Abstract
Transfusion still remains one of the most commonly performed hospital procedures in the US, and many suggest a link between transfusion of older RBC products and adverse clinical outcomes. Certain clinicians have identified a need for the ability to order blood products that meet higher efficacy standards. The RBC storage lesion – meaning the chemical and morphological changes that occur as red blood cells age – greatly affects the transfusion efficacy of red cell products in cold storage. Because of the significant variation between donors, that assigned shelf life for pRBC products may not be appropriate for each individual unit. This leads to some units being transfused past their effective periods and others being discarded prematurely. A quick method for measuring and predicting transfusion efficacy is needed, especially for units approaching the assigned expiration date or for patients that warrant higher quality blood products. This study characterizes novel osmotic fragility and mechanical fragility assays for quick, low-volume measurement of pRBC membrane integrity. Combined with the newly described Sysmex Delta-Hgb research parameter, these assays demonstrate normal membrane fragility values up to and past current expiration date, suggesting that unit viability might extend beyond currently assigned limits. These assay results are combined to generate an F-Score for the determination of membrane resiliency in pRBC units. The F-Score shows good predictive value for both superior and acceptable units. The ability to test and characterize an individual unit’s suitability for transfusion would have immense impact on storage requirements, transfusion protocols, and inventory management.