What is the maximum time that a unit of red blood cells can be safely left out of controlled temperature storage?
Author(s): Brunskill S, Thomas S, Whitmore E, McDonald CP, Dorée C, Hopewell S, Staves J, Cardigan R, Murphy MF
Publication: Transfus Med Rev, 2012, Vol. 26, Page 209-223.e3
PubMed ID: 22119493 PubMed Review Paper? Yes
Purpose of Paper
The purpose of this paper was to conduct a systematic literature review to identify the effects of temperature fluctuations during storage of red blood cells (RBCs) at 4 degrees C on bacterial contamination and RBC quality.
Conclusion of Paper
Based on the findings of 23 papers, the authors conclude that there is no clear adverse effect of temperature fluctuations during refrigerated storage on RBC quality as assessed by hemolysis, ATP levels, RBC recovery, RBC morphology, or supernatant potassium, as long as the RBCs were collected in citrate phosphate dextrose (CPD) and stored in saline, adenine, glucose, and mannitol (SAGM). 2 of 6 studies found a slight increase in bacterial contamination when cells were exposed to room temperature during refrigerated storage.
Studies
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Study Purpose
The purpose of this study was to conduct a systematic literature review to identify the effects of temperature fluctuations during storage of RBCs at 4 degrees C on bacterial contamination and RBC quality. The authors identified 23 papers which investigated the effects of interruptions in storage at 4 degrees C ranging from 20 min to 42 days.
Summary of Findings:
Two studies reported increased hemolysis, one reported slightly reduced hemolysis, and another reported significant reduction in hemolysis when RBCs experienced temperature fluctuations, but even after temperature fluctuations, rates of hemolysis remained below 0.8%. 9 studies reported that adenosine triphosphate (ATP) levels decreased more rapidly when blood was warmed (10 to 37 degrees C), but one study (warming to 10 degrees C) found no difference, and three studies reported the decrease in ATP levels was not maintained when specimens were returned to 4 degrees C for 1 week or more. 5 studies reported warming decreased RBC recovery rates, but 2 studies found no effect of warming on RBC recovery. Supernatant potassium increased in 4 studies when acid citrate dextrose (ACD) RBCs were exposed to warm temperatures, but exposure to increased temperatures had no effect on supernatant potassium levels in 4 studies examining packed RBCs collected in CPD and preserved in SAGM. All 3 studies investigating RBC morphology found that exposure to temperatures above 4 degrees C improved morphology, but this improvement may not be maintained after return to 4 degrees C. 4 of 6 studies found that warming RBCs had no effect on bacterial contamination, but the other 2 studies reported bacterial contamination in 4/102 and 1/396 specimens exposed to room temperature for 48 h and two 6 h pulses, respectively, during otherwise refrigerated storage.
Biospecimens
Preservative Types
- Other Preservative
Diagnoses:
- Not specified
Platform:
Analyte Technology Platform Cell count/volume Spectrophotometry Morphology Hematology/ auto analyzer Small molecule Clinical chemistry/auto analyzer Electrolyte/Metal Clinical chemistry/auto analyzer Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Storage Storage temperature 4 degrees C
Fluctuations ranging from 10 to 37 degrees C
Storage Storage duration 20 min to 42 days