found the red blood cells remained less “sticky” when the stored blood was treated with either coinfusion of an adenosine-5'-triphosphate analog or pretransfusion incubation of the red blood cells with an antibody against the erythrocyte adhesion receptor Landsteiner-Wiener (intercellular adhesion molecule-4).
McMahon said the researchers are now exploring whether they can ease the problem, perhaps by fortifying stored red blood cells with additional ATP or with an agent that stimulates ATP release.
"We show that the export of ATP is important to prevent red blood cells from sticking to the inner lining of blood vessel walls," McMahon said. "Whereas previous reports had shown increasing adhesion as a function of storage time, there were very few studies on the mechanism of that adhesion."
Please, donate blood if you are able. There is a continued need daily. Blood levels are critically low across the nation.
CBER Reports on Safety of Blood Transfusions in 2010
The above story is reprinted (with editorial adaptations by Ramona Bates, MD) from materials provided by Duke University Medical Center.
Impaired adenosine-5′-triphosphate release from red blood cells promotes their adhesion to endothelial cells: A mechanism of hypoxemia after transfusion.; Hongmei Zhu, Rahima Zennadi, Bruce X. Xu, Jerry P. Eu, Jordan A. Torok, Marilyn J. Telen, Timothy J. McMahon.; Critical Care Medicine, 2011; DOI: 10.1097/CCM.0b013e318225754f
Duration of Red-Cell Storage and Complications after Cardiac Surgery; Colleen Gorman Koch, M.D., Liang Li, Ph.D., Daniel I. Sessler, M.D., Priscilla Figueroa, M.D., Gerald A. Hoeltge, M.D., Tomislav Mihaljevic, M.D., and Eugene H. Blackstone, M.D.; N Engl J Med 2008; 358:1229-123