Variability in the Deformability of Red Blood Cells: Application to Treating Premature Newborns with Blood Transfusion

Blood units are routinely collected from adult donors and stored as packed red blood cells (PRBC). The quality of PRBC, including their deformability, decreases during storage. Since PRBC transfusion has been reported to promote circulatory issues in premature neonates (PNs), they typically receive freshly stored units. To test the hypothesis that freshly stored PRBCs can provide red blood cells (RBCs) with appropriate deformability for PN recipients, we compared the deformability of PRBCs transfused to PNs with that of cord blood RBCs (CRBCs), which are known to have deformability equivalent to that of newborn RBCs (PN-RBC). We found that, on average, CRBC deformability was higher than that of PRBCs. However, both showed significant variability with overlapping ranges. A highly significant correlation was observed between cell deformability and the combined levels of specific membrane proteins (ezrin, stomatin, flotillins) and membrane-bound hemoglobin (Pearson coefficient > 0.70, p < 0.02). This study indicates that the storage duration is inadequate for selecting PRBCs for PN recipients. PRBCs with deformability similar to that of PN-RBCs could enable safer and more effective transfusions for PN patients. Measuring membrane proteins alongside membrane-bound hemoglobin can serve as a useful method for selecting appropriate PRBC units for transfusion to PNs.