Inter-donor variability in deformability of red blood cells in blood units

Gregory Barshtein*, Tanja L. Rasmusen, Orly Zelig, Dan Arbell, Saul Yedgar

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objective: This study aimed to examine the donor-to-donor variability in the deformability of red blood cells (RBCs) from freshly collected blood donations (F-RBC) and packed RBCs. Background: Packed RBCs are supplied for transfusion by the first-in-first-out (FIFO) criterion, assuming that their quality is the same for packed RBCs with equal storage duration. To challenge this notion, we determined the deformability of F-RBC and packed RBCs stored for different durations. Methods: Three RBC groups were employed: A. 79 samples of F-RBC; B. 76 samples of packed RBC units, randomly used for transfusion at different storage durations; and C. 65 samples of outdated packed RBCs stored for 35 to 37 days. All packed RBC units were non-leukofiltrated and stored in Citrate-phosphate-dextrose solution with adenine (CPDA-1). RBC deformability was determined using a computerised cell-flow properties analyser, which monitors the shape change of cells directly visualised in a narrow-gap flow chamber and provides the cells' deformability distribution in a large RBC population. Results: The F-RBC deformability exhibited a wide-range inter-donor variability. The cold storage of packed RBCs exerted a mild reduction of deformability, which became significant, compared to the initial inter-donor variability, only after 3 weeks of storage. Conclusion: Packed RBCs are generally supplied for transfusion by the FIFO criterion based on the assumption that the storage duration is a key factor of RBC quality. This study demonstrates that the deformability of red blood cells is significantly different in donors, and substantial variability persists throughout the entire process of their storage. Therefore, the FIFO criterion is not sufficient for assessing the RBC deformability, which should, therefore, be specifically characterised for each unit.

Original languageAmerican English
Pages (from-to)492-496
Number of pages5
JournalTransfusion Medicine
Issue number6
StatePublished - Dec 2020

Bibliographical note

Funding Information:
This study was supported by grants from the Israel Science Foundation (1661/13 to G.B.). The authors are grateful to Ms. O. Fredman and H. Greenbaum for their technical assistance. G.B. performed the data analysis and manuscript preparation. T.R. (medical students) performed the experiments. O.Z. provided the blood samples. D.A. participated in the result discussion and writing the manuscript draft. S.Y. initiated the study, supervised its execution and wrote the manuscript.

Publisher Copyright:
© 2020 British Blood Transfusion Society


  • Donor-to-donor variability
  • RBC deformability
  • RBC storage
  • Red blood cells


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