Blood storage effect of G6PD on RBC quality

The most prevalent metabolic condition of red blood cells, glucose-6-phosphate dehydrogenase (G6PD) deficiency, affects around 35 million people globally. The highest prevalence is seen in tropical and subtropical areas of the eastern hemisphere, where it can affect up to 35 % of the population. G6PD deficiency, the most prevalent enzyme deficit, is not currently tested for in blood products. G6PD deficiency is a genetic factor that influences the quality of stored red blood cells impacting their ability to respond to oxidative stress. This hospital-based cross-sectional study aimed at assessing the prevalence of G6PD deficiency in donor blood and the impact of the enzyme deficiency on red cell indices during storage.

A total of 57 blood bags were screened for G6PD deficiency. Red cell indices and blood film comments were investigated on Day 0, Day 7 and Day 14 of storage.

Eight out of 57 (14 %) had the G6PD full defect and 86 % (49/57) had no defect. Over the course of 14 days storage, the hemoglobin and red blood cell count significantly decreased in G6PD-deficient blood units with a corresponding significant increase in mean corpuscular volume and red cell distribution width-standard deviation compared to baseline and normal G6PD activity. The blood film comment showed 85.7 % normocytic normochromic, 2.0 % microcytic hypochromic and 12.2 % macrocytic hyperchromic from G6PD-non-deficient donors whereas G6PD-deficient donors had 75 % normocytic normochromic with 12.5 % microcytic hypochromic and 12.5 % macrocytic hypochromic after 2 wk in storage.

Red blood cell count and hemoglobin reduce significantly in G6PD-deficient donor units during storage with an associated increased mean corpuscular volume indicating progressive loss of the cellular membrane homeostatic mechanism that could potentially result in further hemolysis during long term storage.