Extended storage of leukoreduced whole blood for transfusion stored in CPD from 21 to 35 days to improve prehospital blood supply logistics in rural areas.

Rural blood services with limited access to blood donors face challenges in supplying helicopter emergency medical services and local hospitals with leukoreduced whole blood. Extending the shelf life of whole blood can improve emergency preparedness during crises and conflicts and address critical transfusion needs and blood supply challenges. This study investigated whether the in vitro quality of stored leukoreduced whole blood in citrate-phosphate-dextrose (CPD) declined with extended storage for up to 35 days. Twenty units of whole blood were collected in CPD (Imuflex, BB*LGQ456E6, Terumo BCT), leukoreduced with a platelet-sparing filter, and stored (2-6°C) for 35 days. The units were sampled on days 1, 21, 28, and 35, and hematology parameters, hemolysis, blood gas, glucose, coagulation, and thromboelastography were analyzed. Results were compared to historical controls (n = 26). All units complied with European requirements throughout storage for 35 days, except one, which showed hemolysis of 0.9% on day 35. There was a decline in platelet count, hemostatic function, and plasma quality during storage. Comparisons with historical controls indicated few in vitro quality differences between CPD and CPDA-1 whole blood. Leukoreduction had a favorable effect on factor VIII concentration during storage. When comparing to European requirements, our results indicate that the shelf life of whole blood in CPD can be extended beyond 21 days. A risk-benefit analysis should be done to evaluate if shelf life can be extended to improve the availability of blood products for patients with severe bleeding in remote regions, crises, and war.