Red blood cell hemolysis during processing

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Red blood cell (RBC) hemolysis has been reported in units of RBC for transfusion. This has significant clinical implications for transfused patients because the free hemoglobin dissociates into dimers that have to be bound to haptoglobin to be removed by the reticuloen-dothelial system. Once the binding capacity of haptoglobin has been exceeded, hemoglobinemia occurs. Hemolysis is caused by the breakdown of the RBC, causing release of hemoglobin and resulting in the discoloration of the plasma. Abnormal hemolysis in an individual RBC unit may be caused by several factors including inappropriate handling during processing of blood, inappropriate storage conditions, bacterial hemolysins, antibodies that cause complement lysis, defects in the RBC membrane, or an abnormality in the blood donor. The degree of hemolysis is described as the percent of free hemoglobin in relation to the total hemoglobin with appropriate correction for the hematocrit. The acceptable level of hemolysis has not been established in North America, but the value of 1% currently is used to assess biocompatibility of blood storage materials, whereas the Council of Europe has set the standard at 0.8%. This report emphasizes the need for the adequate control of the various processes that are involved in the preparation of RBCs from whole blood to minimize the occurrence of hemolysis. Careful evaluation of manufacturing processes will minimize RBC wastage caused by hemolysis.

References (117)

  • NashGB et al.

    Influence of oxygen tension on the viscoclastic behaviour of red blood cells in sickle cell disease

    Blood

    (1986)
  • MohandasN et al.

    A technique to detect reduced mechanical stability of red cell membranes: Relevance to elliptocytic disorders

    Blood

    (1982)
  • WilliamsonJR et al.

    The influence of temperature on red cell deformability

    Blood

    (1975)
  • OpitzJC et al.

    Hemolysis of blood in intravenous tubing caused by heat

    J Pediatr

    (1988)
  • RavalPJ et al.

    Relationship of hemolysis buffer structure, pH and ionic strength to spontaneous contour smoothing of isolated erythrocyte membranes

    Biochim Biophys Acta

    (1989)
  • TakahashiT et al.

    Thermal shock hemolysis in human red cells. I. The effects of temperature, time and osmotic stress

    Cryobiology

    (1983)
  • MoroffG et al.

    The irradiation of blood and blood components to prevent Graft-Versus-Host Disease: Technical issues and guidelines

    Trans Med Rev

    (1997)
  • RosseWF et al.

    The variability of hemolysis in the cold agglutinin syndrome

    Blood

    (1980)
  • NielsenHJ et al.

    Leukocyte-derived bioactive substances in fresh frozen plasma

    Br J Anaesth

    (1997)
  • AngueM et al.

    Viabilite des globules rouges humains conserves pendant 35 jours apres depletion en leucocytes (etude in vitro)

    Rev Fr Transfus Hemobiol

    (1989)
  • MillerWV et al.

    Effects of centrifugation on erythrocytes

    Transfusion

    (1974)
  • LaddDJ et al.

    Effect of centrifugation and subsequent storage on red cell content

    Vox Sang

    (1978)
  • BeutlerE et al.

    Storage of red cell concentrates in CPD-A2 for 42 and 49 days

    J Lab Clin Med

    (1983)
  • ButtonLN et al.

    The quality of over-and under collected blood for transfusion

    Transfusion

    (1976)
  • Muller-SteinhardtM et al.

    Impact of various red cell concentrate preparation methods on the efficiency of prestorage white cell filtration and on red cells during storage for 42 days

    Transfusion

    (1997)
  • HogmanCF

    Preparation and preservation of red cells

    Vox Sang

    (1998)
  • HogmanCF

    Liquid storage of human erythrocytes

  • HogmanCF et al.

    Storage of saline-adenine-glucose-mannitol-suspended red cells in a new plastic container: Polyvinyl chloride plasticized with butyryl-n-trihexyl-citrate

    Transfusion

    (1991)
  • RockG et al.

    Incorporation of plasticizer into red cells during storage

    Transfusion

    (1984)
  • MyreBA et al.

    Survival of red cells stored for 21 and 35 days in a non-di-(2-ethyl) phthalate plastic container

    Vox Sang

    (1987)
  • DaveyRJ et al.

    Characteristics of white cell-reduced red cells stored in tri-(2 ethylhexyl)trimellitate plastic

    Transfusion

    (1994)
  • OffemanRD et al.

    Observations on shear-induced hemolysis

    Biomat Med Dev Artif Organs

    (1979)
  • BeissingerRL et al.

    Effects of blood storage on rheology and damage in low-shear flow

    Biorheology

    (1985)
  • SuteraSP

    A note on hemolysis during filtration through micropores

    Biorheology

    (1980)
  • MonroeJM et al.

    Surface roughness and edge geometries in hemolysis with rotating disk flow

    J Biomed Mater Res

    (1981)
  • NakaharaT et al.

    Mechanical effects on rates of hemolysis

    J Biomed Mater Res

    (1986)
  • UmezuM et al.

    Effects of surface roughness on mechanical hemolysis

    Artif Organs

    (1996)
  • KuypersFA

    Red cell damage

    J Heart Valve Dis

    (1998)
  • BrecherME et al.

    Hemolytic transfusion reactions

  • KimDM et al.

    Visual identification of bacterially contaminated red cells

    Transfusion

    (1992)
  • MohandasN et al.

    Red blood cell deformability, membrane material properties and shape. Regulation by transmembrane, skeletal and cytosolic proteins and lipids

    Semin Hematol

    (1993)
  • MaedaN et al.

    Decreased deformability of red cells in refractory anemia and the abnormality of membrane skeleton

    Biorheology

    (1994)
  • LaCellePL et al.

    Erythrocyte membrane elasticity, fragmentation and lysis

    Blood Cells

    (1977)
  • MotulskyAG

    Hemolysis in glucose-6-phosphate dehydrogenase deficiency

    Fed Proc

    (1972)
  • MohandasN et al.

    The influence of membrane skeleton on red cell deformability, membrane material properties and shape

    Semin Hematol

    (1983)
  • MohandasN et al.

    Mechanical properties of the red cell membrane in relation to molecular structure and genetic defects

    Annu Rev Biophys Biomol Struct

    (1994)
  • MohandasN et al.

    Red blood cell deformability and hemolytic anemias

    Semin Hematol

    (1979)
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