Bioanalysis and Analytical Services Research Group, IMIM–Hospital del Mar Research Institute, Pompeu Fabra University, Barcelona, Spain.
Transfus Med Rev. 2012 Jan;26(1):27-37. doi: 10.1016/j.tmrv.2011.06.001. Epub 2011 Aug 5.
Polyvinylchloride (PVC) is used in blood component containers as well as in many other medical devices because it shows optimal inertness, durability, and resistance to heat and chemicals. However, the polymer itself does not provide good handling characteristics or the necessary properties for red blood cell (RBC) survival. PVC thus needs to be plasticized, and di-(2-ethylhexyl)phthalate (DEHP) has been the most common plasticizer to produce the required flexibility to PVC. However, DEHP has been found to leach out from the containers, causing toxic effects, as demonstrated mainly in rodents. It is considered to be a possible carcinogen and suspected to also produce endocrine effects especially in young males. Although controversial, it is commonly accepted that in vulnerable patients such as newborns, trauma patients, or pregnant women, high exposure to DEHP should be avoided. The replacement of the common PVC + DEHP blood bags poses technical challenges due to the positive influence of the DEHP molecules on the red blood cell (RBC) membrane, and thus it has been shown to affect RBC storage and survival after transfusion. Different approaches are thus being taken to find a suitable alternative to DEHP for blood components bags. Environmentalists even favor the substitution of the PVC to avoid not only the plasticizers but even the other residues contained in the polymer material. Consequently, whereas the simplest solution is the substitution of the DEHP by other plasticizers, alternative plasticizer-free materials are becoming explored. Even modifications of existing materials are being presented by some research groups, ranging from covering of the DEHP-containing materials to alloys or special additive solutions. Different strategies as well as the most promising approaches are presented in this review. In any case, the degree of stabilization of RBCs undergoing prolonged storage will dictate the final acceptance for such alternatives.
聚氯乙烯（PVC）用于血液成分容器以及许多其他医疗设备中，因为它表现出最佳的惰性、耐用性和耐热性以及耐化学性。然而，聚合物本身并不能提供良好的处理特性或红细胞（RBC）生存所需的特性。因此，PVC 需要增塑，邻苯二甲酸二（2-乙基己基）酯（DEHP）一直是生产 PVC 所需柔韧性的最常见增塑剂。然而，已经发现 DEHP 会从容器中浸出，造成毒性作用，主要在啮齿动物中证明。它被认为是一种可能的致癌物质，并被怀疑会产生内分泌影响，尤其是在年轻男性中。尽管存在争议，但人们普遍认为，在易受伤害的患者（如新生儿、创伤患者或孕妇）中，应避免高浓度暴露于 DEHP。由于 DEHP 分子对红细胞（RBC）膜的积极影响，常见的 PVC+DEHP 血袋的替代物会带来技术挑战，因此已证明其会影响输血后的 RBC 储存和存活。因此，正在采取不同的方法来寻找 DEHP 的合适替代品，用于血液成分袋。环保主义者甚至赞成用 PVC 替代，以避免不仅是增塑剂，甚至是聚合物材料中包含的其他残留物。因此，虽然最简单的解决方案是用其他增塑剂替代 DEHP，但正在探索替代的无增塑剂材料。甚至一些研究小组提出了对现有材料的修改，从覆盖含 DEHP 的材料到合金或特殊添加剂溶液。本综述介绍了不同的策略和最有前途的方法。在任何情况下，经历长期储存的 RBC 的稳定性程度将决定最终是否接受此类替代品。
