Effect of leukoreduction and temperature on risk of bacterial growth in CPDA-1 whole blood: A study of Escherichia coli

Background Collection of non-leukoreduced citrate-phosphate-dextrose-adenine (CPDA-1) whole blood is performed in walking blood banks. Blood collected under field conditions may have increased risk of bacterial contamination. This study was conducted to examine the effects of WBC reduction and storage temperature on growth of Escherichia coli (ATCC® 25922™) in CPDA-1 whole blood. Methods CPDA-1 whole blood of 450 ml from 10 group O donors was inoculated with E. coli. Two hours after inoculation, the test bags were leukoreduced with a platelet-sparing filter. The control bags remained unfiltered. Each whole blood bag was then split into three smaller bags for further storage at 2–6°C, 20–24°C, or 33–37°C. Bacterial growth was quantified immediately, 2 and 3 h after inoculation, on days 1, 3, 7, and 14 for all storage temperatures, and on days 21 and 35 for storage at 2–6°C. Results Whole blood was inoculated with a median of 19.5 (range 12.0–32.0) colony-forming units per ml (CFU/ml) E. coli. After leukoreduction, a median of 3.3 CFU/ml (range 0.0–33.3) E. coli remained. In the control arm, the WBCs phagocytized E. coli within 24 h at 20–24°C and 33–37°C in 9 of 10 bags. During storage at 2–6°C, a slow self-sterilization occurred over time with and without leukoreduction. Conclusions Storage at 20–24°C and 33–37°C for up to 24 h before leukoreduction reduces the risk of E. coli-contamination in CPDA-1 whole blood. Subsequent storage at 2–6°C will further reduce the growth of E. coli.publishedVersio

In vitro quality and hemostatic function of cold-stored CPDA-1 whole blood after repeated transient exposure to 28°C storage temperature

Postponed access: the file will be accessible after 2022-11-15Bakgrunn: Blodprodukter blir ofte utsatt for romtemperatur eller høyere i lengre perioder enn tillatt av retningslinjer. Jeg undersøkte om dette førte til målbar effekt på mye brukte kvalitetsparametere og viskoelastisk hemostatisk funksjon. Metode: 450 ml fullblod fra 16 O Rh(D)-positive blodgivere ble tappet på poser inneholdende 63 ml med CPDA-1 og lagret kaldt. Åtte poser ble utsatt for fem ukentlige fire timers lange temperatursvingninger til 28 °C. Åtte poser ble lagret kontinuerlig ved 4 °C som kontroll. Prøver ble tatt på som grunnlinje på dag 1, etter første svingning på dag 1 og deretter en uke etter hver temperatursvingning (dag 7, 14, 21, 28 og 35). Hemolyse, hematologiske parametere, pH, glukose, laktat, kalium, tromboelastografi, INR, APTT, fibrinogen og faktor VIII ble målt. Resultater: Testgruppen viste ikke redusert kvalitet sammenlignet med kontrollgruppen på dag 35. To poser i testgruppen hadde hemolyse på 1,1 og 1,2 %, og to poser i kontrollgruppen hemolyse på 0,8 %. Gjenværende tromboelastografi-klottstyrke (MA) på dag 35 var 51.7 mm (44.8, 58.6) i testgruppen og 46.1 (41.6, 50.6) i kontrollgruppen (p=0.023). Blodplatetallet var bedre bevart i testgruppen (166.7 [137.8, 195.6] mot 117.8 [90.3, 145.2], p=0.018). En pose i testgruppen var positiv på C. acne på dag 35+6. Konklusjon: Hemolysefunnene bør undersøkes videre. Andre faktorer ble ikke negativt påvirket av forbigående temperatursvingninger.Background: Blood products are frequently exposed to room temperature or higher for longer periods than permitted by policy. I aimed to investigate whether this resulted in a measurable effect on common quality parameters and viscoelastic hemostatic function. Method: 450 ml of whole blood from 16 O Rh(D) positive donors was collected in bags containing 63 ml of CPDA-1 and stored cold. Eights bags were exposed to five weekly four-hour long transient temperature changes to 28°C. Eight bags were stored continuously at 4°C as a control. Samples were collected at baseline on day 1, after the first cycle on day 1 and one week after each subsequent cycle (day 7, 14, 21, 28 and 35). Hemolysis, hematological parameters, pH, glucose, lactate, potassium, thromboelastography, INR, APTT, fibrinogen and factor VIII was measured. Results: The test group did not show reduced quality compared to the control group on day 35. Two units in the test group had hemolysis of 1.1 and 1.2%, and two units in the control group hemolysis of 0.8%. Remaining thromboelastography clot strength (MA) on day 35 was 51.7 mm (44.8, 58.6) in the test group and 46.1 (41.6, 50.6) in the control group (p=0.023). Platelet count was better preserved in the test group (166.7 [137.8, 195.6] vs 117.8 [90.3, 145.2], p=0.018). One bag in the test group was positive for C. acne on day 35+6. Conclusion: Hemolysis findings warrant further investigation. Other factors were not negatively affected by transient temperature changes.Masteroppgave for radiograf/bioingeniørRAB395MAMD-HELS

In vitro quality and hemostatic function of cold-stored CPDA-1 whole blood after repeated transient exposure to 28°C storage temperature

