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131 124 – 126 123 Supernatant potassium (mEq/L) 1.6 17 27 34 – 44 46 Supernatant glucose (mg/dL) 909 780 724 697 660 617 604 Hemolysis (%) 0.02 0.06 0.11 0.14 0.20 0.16 0.24

      AS‐1 cells: N = 13; volume = 325 + 29 mL; hematocrit = 58% + 4%; mean red cell mass = 188 mL; mean supernatant volume = 136 mL; mean total hemoglobin = 19.3 g%.ATP, adenosine triphosphate; DPG, diphosphoglycerate; Hgb, hemoglobin; RBC, red blood cell.

      Red blood cells

      Description of component

      RBCs are the cells remaining after most of the plasma has been removed from WB. They must have a final hematocrit of less than 80% [24]. This blood component is often called “packed red cells” or “packed cells.” Usually the red cells and plasma are separated within 8 hours of collection, because for the plasma to be used as a source of factor VIII it must be placed in the freezer less than 8 hours after collection.Centrifugation is used when the red cells are being prepared within a few hours after collection, because usually this is done as part of a large‐scale operation, and speed is important. The centrifugation conditions (time and speed) are determined by the method being used to prepare the platelets or plasma. If platelets or fresh frozen plasma (FFP) are not being produced from the original unit of WB, the red cells can be separated from the plasma at any time during the storage period of the blood. If the unit of WB is allowed to remain undisturbed for several hours, the red cells sediment and the plasma can be removed. When sedimentation is used, the red cells are not as concentrated; as a result, the red cell unit has a lower hematocrit and less plasma is recovered. Because the plasma is valuable as a source for production of plasma derivatives, it is desirable to recover the maximum amount of plasma; therefore, sedimentation currently is not usually used to separate WB into its components. However, sedimentation can be used quite effectively when equipment for centrifugation is not available, such as in developing countries.

      Studies of biochemical and morphologic alterations that occur during storage of RBCs have expanded to investigate not only the correlation between storage lesion and anticoagulant–preservative solutions but also donor‐to‐donor variability. In 2013, RBC‐Omics Recipient Epidemiology Donor Evaluation (REDS)‐III study was lunched [25]. One of the main objectives of the study was to determine whether genetic and biological variability of blood donors defines the quality of RBCs and their capacity to withstand cold storage temperatures. The study demonstrated an association between donor characteristics, such as sex, age, race/ethnicity, iron intake, and donation frequency, and in vitro hemolysis in RBC product [26–28]. A genome‐wide association study provided additional information on gene loci and association with hemolysis [27, 29]. Overall, the new way of thinking about “storage lesion” and RBC‐Omics paves the way for future studies.

      Storage conditions and duration

      Source: Adapted from Hess JR. Measures of stored red blood cell quality. Vox Sang 2014; 107:1–9.

Increase Decrease
Lactate ATP
Pyruvate 2,3‐DPG
Ammonia Intracellular potassium
Intracellular sodium pH
Membrane vesicles Intravascular recovery
Plasma hemoglobin Oxygen release
Free iron Nitric oxide secretion

      ATP, adenosine triphosphate; 2,3‐DPG, 2,3‐diphosphoglycerate.

      Blood components must be maintained under proper storage conditions during transportation from the blood center to the hospital transfusion service. Various containers are available for this purpose, and these processes are standard and work well in developed countries. However, in developing or undeveloped parts of the world, usually these kinds of containers are not available and red cells may not be refrigerated or stored properly during this transportation. This is also an issue in military settings, where it also important that these containers be lightweight.

      Frozen or deglycerolized red blood cells

      Description of component

      RBCs, frozen or deglycerolized, are the cells that have been stored in the frozen state at optimal temperatures in the presence of a cryoprotective agent, which is removed by washing before transfusion [24, 31]. The red cells must be frozen within 6 days after collection, and they can be stored for up to 10 years, although the AABB (formerly American Association of Blood Banks) Standards

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