Evaluating the 4-hour and 30-minute rules: effects of room temperature exposure on red blood cell quality and bacterial growth.

Author(s): Ramirez-Arcos S, Mastronardi C, Perkins H, Kou Y, Turner T, Mastronardi E, Hansen A, Yi QL, McLaughlin N, Kahwash E, Lin Y, Acker J

Publication: Transfusion, 2013, Vol. 53, Page 851-9

PubMed ID: 22845177 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   The purpose of this study was to determine the effects of a single 5 h or 5 30 min exposures to room temperature during refrigerated storage on markers of RBC quality and bacterial contamination. Leukoreduced red blood cells (RBCs) were obtained from citrate-phosphate-dextrose (CPD) whole blood and stored in saline-adenine-glucose-mannitol (SAGM). Bacterial contaminated and uncontaminated specimens were exposed to room temperature for 5 h on day 9 and sampled after 30 min and then hourly before being returned to 4 degrees C for 6 additional days, exposed to room temperature for 30 min on day 9, 13, 14, 15, and 16 and then returned to 4 degrees C until day 20, or stored at 4 degrees C for the entire duration. After 30 min at room temperature, the internal temperature of RBCs was 7.3-11.6 degrees C.

   Summary of Findings:

   ATP level, hematocrit, hemoglobin, and percent hemolysis were similar between specimens exposed to 5 h at room temperature on day 9 or multiple 30 min exposures with evaluation on day 6 or 20 and specimens kept at 4 degrees C for the entire storage duration. Supernatant potassium increased in specimens kept at 4 degrees C for 5 h on day 9 but not those exposed to room temperature for 5 h on day 9 (p<0.0001), but after 15 days of storage, specimens exposed to room temperature for multiple 30 min windows between day 9 and 16 had lower supernatant potassium and ATP levels than those maintained at 4 degrees C (p=0.0287 and 0.0003, respectively). Hemoglobin decreased and supernatant potassium increased between day 6 and 20 in specimens exposed to room temperature for 30 min windows and those maintained at 4 degrees C. Additionally, percent hemolysis increased in specimens exposed to room temperature (p=0.0017) but not those maintained at 4 degrees C. Bacterial growth was accelerated in inoculated specimens with exposure to room temperature for at least 2 h or multiple 30 min windows, but the authors state the changes may not be clinically relevant.

   Biospecimens

   • Cell - Red Blood Cells

   Preservative Types

   • Other Preservative

   Diagnoses:

   • Normal

   Platform:

   Analyte	Technology Platform
   Cell count/volume	Hematology/ auto analyzer
   Cell count/volume	Microbiological assay
   Protein	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	Time at room temperature	0.5 h 1 h 2 h 3 h 4 h 5 h 2 x 30 min 3 x 30 min 4 x 30 min 5 x 30 min
   Storage	Storage duration	6 days 9 days 15 days 20 days
   Biospecimen Aliquots and Components	Biospecimen components	Inoculated with S. liquefaciens Inoculated with S. marcescens No Inoculation

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