Toward a definition of "fresh" whole blood: an in vitro characterization of coagulation properties in refrigerated whole blood for transfusion.
BACKGROUND
The hemostatic property of "fresh" whole blood (WB) has been observed in military application and cardiac surgery and is associated with reduced blood loss, transfusion requirements, and donor exposures. The time from donation to transfusion defining "fresh" has not been systematically studied. We undertook an in vitro study of coagulation properties of refrigerated WB stored for 31 days.


METHODS
Twenty-one WB units were obtained from healthy volunteer donors and stored under standard AABB refrigerated conditions. Samples were obtained on the day after donation and again on Days 2, 4, 7, 11, 14, 17, 21, 24, and 31. Tests included complete blood count, pH, pO2, pCO2, glucose, lactate, thromboelastography (TEG), and platelet function by light transmission aggregometry (LTA).


RESULTS
There was progressive decline in pH, pO2, glucose, and sodium, but progressive increase in potassium, pCO2, and lactate. TEG variables in all units were normal through Day 11; abnormal values in some variables in some units began on Day 14. Final aggregation levels exhibited no change from Day 1 to Day 21 with adenosine diphosphate and epinephrine, but a decline with collagen (Day 7) and ristocetin (Day 17).


CONCLUSIONS
This in vitro study of coagulation properties demonstrates preservation of normal integrated coagulation function to a minimum of 11 days under standard conditions of refrigerated storage of WB for transfusion. These observations strongly suggest that the hemostatic quality of WB may extend beyond current transfusion practices. If confirmed clinically, this would increase availability and extend benefits of reduced donor exposure and transfusion requirements.
Jobes
David
D
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. jobes@email.CHOP.edu
Wolfe
Yanika
Y
O'Neill
Daniel
D
Calder
Jennifer
J
Jones
Lisa
L
Sesok-Pizzini
Deborah
D
Zheng
X Long
XL
D001772:Blood Cell Count; D001777:Blood Coagulation; D001786:Blood Glucose; D001803:Blood Transfusion / Q000379:methods*; D002245:Carbon Dioxide / Q000097:blood; D006801:Humans; D006863:Hydrogen-Ion Concentration; D019344:Lactic Acid / Q000097:blood; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D010979:Platelet Function Tests; D012034:Refrigeration / Q000379:methods*; D013916:Thrombelastography
D001786:Blood Glucose; D002245:Carbon Dioxide; D019344:Lactic Acid; D010100:Oxygen