Shelf life of a volume reduced RBC product

A colleague in Saudi Arabia asks what is the practice regarding the storage of a unit of additive solution suspended RBC that is volume reduced aseptically by centrifugation? Assuming the RBC originally have a 42 days shelf live, after removal of the additive, how long would colleagues store the product, if it is stored at 1 to 6 C? Would such a product be used for neonates, and if so, would that influence the storage duration?

The following comments have been submitted in response.

ADDENDA March 1, 2010

1. Dr. Neil Blumberg, Professor of Pathology & Laboratory Medicine and Director, Transfusion Medicine/Blood Bank Director, Clinical Laboratories at University of Rochester Medical Center (attribution used with permission) is not familiar with any data on this issue. He indicates that in his institution, he would have no problems with storing such a volume reduce product for up to 24 hours at 1-6C, if a sterile docking device had been used to remove the supernatant. However, he would not store it much beyond a week or so in the absence of any appreciable preservative solution.
   
   
2. According to Dr. Ellen Klapper at Cedars-Sinai Medical Center (attribution used with permission), the main issue is that by volume depleting an AS unit of red cells, both the additive solution and anticoagulant/nutrient are being removed. Since there are no studies (that she is aware of) that establish the shelf life of such a component, one would have to do the post transfusion recovery studies. She does not believe that the use of the product for neonates would change the expiration of the product.
   
   
3. Three experienced transfusion medicine physicians who work at an academic center in Virginia comment that neither one of them is familiar with such a procedure. Given the absence of information about such storage (at least known to then), they would not store the manipulated component at all.

ADDENDA March 8, 2010

4. A colleague at a blood donor collection center in Central California comments that the answer to this discussion's questions can be found in the Circular of Information for the Use of Human Blood and Blood Components (August 2009), which addresses this on pages 26 and 27.

The relevant information is shown below:

Volume Reduction

Description: Volume reduction is a special manipulation of cellular blood products using centrifugation. The process involves the aseptic removal of a portion of the supernatant, containing plasma and storage medium. Volume reduction removes excess plasma, thereby reducing unwanted plasma proteins, including antibodies. It is more commonly used in pediatric and in-utero transfusions. There will be some loss of platelet function through platelet activation as a result of volume reduction. The shelf life of volume reduced components is no more than 24 hours at 1 to 6 C or 4 hours at 20 to 24 C.

Indications: Reducing the plasma volume of cellular components is indicated in cases where the volume status of a patient is being aggressively managed, such as in infants with compromised cardiac function. Volume reduction may be used to reduce exposure to plasma proteins or additives (such as mannitol), to achieve a specific component concentration, or to reduce exposure to antibodies targeting known recipient antigens (especially in an Apheresis Platelet unit containing ABO-incompatible plasma collected from a mother for the treatment of neonatal alloimmune thrombocytopenia).

Contraindications: Volume reduction is not a substitute for washing or for dosing with small aliquots. Volume reduction of platelets may result in adverse consequences associated with overtransfusion of platelets.

Specific Volume-Reduced Components

• RED BLOOD CELLS VOLUME REDUCED (VOLUME REDUCED RED BLOOD CELLS)
• APHERESIS RED BLOOD CELLS VOLUME REDUCED (VOLUME REDUCED RED BLOOD CELLS PHERESIS)
• PLATELETS VOLUME REDUCED (VOLUME REDUCED PLATELETS)
• APHERESIS PLATELETS VOLUME REDUCED (VOLUME REDUCED PLATELETS PHERESIS)

References

• American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: An updated report. Anesthesiology 2006;105:198-208.
• Desmet L, Lacroix J. Transfusion in pediatrics. Crit Care Clin 2004;20:299-311.
• Expert Working Group. Guidelines for red blood cell and plasma transfusion for adults and children. CMAJ 1997;156(11 Suppl):S1-S24.
• Gibson BE, Todd A, Roberts I, et al for the British Commitee for Standards in Haematology Transfusion Task Force. Transfusion guidelines for neonates and older children. Br J Haematol 2004;124:433-53.
• Herman JH, Manno CS, eds. Pediatric transfusion therapy. Bethesda, MD: AABB Press, 2002.
• Kleinman S, Chan P, Robillard P. Risks associated with transfusion of cellular blood components in Canada. Transfus Med Rev 2003;17:120-62.
• McFarland JG. Perioperative blood transfusions. Chest 1999; 115:113S-21S. Popovsky MA, ed. Transfusion reactions. 3rd ed. Bethesda, MD: AABB Press, 2007.
• Price TH, ed. Standards for blood banks and transfusion services. 26th ed. Bethesda, MD: AABB, 2009.
• Roback JD, Combs MR, Grossman BJ, Hillyer CD, eds. Technical manual. 16th ed. Bethesda, MD: AABB, 2008.
• Roseff SD, Luban NL, Manno CS. Guidelines for assessing appropriateness of pediatric transfusion. Transfusion 2002;42:1398-413.
• Sazama K, DeChristopher PJ, Dodd R, et al. Practice parameter for the recognition, management, and prevention of adverse consequences of blood transfusion. Arch Pathol Lab Med 2000;124:61-70.

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