Primary Hemostatic Capacity of Whole Blood: A Comprehensive Analysis of Pathogen Reduction and Refrigeration Effects Over Time

Abstract

BACKGROUND: Whole blood (WB) has been used in combat since World War I as it is readily available and replaces every element of shed blood. Component therapy has become standard; however, recent military successes with WB resuscitation have revived the debate regarding wider WB use. Characterization of optimal WB storage is needed. We hypothesized that refrigeration preserves WB function and that a pathogen reduction technology (PRT) based on riboflavin and ultraviolet light has no deleterious effect over 21 days of storage. STUDY DESIGN AND METHODS: WB units were stored for 21 days either at 4 C or 22 C. Half of each temperature group underwent PRT, yielding four final treatment groups (n = 8 each): CON 4 (WB at 4 C); CON 22 (WB at 22 C); PRT 4 (PRT WB at 4 C); and PRT 22 (PRT WB at 22 C). Testing was at baseline, Days 1-7, 10, 14, and 21. Assays included coagulation factors; platelet activation, aggregation, and adhesion; and thromboelastography (TEG). RESULTS: Prothrombin time (PT) and partial thromboplastin time increased over time; refrigeration attenuated the effects on PT (p </= 0.009). Aggregation decreased over time (p </= 0.001); losses were attenuated by refrigeration (p </= 0.001). Refrigeration preserved TEG parameters (p </= 0.001) and PRT 4 samples remained within normal limits throughout the study. Refrigeration in combination with PRT inhibited fibrinolysis (p </= 0.001) and microparticle formation (p </= 0.031). Cold storage increased shear-induced platelet aggregation and ristocetin-induced platelet agglutination (p </= 0.032), as well as GPIb-expressing platelets (p </= 0.009). CONCLUSION: The in vitro hemostatic function of WB is largely unaffected by PRT treatment and better preserved by cold storage over 21 days. Refrigerated PRT WB may be suitable for trauma resuscitation. Clinical studies are warranted.

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Document Details

Document Type
Technical Report
Publication Date
Jan 01, 2013
Accession Number
ADA614617

Entities

People

  • Alex G. Mora
  • Anand K Ramasubramanian
  • Armando C. Rodriguez
  • Bijaya K. Parida
  • Chriselda G. Fedyk
  • Heather Pidcoke
  • Krystal K. Valdez-delgado
  • Robbie K. Montgomery
  • Steve J. Mcfaul

Organizations

  • United States Army Institute of Surgical Research

Tags

Communities of Interest

  • Biomedical

DTIC Thesaurus Topics

  • Anticoagulants
  • Blood
  • Blood Cells
  • Blood Coagulation
  • Blood Coagulation Factor Inhibitors
  • Blood Coagulation Factors
  • Blood Groups
  • Blood Transfusions
  • Cells
  • Chemistry
  • Cold Storage
  • Fibrinolysis
  • Health Services
  • Hemorrhage
  • Pathogenic Bacteria
  • Therapy
  • Vietnam War

Fields of Study

  • Engineering

Readers

  • Marine Ecological Systems Migration
  • Trauma Surgery or Emergency Medicine.