title: Feasibility and transport of packed red blood cells into Special Forces operational conditions.
abstract: BACKGROUND
  Transfusing packed red blood cells (PRBCs) into Special Forces may provide a survival advantage from hemorrhage-induced battlefield injuries; however, the effect of the unique operational stressors on RBC integrity is not known.
  
  
  METHODS
  Pooled PRBCs (20 U) (7 days old), stored in Golden Hour containers, were exposed to the following simulated operational stressors: High-Altitude Low-Opening parachute descent from 30,000 ft, followed by a simulated soldier presence patrol in a climatic chamber set to 48 °C and 9% humidity for 12 hours (test). Biochemical (pH, lactate, potassium, and adenosine triphosphate) and biomechanical (percent hemolysis, deformability, and morphology) were measured to determine the integrity of PRBCs.
  
  
  RESULTS
  The simulated parachute descent significantly raised pH (p = 0.025) and potassium (p = 0.014) levels compared with the control; however, this was not clinically significant. Lactate (mmol/L) and adenosine triphosphate levels (0 μmol/g Hgb) were unaffected (p > 0.05). Potassium and pH levels increased with time but not significantly compared with controls. Lactate levels were unaffected with time.Mechanical agitation of PRBCs from the simulated soldier presence patrol did not significantly affect the biochemical (p ≥ 0.08) or biomechanical (p ≥ 0.33) parameters compared with control.Hemolysis was found to be less than 0.8% at the end of 12 hours. No significant difference in RBC morphology and RBC deformability were noted.
  
  
  CONCLUSIONS
  Carrying PRBCs into the austere Special Forces environment is feasible as biochemical and biomechanical markers of RBC stress remain within published transfusion safety parameters when PRBCs were stored in new cold technology containers for 12 hours at 48°C during a simulated Special Forces operation.
authors.affiliation: From the Defence Research and Development Canada-Toronto (C.B.); and Sunnybrook Health Sciences Centre (H.T., J.C., A.N., A.B.), Toronto; Canadian Field Hospital(H.T., A.B.), Canadian Forces Health Services, Canadian Forces Base, Petawawa; Canadian Blood Services (J.A., A.L.H.); Royal Alexandra Hospital (P.E.), Edmonton, Alberta, Canada; and Medical Corps (E.G.), Surgeon General's Headquarters, Israel Defense Force, Ramat Gan, Israel.
authors.forename: Cathy
authors.initials: C
authors.lastname: Boscarino
authors.forename: Homer
authors.initials: H
authors.lastname: Tien
authors.forename: Jason
authors.initials: J
authors.lastname: Acker
authors.forename: Jeannie
authors.initials: J
authors.lastname: Callum
authors.forename: Adele L
authors.initials: AL
authors.lastname: Hansen
authors.forename: Paul
authors.initials: P
authors.lastname: Engels
authors.forename: Elon
authors.initials: E
authors.lastname: Glassberg
authors.forename: Avery
authors.initials: A
authors.lastname: Nathens
authors.forename: Andrew
authors.initials: A
authors.lastname: Beckett
mesh_terms: D000293:Adolescent; D000328:Adult; D001793:Blood Preservation / Q000379:methods*; D017707:Erythrocyte Transfusion; D004912:Erythrocytes / Q000166:cytology; D005240:Feasibility Studies; D013502:General Surgery; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008875:Middle Aged; D008887:Military Medicine / Q000379:methods*; D008889:Military Personnel; D014947:Wounds and Injuries / Q000628:therapy; D055815:Young Adult