NIH, National Cancer Institute, Division of Cancer Treatment and Diagnosis (DCTD) NIH - National Institutes of Health National Cancer Institute DCTD - Division of Cancer Treatment and Diagnosis

The effects of pen ink and surface disinfectants on red blood cells stored in plasticized polyvinylchloride transfusion bags.

Author(s): Uy RJ, Serrano K, Hadjesfandiari N, Shih AW, Devine D

Publication: Transfusion, 2024, Vol. 64, Page 141-149

PubMed ID: 38059437 PubMed Review Paper? No

Purpose of Paper

This paper compared the quality of red blood cells (RBC) that were stored for 24 h or 42 days at 4°C in bags labelled with different types of markers (water-, oil-, or alcohol-based ink) or disinfected with three different types of wipes (ethanol-, hydrogen peroxide-, or benzalkonium chloride-based).

Conclusion of Paper

No differences in any of the assessed quality metrics were noted between RBCs stored in control bags and those stored in bags labeled with the three different marker types or those disinfected with the three different types of wipes. However, the expected change in RBC morphology from discoid to echinocytic, a decrease in the maximum elongation index (EImax), an increase in shear stress to reach 50% EImax (KEI), and increases in extracellular potassium and hemolysis were observed with storage, regardless of whether or not the bag was labeled or disinfected and by what means. RBC count was unaffected by storage. Finally, ink compounds from the markers used for labeling were not detected in any of the supernatant bags.

Studies

  1. Study Purpose

    This study compared the quality of red blood cells (RBC) that were stored for 24 h or 42 days at 4°C in bags labelled with different types of markers (water-, oil-, or alcohol-based ink) or disinfected with three different types of ethanol-, hydrogen peroxide-, or benzalkonium chloride-based wipes. Leuko-reduced RBCs were collected from an unspecified number of donors into twenty-four 500 mL PVC/Di-ethylhexyl phthalate (DEHP) bags with SAGM additive. After 2-5 days, groups of four bags of RBCs were pooled into six CompoStop pooling bags and then each pool was divided back into the four original DEHP bags. For the marker study, a one inch square was drawn on three of the four matched bags of three pools using a BIC Round Stic Ballpoint pen (black, oil-based ink), a Pentel Smooth Gel Pen (black, water-based ink), or a Sharpie Fine Point permanent marker (black, alcohol-based ink), and the remaining bag of each pool was left unmarked. For the disinfectant study, three of the bags from three pools were wiped down for 3 min with either 70% ethanol, Preempt Wipes (0.5% hydrogen peroxide), or CaviWipes (0.28% diisobutylphenoxyethoxyethyl dimethyl benzyl ammonium chloride and 17.20% isopropanol) wipes. RBCs were subsequently stored at 4°C for 24 h or 42 days before aseptic sampling. RBCs were centrifuged at 4°C at 1962 g for 10 min. RBC count, hematocrit, total hemoglobin, and mean corpuscular volume (MCV) were quantified using a hematology analyzer. The morphology of 100 RBCs from each bag was evaluated by phase contrast microscopy. Deformability was assessed by the maximum elongation index (EImax) on a Lorrca Maxsis ektacytometer. Hemoglobin and hemolysis were calculated based on absorbance on a SpectraMax 190 Microplate Reader. Potassium was quantified in the RBC supernatant using a Gem Premier 5000 Blood Gas Analyzer. For the marker experiment, protein profiles and ink residues were detected in the RBC supernatant by electrospray ion source mass spectrometry.

    Summary of Findings:

    No differences in any of the assessed quality metrics (count, hematocrit, total hemoglobin, MCV, morphology, extracellular potassium, and deformability) were noted between RBCs stored in control bags and those stored in bags that were labeled with the three different marker types or those disinfected with three different types of disinfecting wipes. However, the expected change in morphology of the RBCs from discoid to echinocytic; a decrease in the maximum elongation index (EImax); and increases in shear stress to reach 50% EImax (KEI), extracellular potassium, and hemolysis were observed regardless of whether or not the storage bags were labeled and disinfected and by what means. RBC count was unaffected by storage. Finally, the ink compounds from the markers used for labeling were not detected in any of the supernatant bags.

    Biospecimens
    Preservative Types
    • None (Fresh)
    Diagnoses:
    • Not specified
    Platform:
    AnalyteTechnology Platform
    Cell count/volume Hematology/ auto analyzer
    Morphology Hematology/ auto analyzer
    Small molecule ESI MS
    Electrolyte/Metal Clinical chemistry/auto analyzer
    Protein Spectrophotometry
    Morphology Light microscopy
    Pre-analytical Factors:
    ClassificationPre-analytical FactorValue(s)
    Storage Storage conditions Control bag
    Bag labelled with water based marker
    Bag labelled with oil based marker
    Bag labelled with alcohol based marker
    Bag disinfected with 70% ethanol wipe
    Bag disinfected with Preempt Wipe (0.5% hydrogen peroxide)
    Bag disinfected with CaviWipe (0.28% diisobutylphenoxyethoxyethyl dimethyl benzyl ammonium chloride and 17.20% isopropanol)
    Storage Storage duration 24 h
    42 days

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