Background Blood products are frequently exposed to room temperature or higher for longer periods than permitted by policy. We aimed to investigate if this resulted in a measurable effect on common quality parameters and viscoelastic hemostatic function of cold stored CPDA-1 whole blood. Study Design and Methods 450 ml of whole blood from 16 O Rh(D) positive donors was collected in 63 ml of CPDA-1 and stored cold. Eights bags were exposed to five weekly 4-h long transient temperature changes to 28°C. Eight bags were stored continuously at 4°C as a control. Samples were collected at baseline on day 1, after the first cycle on day 1 and weekly before each subsequent cycle (day 7, 14, 21, 28 and 35). Hemolysis, hematological parameters, pH, glucose, lactate, potassium, thromboelastography, INR, APTT, fibrinogen, and factor VIII were measured. Results CPDA-1 whole blood repeatedly exposed to 28°C did not show reduced quality compared to the control group on day 35. Two units in the test group had hemolysis of 1.1% and 1.2%, and two in the control group hemolysis of 0.8%. Remaining thromboelastography clot strength (MA) on day 35 was 51.7 mm (44.8, 58.6) in the test group and 46.1 (41.6, 50.6) in the control group (p = .023). Platelet count was better preserved in the test group (166.7 [137.8, 195.6] vs. 117.8 [90.3, 145.2], p = .018). One sample in the test group was positive for Cutibacterium acnes on day 35 + 6. Conclusion Hemolysis findings warrant further investigation. Other indicators of quality were not negatively affected.publishedVersio

Effect of leukoreduction and temperature on risk of bacterial growth in CPDA-1 whole blood: A study of Escherichia coli

Background Collection of non-leukoreduced citrate-phosphate-dextrose-adenine (CPDA-1) whole blood is performed in walking blood banks. Blood collected under field conditions may have increased risk of bacterial contamination. This study was conducted to examine the effects of WBC reduction and storage temperature on growth of Escherichia coli (ATCC® 25922™) in CPDA-1 whole blood. Methods CPDA-1 whole blood of 450 ml from 10 group O donors was inoculated with E. coli. Two hours after inoculation, the test bags were leukoreduced with a platelet-sparing filter. The control bags remained unfiltered. Each whole blood bag was then split into three smaller bags for further storage at 2–6°C, 20–24°C, or 33–37°C. Bacterial growth was quantified immediately, 2 and 3 h after inoculation, on days 1, 3, 7, and 14 for all storage temperatures, and on days 21 and 35 for storage at 2–6°C. Results Whole blood was inoculated with a median of 19.5 (range 12.0–32.0) colony-forming units per ml (CFU/ml) E. coli. After leukoreduction, a median of 3.3 CFU/ml (range 0.0–33.3) E. coli remained. In the control arm, the WBCs phagocytized E. coli within 24 h at 20–24°C and 33–37°C in 9 of 10 bags. During storage at 2–6°C, a slow self-sterilization occurred over time with and without leukoreduction. Conclusions Storage at 20–24°C and 33–37°C for up to 24 h before leukoreduction reduces the risk of E. coli-contamination in CPDA-1 whole blood. Subsequent storage at 2–6°C will further reduce the growth of E. coli

Cold-stored whole blood in a Norwegian emergency helicopter service: an observational study on storage conditions and product quality

BACKGROUND Increasing numbers of emergency medical service agencies and hospitals are developing the capability to administer blood products to patients with hemorrhagic shock. Cold‐stored whole blood (WB) is the only single product available to prehospital providers who aim to deliver a balanced resuscitation strategy. However, there are no data on the safety and in vitro characteristics of prehospital stored WB. This study aimed to describe the effects on in vitro quality of storing WB at remote helicopter bases in thermal insulating containers. STUDY DESIGN AND METHODS We conducted a two‐armed single‐center study. Twenty units (test) were stored in airtight thermal insulating containers, and 20 units (controls) were stored according to routine procedures in the Haukeland University Hospital Blood Bank. Storage conditions were continuously monitored during emergency medical services missions and throughout remote and blood bank storage. Hematologic and metabolic variables, viscoelastic properties, and platelet (PLT) aggregation were measured on Days 1, 8, 14, and 21. RESULTS Storage conditions complied with the EU guidelines throughout remote and in‐hospital storage for 21 days. There were no significant differences in PLT aggregation, viscoelastic properties, and hematology variables between the two groups. Minor significantly lower pH, glucose, and base excess and higher lactate were observed after storage in airtight containers. CONCLUSION Forward cold storage of WB is safe and complies with EU standards. No difference is observed in hemostatic properties. Minor differences in metabolic variables may be related to the anaerobic conditions within the thermal box

A whole blood based resuscitation strategy in civilian medical services: Experience from a Norwegian hospital in the period 2017–2020

Background: Civilian and military guidelines recommend early balanced transfusion to patients with life-threatening bleeding. Low titer group O whole blood was introduced as the primary blood product for resuscitation of massive hemorrhage at Haukeland University Hospital, Bergen, Norway, in December 2017. In this report, we describe the whole blood program and present results from the first years of routine use. Study design and methods: Patients who received whole blood from December 2017 to April 2020 were included in our quality registry for massive transfusions. Post-transfusion blood samples were collected to analyze isohemagglutinin (anti-A/-B) and hemolysis markers. Administration of other blood products, transfusion reactions, and patient survival (days 1 and 30) were recorded. User experiences were surveyed for both clinical and laboratory staff. Results: Two hundred and five patients (64% male and 36% female) received 836 units in 226 transfusion episodes. Patients received a mean of 3.7 units (range 1–35) in each transfusion episode. The main indications for transfusion were trauma (26%), gastrointestinal (22%), cardiothoracic/vascular (18%), surgical (18%), obstetric (11%), and medical (5%) bleeding. There was no difference in survival between patients with blood type O when compared with non-group O. Haptoglobin level was lower in the transfusion episodes for non-O group patients, however no clinical hemolysis was reported. No patients had conclusive transfusion-associated adverse events. Both clinical and laboratory staff preferred whole blood to component therapy for massive transfusion. Discussion: The experience from Haukeland University Hospital indicates that whole blood is feasible, safe, and effective for in-hospital treatment of bleeding