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Title: The red cell storage lesion and therapeutic blood transfusion in the critically ill patient
Author: McLellan, Stuart Andrew
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2006
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Methods: 1. The quality of the current RBC product was assessed using in-vitro assays of red cell oxygenation/de-oxygenation and red cell deformability. 2. Radiolabel studies were performed to determine the 24 and 48-hour recovery of stored allogenic blood in critically ill patients. 3. The in-vivo regeneration of red cell 2,3 diphophoglycerate (2,3 DPG) in stored blood transfused to critically ill patients was investigated. 4. Antigenic differences between donor and recipient were used to track allogenic RBC’s following therapeutic transfusions to determine RBC survival. Results: 1. In-vitro tests showed that current collection processing and storage procedures: (a) Result in a very rapid reduction in red cell 2,3 DPG concentration. Approximately 50% of 2, 3 DPG had been lost by day 2 of storage and it was rarely detectable by day 14. The in-vitro p50 also decreased rapidly during storage; the time frame of the decrease matched that of the decrease in 2,3 DPG. (b) Result in a reduction in red cell deformability. 2. The current red cell product, stored for between 10 to 29 days, had a mean 24-hour recovery of 91% in critically ill patients. 3. Following transfusion to critically ill patients stored blood rapidly regenerated 2,3 DPG. 4. Red cell antigens were used to track allogenic red cells for up to 12 weeks post-transfusion. The estimated median red cell lifespan was 104 days (range 86 to 124 days). Conclusions: Current red cell storage methods fail to maintain red cell 2,3 DPG and result in a loss of red cell deformability.  Although 2,3 DPG regeneration was found to occur rapidly it still took between 24 and 72 hours for levels to approach normal; whether or not this is clinically significant is not known. The current UK red blood cell product has good short-term and long-term survival characteristics following therapeutic transfusion.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available