Platelet Storage Quality, Plasticizer Migration, and Transfusion Exposure Risk in DEHP Versus Non-DEHP Blood Storage...

Area of Science:

• Biomedical Engineering
• Materials Science
• Hematology

Background:

• The global shift from di(2-ethylhexyl) phthalate (DEHP)-plasticized blood storage systems necessitates evaluating alternatives.
• Concerns exist regarding platelet storage biology, transfusion efficacy, and recipient exposure to plasticizer compounds.

Purpose of the Study:

• To systematically review and evaluate platelet quality, plasticizer migration, and modeled transfusion exposure in DEHP-containing versus DEHP-free systems.
• To compare various DEHP-free plasticizers, including DEHT, DINCH, BTHC, and TOTM.

Main Methods:

• Systematic review of English-language studies on platelet storage, migration, and exposure endpoints.
• Inclusion of studies with quantitative data on plasticizer composition and outcomes.
• Risk of bias and certainty of evidence assessment using adapted frameworks.
• Random-effects meta-analysis for day 7 platelet pH; descriptive synthesis for other endpoints.

Main Results:

• Platelet metabolic stability (pH, glucose, lactate, mitochondrial potential) was maintained across all plasticizer systems.
• No significant difference in pooled day 7 platelet pH between DEHP and non-DEHP systems (mean difference +0.025).
• DEHP-free systems maintained platelet aggregation and activation responses, with reduced CD62P and Annexin V binding.
• DEHP leaching was substantially greater than DINCH and DEHT, leading to higher modeled exposure, particularly in neonates.
• DEHP-containing systems contaminate platelet products with DEHP and MEHP.

Conclusions:

• Replacing DEHP preserves transfusion-relevant platelet quality while reducing plasticizer migration and recipient exposure.
• The findings support the biologic and toxicologic rationale for transitioning to phthalate-free blood collection and storage systems.