OA4-AM24-SN-23 - Prolonged Storage of Leukoreduced Whole Blood Stored in CPD from 21 to 35 Days to Improve Prehospital Blood Supply Logistics

Early administration of balanced transfusion, including platelet-containing products, plays a pivotal role in ensuring that patients reach the hospital alive for further medical intervention. During periods of crisis and emergency preparation, rural blood services face significant challenges in supplying helicopter emergency medical services with balanced blood transfusion products. Norway mandates the use of leukoreduced blood components to minimize transfusion reactions. Whole blood is the preferred prehospital blood product for its logistical simplicity in prehospital settings. However, the shorter shelf life of leukoreduced (LR) whole blood stored in CPD compared to non-leukoreduced (NLR) CPDA-1 whole blood or red cell concentrates presents a challenge, especially in rural areas with limited donor pools and platelet availability. Extending the shelf life of whole blood becomes imperative during crises and conflicts. This study investigated whether in vitro quality declined with prolonged storage of whole blood in CPD from day 21 to 35 and aimed to address critical transfusion needs and blood supply challenges during crises and conflicts.

Study

Design/Methods:

We collected 20 units of whole blood stored in CPD (Imuflex, BB*LGQ456E6, Terumo BCT). The units were LR before storage at 2-6°C for 35 days and sampled on days 1, 21, 28 and 35. In vitro quality of whole blood was measured by hematological parameters, hemolysis, blood gas, glucose, lactate, potassium, fibrinogen, activated partial thromboplastin time, factor VIII and thromboelastography (TEG) (R, K, angle, and MA). In addition, we performed statistical analyses with comparisons to three historical control groups from 2020 (n=9 LR, n=9 NLR) and 2022 (n=8 NLR) of whole blood stored in citrate-phosphate-dextrose with adenine (CPDA-1).

Results/Findings:

The in vitro quality of the stored whole blood complied with the EDQM Guide to the Preparation, Use and Quality Assurance of Blood Components, 21^st edition, over the entire 35-day storage period, except one unit with hemolysis of 0.9% on day 35. While hemoglobin remained stable (12.2 g/dL) and hematocrit had a slight increase (0.38-0.40), platelet count (Figure A), platelet function (TEG MA from 61.9 to 41.7 mm) and plasma quality (Figure A) declined during storage. Comparisons with historical controls showed few in vitro quality differences between whole blood stored in CPD and CPDA-1 (Figure A). Moreover, LR demonstrated a favorable effect on factor VIII concentration throughout the storage period (Figure A).

Conclusions:

Extending shelf life of whole blood in CPD from 21 to 35 days complies with European requirements and may improve the availability of platelet-containing blood products for patients with severe bleeding in remote regions. Providing blood products with reduced platelet quality remains preferable to not providing platelets in the critical early stages of resuscitation.