title: Enhancing uniformity and overall quality of red cell concentrate with anaerobic storage.
abstract: BACKGROUND
  Recent research focused on understanding stored red blood cell (RBC) quality has demonstrated high variability in measures of RBC function and health across units. Studies have historically linked this high variability to variations in processing, storage method, and age. More recently, a large number of studies have focused on differences in donor demographics, donor iron sufficiency, and genetic predisposition of the donor to poor storage, particularly through mechanisms of accelerated oxidative damage. A study was undertaken to evaluate a potential additional source of unit to unit variation in stored RBC: the role of variable percent oxygen saturation (%SO2) levels on blood quality parameters during storage.
  
  
  METHODS
  %SO2data from 492 LR-RBC/AS-3 units used for internal and external collaborative research was included in the analysis. Whole blood units were processed into red blood cells, AS-3 added, leucocyte reduced, in compliance with American Association of Blood Banks guidelines. LR-RBC/AS-3 products were subsequently analysed for %SO2levels within 3-24 hours of phlebotomy using a co-oximeter. Separately, to evaluate the impact of pre-storage as well as increasing levels of %SO2during storage, a pool-and-split study was performed. Four units of LR-RBC/AS-3 were split 6 ways; "as is" (control), hyperoxygenated to more than 90%, and four levels of pre-storage %SO2. The units were periodically sampled up to 42 days and analysed for %SO2, pCO2, methaemoglobin, ATP, 2,3-BPG as well as with the metabolomics workflow.
  
  
  RESULTS
  The measured mean %SO2in LR-RBC/AS-3 within 24 hours of collection was 45.9±17.5% with (32.7-61.0 IQR). %SO2in all products increased to approximately 95-100% in three weeks. Measured blood quality parameters including ATP, % haemolysis, methaemoglobin, oxidised lipids, and GSH/GSSG indicated suppressed cellular metabolism and increased red cell degradation in response to higher %SO2levels.
  
  
  CONCLUSIONS
  The surprisingly high variability in starting %SO2levels, coupled with negative impacts of high oxygen saturation on red blood cell quality indicates that oxygen levels may be an important and under-appreciated source of unit-to-unit variability in RBC quality.
authors.affiliation: New Health Sciences Inc., Cambridge, MA, United States of America.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: New Health Sciences Inc., Cambridge, MA, United States of America.
authors.forename: Abbejane
authors.initials: A
authors.lastname: Blair
authors.affiliation: University of Colorado, Denver, CO, United States of America.
authors.forename: Angelo
authors.initials: A
authors.lastname: D'alessandro
authors.affiliation: University of Colorado, Denver, CO, United States of America.
authors.forename: Travis
authors.initials: T
authors.lastname: Nemkov
authors.affiliation: New Health Sciences Inc., Cambridge, MA, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Dioguardi
authors.affiliation: University of Colorado, Denver, CO, United States of America.|Bonfils Blood Center, Denver, CO, United States of America.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Silliman
authors.affiliation: New Health Sciences Inc., Cambridge, MA, United States of America.
authors.forename: Andrew
authors.initials: A
authors.lastname: Dunham
mesh_terms: D000693:Anaerobiosis; D001793:Blood Preservation / Q000379:methods* / Q000592:standards*; D004912:Erythrocytes / Q000166:cytology / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D011786:Quality Control