Surface acoustic wave hemolysis assay for evaluating stored red blood cells

Blood transfusion remains a cornerstone of modern medicine, saving countless lives daily. Yet the quality of transfused blood varies dramatically among donors-a critical factor often overlooked in clinical practice. Rapid, benchtop, and cost-effective methods for evaluating stored red blood cells (RBCs) at the site of transfusion are lacking, with concerns persisting about the association between metabolic signatures of stored RBC quality and transfusion outcomes. Recent studies utilizing metabolomics approaches to evaluate stored erythrocytes find that donor biology (e.g., genetics, age, lifestyle factors) underlies the heterogeneity associated with blood storage and transfusion. The appreciation of donor-intrinsic factors provides opportunities for precision transfusion medicine approaches for the evaluation of storage quality and prediction of transfusion efficacy. Here we propose a new platform, the surface acoustic wave hemolysis assay (SAW-HA), for on-site evaluation of stored RBCs utilizing SAW hemolysis temperature (SAWHT) as a marker for RBC quality. We report SAWHT as a mechanism-dependent reproducible methodology for evaluating stored human RBCs up to 42 days. Our results define unique signatures for SAW hemolysis and metabolic profiles in RBCs from two of the six donors in which high body mass index (BMI) and RBC triglycerides associated with increased susceptibility to hemolysis. Metabolic age of the stored RBCs - a recently appreciated predictor of post-transfusion efficacy - reveal that RBCs from the two low SAWHT units were characterized by disrupted redox control, deficient tryptophan metabolism, and high BMI. Together, these findings indicate the potential of the SAW-HA as a point-of-care analysis for transfusion medicine.