"Nowadays when they test if blood is ok or not, the test is not very specific. The only requirement for the blood bank is that when the blood, once it's infused, stays around in circulation. This is the only criteria. There is a very good need to understand if it works or not." - Professor Amy Tsai, PhD
Once regarded as "one of the great advances in modern medicine", blood transfusions are now considered harmful in some clinical situations. As of late, blood transfusions have become a cause of concern across the globe. They have various deleterious effects, such higher mortality rates and transfusion transmitted infections (TTI), in addition to the possibility of repeated transfusions if less than 75% of the RBCs are in circulation after 24 hours1. It has been postulated that one of the causes of transfusion related issues could be storage lesions. Storage lesions are the changes that blood undergoes during the time it is being stored prior to transfusion; deterioration of this blood usually happens after two weeks of storage2. The red blood cells (RBCs) lose their deformability due to changes in 2,3-diphosphoglycerate (DPG) and ATP levels3. When stored RBCs and fresh RBCs are compared, it is seen that the cells demonstrate ereduced microvascular flow and functional capillary density by 63% and 54% respectively, resulting in stored cells that are "significantly malperfused and underoxygenated microvasculature"4.
When blood with altered rheological properties is transfused, the recipient faces complications that have to do with the loss of characteristic RBC membrane deformability. To ensure that blood affected by storage lesions is not transfused, it is imperative that the blood is tested in some manner. Our device does just that: it is a point-of-care device that measures the deformability of a statistically significant volume of blood, giving an indication of whether the blood is transfusable or not. Additionally, the device is a closed system and gives accurate results in less than 5 minutes.
Possible transfusion-related consequences.
In spite of the fact that at least 111 countries have national guidelines of blood transfusions, transfusion committees and hemovigilance groups5, transfusions still come with many adverse side effects. These affect the recipient and the hospital providing the transfusion. More blood transfusions lead to higher mortality rates6 while increasing the length of stay in hospitals due to the need for repetitive transfusions. This increases costs for both the patient and the hospital, in addition to increasing the risk of TTI's since transfusing aged blood leads to the need of repetitive transfusions. In 2004, transfusions cost a patient $17,194 extra7 . Cardiac patients8 are especially susceptible to repetitive transfusions due to issues with clotting factors, potential blood loss, fluid overload, and catheterization infections. All these complications contribute to a higher mortality rate, and the probability of each increases with each successive transfusion. In order to combat the above mentioned complications that come with blood transfusions, specifically transfusing aged blood, an appropriate test of RBC quality and functionality is needed.
1Hod, E. et.al. (2010). Transfusion of red blood cells after prolonged storage produces harmful effects that are mediated by iron and inflammation. Blood, 4284-4292.
2Berezina, Tamara L.et.al. "Influence of Storage on Red Blood Cell Rheological Properties." Journal of Surgical Research 102.1 (2002): 6-12. Web.
3Kim-Shapiro, D., Lee, J., & Gladwin, M. (2011). Storage lesion: role of red blood cell breakdown. Transfusion, 51(4), 844-851. http://dx.doi.org/10.1111/j.1537-2995.2011.03100.x
4Yartsev, Alex. "Storage Lesions of Banked Red Blood Cells." Deranged Phisiology. N.p., 27 Jan. 2016. Web.
5Blood safety and availability. (2016). World Health Organization. Retrieved 22 April 2016, from http://www.who.int/mediacentre/factsheets/fs279/en/
6Aryeh Shander, S. (2013). A new perspective on best transfusion practices. Blood Transfusion, 11(2), 193. http://dx.doi.org/10.2450/2012.0195-12
7Aryeh Shander, S. (2013). A new perspective on best transfusion practices. Blood Transfusion, 11(2), 193. http://dx.doi.org/10.2450/2012.0195-12
8Blood Transfusions Linked To Increased Mortality In Patients Suffering From Cardiac Episodes. (2016). ScienceDaily. Retrieved 22 April 2016, from https://www.sciencedaily.com/releases/2006/03/060319184430.htm