title: Blood Bag Plasticizers Influence Red Blood Cell Vesiculation Rate without Altering the Lipid Composition of the Vesicles.
abstract: BACKGROUND
  Polyvinyl chloride (PVC) plasticized with di(2-ethylhexyl) phthalate (DEHP) is commonly used for blood collection and storage. DEHP has protective effects on RBC membranes, but is also a toxin.
  
  
  METHODS
  A paired study was conducted to investigate the influence of DEHP and two alternative plasticizers, 1,2-cyclohexane-dicarboxylic acid diisononyl ester (DINCH) and n-butyryl-tri-n-hexyl citrate (BTHC), on the preservation of RBCs stored for 42 days in PVC pediatric bags. The RBC membrane was evaluated for supernatant hemoglobin (Hb), release of extracellular microvesicles (EVs), osmotic fragility, deformability, and lipid composition.
  
  
  RESULTS
  In BTHC-plasticized bags, the supernatant Hb increase during storage was 2 times greater than in DINCH- and DEHP-plasticized bags. By day 21, EV concentrations had doubled from day-5 levels in DINCH- and DEHP-, and trebled in BTHC-plasticized bags. RBC mean cell volumes were greater in BTHC- than in DINCH- or DEHP-plasticized bags (p < 0.001). Osmotic fragility differed significantly among plasticizers (p < 0.01). After day 21, RBC deformability decreased in all, but to a greater extent in the bags with BTHC. Phospholipid composition of RBCs and EVs was not different among plasticizers.
  
  
  CONCLUSIONS
  Membrane stabilization capacity differed among the plasticizers. RBC in BTHC bags stored more poorly, while DEHP and DINCH bags offered better protection against vesiculation, osmotic stress, and Hb loss.
authors.affiliation: Canadian Blood Services, Center for Innovation, Edmonton, AB, Canada.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Bicalho
authors.affiliation: Canadian Blood Services, Center for Innovation, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine at the Center for Blood Research, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Serrano
authors.affiliation: Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.
authors.forename: Alberto
authors.initials: A
authors.lastname: Dos Santos Pereira
authors.affiliation: Canadian Blood Services, Center for Innovation, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine at the Center for Blood Research, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Dana V
authors.initials: DV
authors.lastname: Devine
authors.affiliation: Canadian Blood Services, Center for Innovation, Edmonton, AB, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Acker
keywords: BTHC; DEHP; DINCH; Membrane; Red blood cell