title: An investigation of red blood cell concentrate quality during storage in paediatric-sized polyvinylchloride bags plasticized with alternatives to di-2-ethylhexyl phthalate (DEHP).
abstract: OBJECTIVE
  Di-2-ethylhexyl phthalate (DEHP) is a blood bag plasticizer. It is also a toxin, raising concerns for vulnerable populations, for example, neonates and infants. Here, the in vitro quality of red cell concentrates (RCC) stored in paediatric bags formulated with alternative plasticizers to DEHP was compared.
  
  
  METHODS
  RCC were pooled and split into polyvinylchloride (PVC)/DEHP, PVC/1,2-cyclohexanedicarboxylic acid diisononyl ester (DINCH) or PVC/butyryl trihexyl citrate (BTHC) bags. Quality was assessed on storage days 5, 21, 35 and 43.
  
  
  RESULTS
  Metabolism differed among the bags: pCO2 levels were lowest and pO2 were highest in BTHC bags. Glucose consumption and lactate production suggested higher metabolic rates in BTHC bags. ATP levels were best maintained in DINCH bags (day 43 mean level: 2·86 ± 0·29 μmol/g Hb). RCC in BTHC bags had the greatest potassium release (54·6 ± 3·0 mm on day 43). From day 21, haemolysis was higher in BTHC bags (P < 0·01) and by day 43 had exceeded 0·8% (0·85 ± 0·10%). RCC in BTHC bags showed more microparticle formation than RCC in DEHP or DINCH bags.
  
  
  CONCLUSIONS
  The results suggest that the BTHC formulation used was detrimental to RBC quality. DINCH bags could be a viable alternative to DEHP: they outperformed DEHP bags energetically, with better maintenance of ATP levels.
authors.affiliation: Canadian Blood Services' Centre for Innovation, The Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.|Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: K
authors.identifier: http://orcid.org/0000-0002-5259-4897
authors.initials: K
authors.lastname: Serrano
authors.affiliation: Canadian Blood Services' Centre for Innovation, The Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.|Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Levin
authors.affiliation: Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Chen
authors.affiliation: Canadian Blood Services' Centre for Innovation, Edmonton, AB, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Hansen
authors.affiliation: Canadian Blood Services' Centre for Innovation, Edmonton, AB, Canada.
authors.forename: T R
authors.initials: TR
authors.lastname: Turner
authors.affiliation: Canadian Blood Services' Centre for Innovation, Edmonton, AB, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Kurach
authors.affiliation: Fresenius Kabi Deutschland GmbH, Bad Homburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Reidel
authors.affiliation: Fresenius Kabi Deutschland GmbH, Bad Homburg, Germany.
authors.forename: W F
authors.initials: WF
authors.lastname: Boecker
authors.affiliation: Canadian Blood Services' Centre for Innovation, Edmonton, AB, Canada.|Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.
authors.forename: J P
authors.initials: JP
authors.lastname: Acker
authors.affiliation: Canadian Blood Services' Centre for Innovation, The Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada.|Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: D V
authors.initials: DV
authors.lastname: Devine
mesh_terms: D000255:Adenosine Triphosphate / Q000032:analysis; D001772:Blood Cell Count; D001784:Blood Gas Analysis; D001793:Blood Preservation / Q000295:instrumentation / Q000379:methods*; D004051:Diethylhexyl Phthalate / Q000737:chemistry* / Q000494:pharmacology; D004912:Erythrocytes / Q000187:drug effects / Q000378:metabolism*; D005947:Glucose / Q000378:metabolism; D006461:Hemolysis / Q000187:drug effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019344:Lactic Acid / Q000378:metabolism; D010968:Plasticizers / Q000737:chemistry* / Q000494:pharmacology; D011143:Polyvinyl Chloride / Q000737:chemistry* / Q000494:pharmacology; D011188:Potassium / Q000032:analysis / Q000378:metabolism; D013696:Temperature; D013997:Time Factors
chemical_list: D010968:Plasticizers; D019344:Lactic Acid; D000255:Adenosine Triphosphate; D011143:Polyvinyl Chloride; D004051:Diethylhexyl Phthalate; D005947:Glucose; D011188:Potassium
keywords: BTHC; DEHP; DINCH; paediatric bags; plasticizer; red blood cells