Quality of Stored Red Blood Cells: General Perspective

Red blood cell (RBC) transfusion is essential for a variety of medical conditions that are indicated in patients with hemodynamic abnormalities such as anaemia, bleeding, or other life-threatening conditions. In an effort to support these goals, the process of storing human resources must be considered in order to guarantee the quality, safety, and efficacy of blood transfusion. In this regard, this article will endeavour to explore the fundamental principles of understanding the storage of human resources as well as various chemical and morphological changes that occur in them with a common language in order to be recognized by the wider community.

As is known, RBC storage can be obtained from a donor which can then be stored in the form of Whole Blood or Packed Red Cells (PRC). However, today the type of storage of RBC in the form of PRC is more widely known and utilized by clinicians. PRC storage usually uses a plastic bag because it is permeable to gas molecules, making it easier for the diffusion of oxygen and carbon dioxide exchange in it. As for some things that should be considered in ensuring the quality of stored red blood cells include: 1) Conditions and Duration of Storage; 2) Biomechanical Changes; and 3) Chemical Change.

Based on the conditions and duration of storage, PRC should be stored in a 21-42 day timeframe which depends on the anticoagulant-preservative solution used. This storage time must also be ensured to be in the right temperature around 1-6^oC in a refrigerator with good air circulation. The purpose of storing PRC at low temperatures is to ensure that anaerobic metabolic processes can run slowly so that the formation of lactic acid as a secondary metabolite that triggers cell hypoxia can be prevented. The temperature in the refrigerator must be monitored every 4 hours and always ensure the expiration date of the PRC blood bag is well recorded.

As explained earlier, the hypoxic state of the duration of storage and the internal condition of the storage bag will indirectly affect biomechanical and biochemical changes. Biomechanical changes focus more on changes in the morphology of the red blood cell (RBC) plasma membrane, which is due to interference with the protein structure of the RBC cytoskeleton. This causes a decrease in the surface/volume ratio, increased osmosis fragility, and morphological changes from biconcave to echinocytes to spherocytes. The morphological changes of RBC will interfere with the characteristics of RBC in blood circulation, which includes the formation of microparticles, intravascular haemolysis, to various complications related to transfusion.

The storage of RBC also affects the viability and quality of RBC, which is mediated by several biochemical changes in it. The biochemical changes referred to include increased glucose consumption and accumulation of lactic acid, decreased blood acidity (pH), loss of potassium ions and calcium ion addition, loss of NO-bound haemoglobin, as well as reduced ATP concentrations and 2,3-diphosphoglycerate (2,3-DPG). These changes are reversible in that the stored RBC will return to its physiological state when it is returned in the blood circulation. However, various biochemical changes that occur during storage will lead to the occurrence of HR apoptosis during storage.

As has been briefly described above, some things that should be considered from the quality of stored red blood cells (RBC) are the condition and duration of storage, biomechanical changes, and chemical changes. The longer the RBC or PRC is stored, then it will gradually have an impact on the in vitro state of the blood bag, which can affect the clinical efficacy of blood transfusion.