Rheological and biochemical comparison of cord and adult blood red cells for transfusion applications

Cord blood (CB) is a promising alternative source of red blood cells (CB-RBC) for neonatal transfusion due to their high fetal hemoglobin content and potential physiological benefits in preterm infants, but their metabolic and rheological stability during storage and irradiation is not fully defined. This study examined whole cord blood (WCB) and processed CB-RBC stored up to 10 days (D10), with or without irradiation, and compared them with adult RBC (A-RBC) following neonatal transfusion guidelines. Ektacytometry showed significantly lower EImax in CB-RBC at day 0 (D0) and D10 (p < 0.05), while Omin and Ohyper remained stable. CB-RBC had lower ATP than A-RBC at baseline (2.8 ± 1.0 µmol/g Hb vs. 4.0 ± 0.3 µmol/g Hb) and after 10 days (2.0 ± 1.1 µmol/g Hb vs. 3.0 ± 1.9 µmol/g Hb). Hemolysis in CB-RBC was minimal (median 0.05, range 0.04–1.17% at D0 vs. median 0.19, range 0.16–1.23% at D10), and residual WBC content met limits (< 1 × 10⁶). Storage induced expected biochemical changes in both CB-RBC and A-RBC, including increased potassium, pO2 and lactate, decreased sodium and glucose, and pH decline, though D10 pH and potassium evaluation in CB-RBC was partly affected by hemolysis. Irradiation produced minimal effects on ATP and rheology. Overall, CB-RBC preserved acceptable metabolic and rheological properties during short-term storage and irradiation, supporting further exploration of their suitability for neonatal transfusion.