Problems of safety and quality of donor blood components
Objective. Analysis of issues related to the safety and quality of donated blood and its components.
Materials and methods. Many years of experience of hematologists, immunologists, isoserologists, morphologists, biochemists in studying the composition, morpho-functional properties of cells and blood plasma, the use of donor blood and its components in clinical practice have made it possible to reconsider method of chemotherapy “multilateral action”.
Results and discussion. One of the main axioms of modern transfusion medicine: chemotherapy should be performed strictly according to the indications and those blood components that are needed to ensure the viability of the body. The development of transfusiology has proved, with few exceptions, the inexpediency and even harmfulness of the use of whole donor blood. When using blood and its components, it is necessary to clearly consider extremely important point: the use will be in a planned manner, or in special circumstances. Blood components and blood plasma preparations have unique medicinal properties and there is currently no alternative to them. Each country is recommended to switch to self-sufficiency of blood components and their derivatives, to organize their own production structures that would meet the country’s domestic needs in blood components and preparations. The main components of the ideology of component chemotherapy are: recovery of blood component deficiency is not achieved on a “drop by drop” basis; no need to completely replace the existing deficiency of a cellular or protein component. Transfusions of blood components should be treated as a responsible invasive medical procedure – an operation that can have both immediate and long-term complications and consequences. Unreasonable transfusions of whole canned blood, especially after long periods of storage, are not only ineffective, but often pose a danger. In canned blood, during storage, complex biochemical metabolic processes take place both in cells and in plasma, which ultimately reduce the quality of both the blood itself and the morpho-functional properties of its individual components. Thus, 8-day storage of erythrocytes is the threshold after which erythrocytes begin to adversely affect the patient. Morpho-functional properties of blood components are directly dependent on the shelf life and distance of transportation. During the storage of blood and erythrocyte mass, the level of ATP decreases, on which the elasticity of the erythrocyte membrane depends. The magnitude of the negative electrical charge of the surface membrane of blood cells decreases. The number of prehemolytic forms of erythrocytes and cells that are not capable of reverse transformation increases. Within 1-4 days, leukocytes die, bacteria are released, so after this period, the greatest number of complications and reactions. Leukocytes and platelets form microaggregates at an early stage of storage, which can cause microembolism and distress syndrome. Microclots are formed, which include lysed blood cells and fibrin. The number of microclots increases every day, reaching on day 21 to 100 thousand/ml, so when transfusing it is advisable to use antiplatelet filters, rather than leukocyte. The use of bed leukofilters after a long period of storage of erythromass is not advisable, because there are no leukocytes. In addition, up to 2 % of erythrocytes are lost. The pH decreases, the content of 2,3-DFG, which is responsible for oxygen transport function (decreases by 50 % on the third day), hemolysis increases (up to 200 mg% of free hemoglobin). The concentration of potassium and ammonium ions increases. The recommended threshold for erythrocyte concentrate transfusions is a hemoglobin level of less than 70 g/l in adults and most children. It is important to use fresh-frozen plasma, erythrocyte concentrate and platelets obtained from one donor. Modern blood separators technically provide such an opportunity. Conditionally acceptable number of platelets in patients with injuries is more than 50×109/l cells, and in patients with combined brain injury is 100×109/l. Platelet concentrate obtained by the manual method from 4-5 donors leads to the development of refractoriness. With increasing shelf life of platelets, the functional properties of cells deteriorate significantly. All attempts to create the so-called artificial blood in the 19th century ended at the level of scientific developments. Synthetic and bioengineered cellular components of blood, hematopoietic factors, as well as hematopoietic stem cells are considered promising in the future. One of the possible ways to solve the problem of long-term storage of blood components, especially liquid groups, is cryopreservation of individual cells (erythrocytes) at moderately low (-20; -40; -80 ºС) and ultra-low (-165-196 ºС) temperatures, followed by deglycerization (washing), the use of special solutions for resuspension. With the development of low-temperature electric refrigeration equipment in Ukraine, this has become a reality.
Conclusions. Practice has shown that both the blood itself and its components can neither be produced nor extracted as minerals, it can only be shared. All of the above indicates that blood donation is and will remain the main source of cellular components of the blood for at least the next decades.
This work is licensed under a Creative Commons Attribution 4.0 International License.