George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA.
Blood and Shock Resuscitation Research Department, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA.
Mil Med. 2024 Aug 19;189(Supplement_3):560-567. doi: 10.1093/milmed/usae187.
The United States Army has shifted doctrine to focus on large-scale combat operations against peer to near-peer adversaries. Future conflicts could result in a limited supply chain, leaving medical providers with only expired blood products for treatment of hemorrhagic shock. This study evaluated quality, function, and safety metrics of whole blood stored for 1 week past regulated expiration (i.e., 35 days, in CPDA-1).
Whole blood units (n = 6) were collected in citrate phosphate dextrose adenine-1 (CPDA-1) anticoagulant and stored refrigerated for up to 42 days. Units were sampled on days 35, 37, 39, and 42 of storage and evaluated for the following: complete blood count, blood metabolism and chemistries, clotting dynamics, and presence of bacteria.
The majority of evaluated parameters fell outside of normal clinical ranges beginning at day 35 of storage. At 42 days, blood pH was 6.58 ± 0.038, hemolysis was significantly increased (P = .037 vs day 35), and bacterial contamination was not evident. Glucose levels continuously dropped during extended storage. K+ was significantly increased at day 42 compared to day 35 (P = .010). A significant reduction in clot strength, factor V activity, and factor VIII activity was evident beginning at day 39 of storage.
Storage of whole blood out to 42 days results in a continuous decline in function, but further in vivo safety studies should be performed to determine if the benefits of expired blood outweigh the risks. Other methods to safely extend storage of whole blood that maintain hemostatic function and preserve safety should be investigated, with emphasis placed on methods that reduce potassium leak and/or hemolysis.
美国陆军已经转变了理论，专注于针对同等或近乎同等对手的大规模作战行动。未来的冲突可能会导致供应链有限，使医疗提供者在治疗失血性休克时只能使用过期的血液制品。本研究评估了在规定的过期（即 CPDA-1 中的 35 天）后储存 1 周的全血的质量、功能和安全指标。
采集柠檬酸磷酸盐葡萄糖腺嘌呤-1（CPDA-1）抗凝的全血单位（n=6）并冷藏储存，最长可达 42 天。在储存的第 35、37、39 和 42 天采集单位样本，并评估以下参数：全血细胞计数、血液代谢和化学物质、凝血动力学以及细菌存在情况。
从储存的第 35 天开始，大多数评估参数开始超出正常临床范围。在第 42 天，血液 pH 值为 6.58±0.038，溶血显著增加（P=0.037 与第 35 天相比），并且没有明显的细菌污染。葡萄糖水平在延长储存期间持续下降。与第 35 天相比，第 42 天的 K+显著增加（P=0.010）。从储存的第 39 天开始，凝血强度、因子 V 活性和因子 VIII 活性显著降低。
储存全血至 42 天会导致功能持续下降，但应进行进一步的体内安全性研究，以确定过期血液的益处是否超过风险。应研究其他安全延长全血储存的方法，以保持止血功能并确保安全，重点应放在减少钾泄漏和/或溶血的方法上。
