The accumulation of lipids and proteins during red blood cell storage: the roles of leucoreduction and experimental filtration

Abstract

Pre-storage leucoreduction has been universally adopted in most developed countries in Asia, Europe and the Americas. It decreases febrile transfusion reactions, alloimmunisation to HLA antigens, cytomegalovirus exposure, the accumulation of a number of pro-inflammatory mediators in the supernatant, including the accumulation of platelet-and leucocyte-derived proteins and metabolites during routine storage. This review will highlight the lipids and proteins, biological response modifiers (BRMs) that accumulate, their clinical effects in transfused hosts, and methods of mitigation.

Figure 1

Pre-storage experimental filtration removes 5-lipoxygenase activating protein (FLAP) and 5-lipoxygenase (5-LO) from red blood cell (RBC) units. (A) There is significant FLAP immunoreactivity prior to filtration in day 1 (Pre D1) supernatants that is removed by filtration (Post D1) which re-accumulates during routine storage by day 42, the end of storage (Post D42). The supernatants from two different RBC units were used. (B) There is significant reactivity for 5-lipoxygenase (5-LO) both before (Pre) and after (Post) leucoreduction and at the end of storage (D42) with the Haemonetics BPF4 filter. The 5-LO immunoreactivity is present prior to experimental filtration (Pre) that is removed from the supernatant of 2 separate RBC units that does not re-accumulate during routine storage D42. Figure representative of 3 separate experiments which demonstrated similar results.