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Role of Contaminating White Blood Cells in the Storage Lesions of Red Cells and Platelets

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Clinical Benefits of Leukodepleted Blood Products

Part of the book series: Medical Intelligence Unit ((MIUN))

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Summary

Red cell concentrates prepared from whole blood donations without buffy coat removal contain the majority of the original white cells contained in the whole blood donation. These white cells are predominantly granulocytes. Granulocytes may be metabolically active and release oxidant radicals. They certainly degenerate rapidly on storage, releasing proteolytic enzymes. Such substances may damage the red cell membrane, resulting in accelerated glycolysis, possibly to supply ATP for the sodium/potassium pump, followed by in vitro hemolysis and diminished in vivo recovery or survival.

Early studies on buffy coat-depleted additive-suspended red cells showed less hemolysis after storage as compared to nonbuffy coat-depleted concentrates. Furthermore, studies on pre-storage filtration of red cells have consistently shown a favorable effect of early leukocyte removal on in vitro hemolysis and 24-hour recovery in red cell concentrates stored in PVC-DEHP containers, though this improvement was only significant with 〉4 loglo leukodepletion. Recent studies have also indicated that early removal of leukocytes from red cell concentrates stored in nonDEHP containers is also beneficial, though not enough to compensate for the lack of the protective effect of DEHP on red cell membrane integrity.

Platelet concentrates (PC) prepared from whole blood donations or apheresis devices show great variation in white cell content. The predominant cell is the mononuclear cell, except in situations where there is poor cell separation, in which granulocytes may be present in large numbers. Contaminating leukocytes may potentially damage platelets by competing for available oxygen or metabolic substrates, by releasing enzymes which degrade platelet membrane glycoproteins, or by releasing substances which act on platelets to cause activation or degranulation.

Some studies have implied an adverse indirect or direct effect of leukocytes on platelet properties during storage. Most of these studies have involved high residual leukocyte levels in platelet concentrates platelet stored in first-generation containers where insufficient oxygen for cell respiration may have led to a fall in pH. In addition, some studies involved spiking concentrates with buffy coat leukocytes. However, no convincing data indicates that modest levels of mononuclear white cell contamination (〈1 x 108) in second-generation containers affect the platelet storage lesion, and no differences in in vivo recovery or survival have been demonstrated.

In a number of plateletpheresis concentrate studies where mononuclear cells were predominant and present in the 105-108 range, there was no evidence that this was associated with an adverse effect on platelet quality. Manufacturing protocols which result in high residual granulocyte content may affect platelets, but, in practice, this is uncommon.

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  1. Joseph D. Sweeney
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  2. Stein Holme
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  3. Andrew Heaton
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Sweeney, J.D., Holme, S., Heaton, A. (1995). Role of Contaminating White Blood Cells in the Storage Lesions of Red Cells and Platelets. In: Clinical Benefits of Leukodepleted Blood Products. Medical Intelligence Unit. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-26538-3_5

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