article · BMC Hematology
In sub-Saharan Africa, sickle cell trait and malaria infections are widespread, meaning donor blood supplies frequently carry these conditions. A study examined how storage affects the quality of blood from donors with sickle cell trait and asymptomatic Plasmodium falciparum malaria over five weeks using citrate-phosphate-dextrose-adenine preservation. Researchers evaluated baseline and weekly measures across negative, sickle cell trait, and malaria-positive units. Storage caused significant degradation across all cell lines. Red blood cells, haemoglobin, and haematocrit steadily declined in both sickle cell trait and malaria-infected blood. Malaria-positive blood experienced a notable 319 percent surge in plasma lactate dehydrogenase by the fifth week, whereas sickle cell trait units displayed a 382 percent rise in plasma potassium. These severe storage lesions highlight the clinical necessity of screening and deferring prospective blood donors carrying these conditions.
Blood transfusions depend on high-quality stored blood to safely treat patients. In regions where sickle cell trait and malaria are common, transfusing blood that degrades rapidly during storage can introduce elevated potassium and cellular damage. Demonstrating that these units deteriorate severely helps transfusion services understand the risks and reinforces the necessity of screening prospective donors.
The findings are relevant to blood transfusion centres, hospital blood banks, and clinical screening programmes evaluating donor selection protocols. While the study provides early-stage laboratory evidence rather than a commercial product, the data could inform the operational adoption of mandatory rapid screening assays for sickle cell trait and malaria prior to donor blood collection and storage.
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In sub-Saharan Africa where sickle cell trait (SCT) and malaria is prevalent, significant proportions of blood donors may be affected by one or more of these abnormalities. The haemato-biochemical properties of SCT and asymptomatic malaria in donor blood have not been evaluated. This study evaluated the haemato-biochemical impact of SCT and asymptomatic malaria infections in citrate-phosphate-dextrose-adenine (CPDA-1) stored donor blood units. Fifty-milliliters of sterile CPDA-1 anti-coagulated blood were drained into the sample pouch attached to the main blood bag. Ten units each of sickle cell/malaria negative, sickle cell and malaria positive blood were analyzed. Baseline and weekly haematological profiling and week 1, 3 and 5 concentrations of plasma haemoglobin, % haemolysis, sodium, potassium and chloride and lactate dehydrogenase (LDH) were assayed. Differences between baseline and weekly data were determined using one-way analysis of variance (ANOVA) and Kruskal-Wallis test, whereas differences between baseline parameters and week 1–3 data pairs were determined using paired t-test. P-value < 0.05 was considered statistically significant. Storage of SCT and malaria infected blood affected all haematological cell lines. In the SCT donors, red blood cells (RBC) (4.75 × 1012/L ± 1.43baseline to 3.49 × 1012/L ± 1.09week-5), haemoglobin (14.45 g/dl ± 1.63baseline to 11.43 g/dl ± 1.69week-5) and haematocrit (39.96% ± 3.18baseline to 33.22% ± 4.12week-5) were reduced. In the asymptomatic malaria group, reductions were observed in RBC (5.00 × 1012/L ± 0.75baseline to 3.72 × 1012/L ± 0.71week-5), haemoglobin (14.73 g/dl ± 1.67baseline to 11.53 g/dl ± 1.62week-5), haematocrit (42.72% ± 5.16baseline to 33.38% ± 5.80week-5), mean cell haemoglobin concentration (35.48 g/dl ± 1.84baseline to 35.01 g/dl ± 0.64week-5) and red cell distribution width coefficient of variation (14.81% ± 1.54baseline to 16.26% ± 1.37week-5). Biochemically, whereas plasma LDH levels significantly increased in asymptomatic malaria blood donors (319% increase at week 5 compared to baseline), SCT blood donors had the most significant increase in plasma potassium levels at week 5 (382% increase). Sodium ions significantly reduced in SCT/malaria negative and sickle cell trait blood at an average rate of 0.21 mmol/L per day. Moreover, elevations in lymphocytes-to-eosinophils and lymphocytes-to-neutrophils ratios were associated with SCT and malaria positive blood whilst elevation lymphocytes-to-basophils ratio was exclusive to malaria positive blood. Severe storage lesions were significant in SCT or malaria positive donor blood units. Proper clinical evaluation must be done in prospective blood donors to ensure deferral of such donors.
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DOI: 10.1186/s12878-018-0128-x
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