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Improving Packed Red Blood Cells Through A Novel High Viscosity Storage Solution
*Kasiemobi Pulliam, *Bernardin Joseph, Amy Makley, *Charles Caldwell, *Alex Lentsch, Michael Goodman, Timothy A Pritts
University of Cincinnati, CINCINNATI, OH

Objectives: Recent studies demonstrate that massive transfusion in trauma patients who receive older packed red blood cells (pRBCs) is associated with increased risk of morbidity and mortality. As pRBCS age, they undergo biochemical and structural changes known as the storage lesion. We developed a novel solution with inert viscoelastic polymers to increase viscosity in stored pRBCs. We hypothesized that storage of pRBCs in this solution would blunt storage lesion formation and mitigate the inflammatory response following resuscitation from hemorrhage.
Methods: Blood was obtained from 8-10 week old C57BL/6 male donor mice and stored as pRBC units for 14 days (the equivalent of 42 days in humans) in either standard AS-3 storage solution or EAS-1587, the novel pRBC storage solution. pRBCS were analyzed for microvesicles and cell-free hemoglobin content, phosphatidylserine and band-3 protein expression, and erythrocyte osmotic fragility (EC50). Subsequently, mice underwent hemorrhage followed by resuscitation with pRBCs stored in either AS-3 or EAS-1587. After sacrifice, serum was analyzed for inflammatory markers.
Results: As compared to AS-3, pRBCs stored in EAS-1587 demonstrated reductions in microvesicle (7366.9 + 2486.6 vs. 687.8 + 192.9 events/μL; p<0.05; Figure) and cell-free hemoglobin accumulation (197.6 + 15.8 vs. 101.5 + 12.8 g/dL, p<0.05) as well as preserved band-3 expression (18.6 + 0.61 vs. 96.9 + 0.99 % gated, p<0.05) and a reduction in phosphatidylserine expression (24.7 + 1.1 vs. 12.0 + 1.6% gated; p<0.05). Red blood cells stored in EAS-1587 demonstrated reduced susceptibility to osmotic stress (EC50 92.3 + 3.1 vs. 75.0 + 5.1 %, p<0.05). Serum from mice resuscitated with pRBCs stored in EAS-1587 demonstrated a reduction in macrophage inflammatory protein-1 alpha (MIP-1α; 310.7 + 37.2pg/ml vs. 630.6 + 153.3 p<0.05).
Conclusion: Storage of pRBCs in a novel storage solution with increased viscosity mitigated many aspects of the red blood cell storage lesion as well as the inflammatory response to resuscitation following hemorrhage. This modified storage solution may lead to improvement of pRBC storage and reduce harm after massive transfusion.


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