Shelf-life of cord blood red cell concentrates: Comparison of two additive solutions

Cord blood-derived red blood cell concentrates (CB-RBCs) may provide a physiologically tailored transfusion product for preterm neonates, but their limited shelf life remains a major barrier to clinical implementation. We longitudinally characterized CB-RBC storage over 28 days and evaluated the effect of additive solution composition in DEHP-free storage bags.

Thirty-eight CB-RBC units were stored in either PAGGSM (n = 18) or SAGM (n = 20) at 2-6°C for 28 days. Hematological, biochemical, metabolic, and flow-cytometric parameters were assessed at baseline and on days 7, 14, 21, and 28. Longitudinal changes were evaluated using linear mixed-effects models.

All units met predefined quality specifications at baseline. Hemolysis increased over time but was unaffected by additive solution, with approximately 90% of units remaining below the 0.8% threshold at day 28. PAGGSM and SAGM showed distinct electrolyte profiles, with lower sodium and chloride and higher inorganic phosphate concentrations in PAGGSM. Potassium and lactate increased in both groups, but their accumulation was significantly lower with PAGGSM, particularly during the second half of storage. Changes in red cell indices also differed between solutions, with a smaller increase in MCV and better maintenance of MCHC with PAGGSM. ATP progressively declined, while a distinct CFSE-high RBC population emerged over storage.

CB-RBC maintained acceptable in vitro quality over 28 days of storage in DEHP-free bags. PAGGSM was associated with distinct temporal patterns in selected metabolic, ionic, and red cell indices, warranting further investigation as an alternative additive solution for CB-RBCs.