The impact of Asian-Indian criteria for higher body mass index and preservative solutions on haemolysis of stored red blood cells: A prospective observational study

Introduction: The quality of packed red blood cells (PRBC) is influenced by various factors such as the collection and processing method, storage conditions, type of bag materials used, anticoagulant properties, and donor characteristics. Studies have indicated that haemolysis in stored RBC bags is linked to male sex, older age, high haemoglobin count, and increased body mass index (BMI). The study's primary objective was to investigate whether a high BMI, as per Asian Pacific criteria among donors, is associated with an elevated haemolysis rate in stored RBC. Additionally, the study aimed to examine any protective effects of different types of preservatives added to blood bags against RBC haemolysis during storage.

Methods: Stored RBCs from 100 blood donors with different BMI are analysed for haemolysis on 0, 21, and last day (35/42 days) of storage. A BMI cut-off of 23 was taken for healthy and overweight consideration in blood donors. The blood bags selected for storage were either with additive solution (SAGM) or without additive along with an anticoagulant. The association of the percentage of haemolysis with different variables like age, BMI, and Haemoglobin of the donor were analysed. The correlation between the haematocrit of the bag and haemolysis was determined.

Results: This study did not find any significant increase in the percentage of haemolysis in blood bags with higher BMI on the last day of storage (p = 0.424). The haemolysis percentage was higher in bags without SAGM than in bags with an additive solution (p = 0.000). The high haematocrit of the bag has a significant positive correlation with the percentage of haemolysis (p = 0.002). Significantly higher haemolysis in CPDA-1 bags of donor RBC units of BMI >23 groups was observed (p = 0.000) compared to those stored in CPD-SAGM bags.

Conclusion: Indian population for higher BMI, as per Asia Pacific cut-off criteria, did not significantly impact the haemolysis of blood bags. Stored RBCs with SAGM, especially of donors having BMI > 23, had a protective effect against haemolysis in blood bags. The percentage of haemolysis was positively correlated with the haematocrit of stored RBC in bags.