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Randomized study of washing 40- to 42-day-stored red blood cells

Authors

  • Elliott Bennett-Guerrero,

    Corresponding author
    1. Duke Clinical Research Institute, Duke University, Durham, North Carolina
    • Address correspondence to: Elliott Bennett-Guerrero, MD, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710; e-mail: Elliott.BennettGuerrero@Duke.edu.

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    • These authors contributed equally.
  • Brett S. Kirby,

    1. Department of Medicine, Division of Hematology, Duke University Medical Center, Durham, North Carolina
    2. Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
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    • These authors contributed equally.
  • Hongmei Zhu,

    1. Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
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  • Annadele E. Herman,

    1. Department of Pathology, Duke University Medical Center, Durham, North Carolina
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  • Nicholas Bandarenko,

    1. Department of Pathology, Duke University Medical Center, Durham, North Carolina
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  • Timothy J. McMahon

    1. Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
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  • This research was supported in part by National Institutes of Health awards T32-HL007057 (supporting BSK) and VA BX-000281 and R21-HL113943 (TJM). This study was funded in part by Haemonetics, Inc.

Abstract

Background

Pretransfusion washing of red blood cells (RBCs) stored for a longer duration may have theoretical advantages but few data exist to support this practice. In many hospital settings, use of a point-of-care cell washer could conceivably be used to quickly wash allogeneic RBCs before transfusion. The purpose of this preliminary study was to compare a point-of-care device with a common blood bank device for washing longer-stored RBCs.

Study Design and Methods

Forty RBC units stored for 40 to 42 days were randomized to washing with the COBE 2991 device (Terumo BCT; FDA-cleared for washing stored RBCs) or the Cell Saver Elite (Haemonetics; FDA-cleared point-of-care device for processing and washing fresh autologous shed whole blood). Supernatant and unit RBCs from unwashed (baseline) and washed blood were assayed for potassium, lactate, intracellular ATP, percentage of RBC recovery, cell-free hemoglobin, RBC microparticles, and RBCs were examined for susceptibility to hemolysis by physical stress.

Results

Both devices recovered a high percentage of RBCs and efficiently removed extracelluar potassium. Washing with the Elite resulted in significant increases in cell-free Hb, percent hemolysis, and RBC microparticle production, whereas washing with the COBE 2991 did not (fold Δ = 2.1 vs. 1.0, 4.6 vs. 1.2, 2.0 vs. 1.1, respectively; p < 0.05). Hemolysis induced by physical stress was not altered by washing.

Conclusion

Although point-of-care washing of longer-stored RBCs is appealing, these preliminary data suggest that transfusion of washed, longer-stored units could result in potentially greater exposure to plasma free Hb. More data are needed before this practice can be routinely recommended.

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